I had an insurance company that every year would stop paying anything at all and mail me a convoluted form claiming I had some other insurance that should be paying.
Every year I had to fill out the forms saying that I didn’t have any other insurance before they paid.
It felt like a straight up scam to get people to pay some bills that show up without realizing what was going on / receiving and returning the forms.
I think this is pretty common practice. I get a letter every single