I worked at a Health Tech Silicon Valley company and our clients were healthcare companies. Our job was essentially to delay and put up barriers to care. So before they could see a doctor they would have to call us, go through the computer system, get routed to a phone doctor who would suggest cheaper things than what they really needed, give them a bunch of hoops to jump through before they could really get the thing they needed.
A big part of my job was to re-route people who needed wheelchairs into getting cheaper things. Our clients were United Healthcare, unions, large health insurers.
It sucked working there it was a total hellhole. I quit when they actually defrauded medicare. Their glassdoor reviews were wild. The owners daughter bragged about dating a glassdoor exec and that he would take down all the honest bad reviews for her.
avalys · 8m ago
If it’s not up to health insurers to limit healthcare spending, then which organizational role in the healthcare system do you think is appropriate to place this responsibility with?
kstrauser · 6m ago
Elected representatives answerable to their constituents would be a vast improvement in health outcomes.
OhMeadhbh · 1h ago
I assumed health plans always say "no" the first time you submit, to weed out people who give up too easily.
kstrauser · 1h ago
All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300.
The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
arwhatever · 1h ago
1. A properly competitive marketplace
2. Socialized medicine
3. What we have now
I would like to see #1 tried but at this point I’ll gladly accept #2
mattnewton · 48m ago
I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.
arwhatever · 6m ago
When did the U.S. really try?
SamoyedFurFluff · 27m ago
How can we have a competitive marketplace? I’m not a doctor (and therefore cannot informed evaluate the services) and even if I was I can’t search for my preferred cardiologist when I’m having a heart attack.
arwhatever · 9m ago
Is all of your healthcare 100% heart attacks?
kstrauser · 9m ago
I agree in theory, but I no longer believe #1 is possible in reality. #2 would make tens of millions of lives better than the dystopian nightmare #3 we have today.
azemetre · 1h ago
These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction.
There’s no reason why this system has to exist. We can make it better any time we want.
kstrauser · 7m ago
There’s a huge reason it continues to exist: exorbitant lobbying from the people profiting from the death panels. Almost everyone supports Medicare, but too many have been convinced that Medicare for all is some kind of nefarious communist plot.
SpicyLemonZest · 5m ago
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards.
You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction.
Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan".
(A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)
lotsofpulp · 1h ago
> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).
The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.
In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.
But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).
Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
georgemcbay · 42m ago
Healthcare, when you actually need it, is an inelastic demand very often combined with an inelastic supply (or more exactly, an inelastic supply of suppliers) due to IP laws and the realities of specialization.
It is not at all surprising that capitalism fails miserably here, IMO.
lordnacho · 1h ago
I thought I saw a meme about denail rates when that healthcare CEO got shot? Where did those numbers come from?
> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
carabiner · 1h ago
FYI the shooter has received $1.2m in donations for his defense fund, and counting.
danaris · 46m ago
The accused shooter.
Firstly, Luigi Mangione is presumed innocent until proven guilty.
Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.
kstrauser · 2m ago
First part: yes, definitely. That’s a critical part of how the system works.
Second part: I’m not buying that for a moment. It’s way easier for me to believe that an individual working alone, screwed over by a megacorp who earns more based on how many people they can deny healthcare to, had enough and went vigilante. Vigilanteism and cold blooded murder are not OK, but it’s pretty easy to link cause and effect there. That’s vastly more likely than a shadow conspiracy that’s managed to keep its mouth shut so far.
eth0up · 35m ago
For what it's worth, I've been thrown in society's waste basket altogether on this one.
No insurance, none, of any kind.
I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer.
One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke.
Soylent Green is here. Read your labels carefully.
Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters.
Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.
downrightmike · 2h ago
So far this year I'm seeing basically "We got $100 off! $0 paid by plan. You owe $xxx" I barely use it, but so far insurance isn't covering anything except basic $x refills
Guvante · 2h ago
You are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y.
Sometimes certain things are covered before you hit your deductible other times not.
ceejayoz · 1h ago
Yes, but you'll often find that in a high-deductible plan the insurance company gets a "discount" of your $1k med down to $200, which they brag about in your EOB… but the medication's cash price for uninsured people would be $20.
You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
mustyoshi · 1h ago
What if the medicine costs 100$ to produce, should uninsured have to pay that rather than a subsidized 20$?
ceejayoz · 51m ago
What if the medicine costs $0.01 to produce and both are getting hosed?
vjvjvjvjghv · 3h ago
Is there any hope to clean up the US health system in any foreseeable future? How did the health lobby get so much power and get away with all this abuse?
jmcgough · 2h ago
There's a lot of problems you can point at:
- Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy.
- The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes.
- The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients.
- Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.
FireBeyond · 1h ago
> and creating vertical monopolies like OptumRX
Aetna "forces" you into using its pharmacy by refusing to authorize any prescription with more than a 30-day supply unless through its wholly-owned pharmacy-by-mail subsidiary.
kstrauser · 1h ago
I’d much rather go to the pharmacy once a month with Aetna than with UHC, because at least Aetna actually pays for things. They’re both awful in their own ways; don’t read that as me endorsing Aetna.
bobthepanda · 2h ago
there's a bunch of problems with the setup but a major one is that employer health plans are tax deductible. employees don't really get market choice, and employers really only care about reducing their own expense in regards to healthcare. ending this would be very expensive and disruptive for both employer and employee in the short term, and people have a strong preference for the devil they know vs. the devil they don't (either a public option or fully market-based healthcare)
it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.
lostdog · 2h ago
I'm not sure if there's any hope of US healthcare improving for a long while. The ACA was the only recent improvement. It was a small change, but the electorate decided that it was bad, pushed its supporters out of office, and elected a series of people who promised to "repeal and replace" it, but weren't really serious about any improvement. And then when the "repeal and replace" crowd failed, they were not held accountable, but reelected anyways.
There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.
wtbdbrrr · 2h ago
All the time is not a number but in Germany it's common that your legitimate insurance claim gets rejected at first and then you appeal once or twice and do the paperwork and
document the proof again, citing all terms & conditions that apply and you get what you are
owed or you get a lawyer to do the whole thing again and get what you are owed then.
"Arbeitsbeschaffungsmassnahmen" ( German for "employment creation scheme" ) in an industry where there is not enough actual work for--and or to justify the--number of employees. One of the more useful Ponzi schemes; if you are not a real capitalist, that is. Because if you are, then this shit is just fugly drag.
braabe · 1h ago
I have had this experience, but not with healthcare insurers (in Germany). I cannot remember the last time I had to contact them - the last two times they contacted me, was to explain to me, that they have expanded their preventive care offerings and they recommend I go and get them.
Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month.
Universities, some agencies and especially the god-damned GEZ on the other hand...
What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?
1. https://theonion.com/health-insurance-ceo-reveals-key-to-com...
A big part of my job was to re-route people who needed wheelchairs into getting cheaper things. Our clients were United Healthcare, unions, large health insurers.
It sucked working there it was a total hellhole. I quit when they actually defrauded medicare. Their glassdoor reviews were wild. The owners daughter bragged about dating a glassdoor exec and that he would take down all the honest bad reviews for her.
The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.
I was raised a die-hard capitalist and in many ways still am. When it comes to healthcare these days, I’m somewhere to the left of Marx. What we have now is a failed system. It simply does not work. The turnip has been squeezed and there’s no blood left to wring from it.
I would like to see #1 tried but at this point I’ll gladly accept #2
There’s no reason why this system has to exist. We can make it better any time we want.
The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards.
You and I agree that it would be best to have a system where this is never the patient's problem. Someone determines a standard of care that will achieve the best patient results with the resources available, and then any patient can get whatever treatment's best for them within that framework. That's why I have and recommend Kaiser, they do a good job of presenting that abstraction.
Other people are terrified of the idea of having the standard of care determined by some centralized committee, because what if they decide a treatment that my doctor and I like isn't appropriate? I think the fear is wrong, to be clear, but it's genuine and does deserve to be addressed. Thus all the promises about "if you like your plan you can keep your plan".
(A third group of people believe that healthcare is only limited because of shenanigans, and with the appropriate reforms we could build a system where anyone is entitled to any treatment that might reasonably help them. I'm never quite sure what to tell them, since I don't think that's true but I don't know how to prove it beyond the lack of examples.)
The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).
The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.
In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.
But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).
Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.
It is not at all surprising that capitalism fails miserably here, IMO.
https://www.yahoo.com/news/no-one-knows-often-health-2020566...
> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.
Firstly, Luigi Mangione is presumed innocent until proven guilty.
Secondly, there's a fair amount of real evidence that Luigi is being set up as a scapegoat by the NYPD—a police department with a known history of planted evidence.
Second part: I’m not buying that for a moment. It’s way easier for me to believe that an individual working alone, screwed over by a megacorp who earns more based on how many people they can deny healthcare to, had enough and went vigilante. Vigilanteism and cold blooded murder are not OK, but it’s pretty easy to link cause and effect there. That’s vastly more likely than a shadow conspiracy that’s managed to keep its mouth shut so far.
No insurance, none, of any kind.
I've got a Free h D in hillbilly medicine though. I've accomplished some amazing shit, but it's unraveling a bit now, and I'll be super surprised if I last much longer.
One can certainly say such a hit to morale is just collateral damage in the beautiful face of our wondrous mutant hive, but what are you guys gonna do when we start stinking up your streets en masse? One way or another, you'll be smelling the smoke.
Soylent Green is here. Read your labels carefully.
Proudly Made in the USA with Harshly Sourced Ingredients. I was free roaming though, if that matters.
Edit: returned to clarify that I was pulling myself up by me bootstraps. It's just that it's getting tough to hold on to em tightly enough. No shoes no service though, I guess.
Sometimes certain things are covered before you hit your deductible other times not.
You're out of pocket $180 more than you should be, and paying the $20 cash price out of pocket means your deductible doesn't budge.
- Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy.
- The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes.
- The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients.
- Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.
Aetna "forces" you into using its pharmacy by refusing to authorize any prescription with more than a 30-day supply unless through its wholly-owned pharmacy-by-mail subsidiary.
it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.
There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.
"Arbeitsbeschaffungsmassnahmen" ( German for "employment creation scheme" ) in an industry where there is not enough actual work for--and or to justify the--number of employees. One of the more useful Ponzi schemes; if you are not a real capitalist, that is. Because if you are, then this shit is just fugly drag.
Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month. Universities, some agencies and especially the god-damned GEZ on the other hand...
What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?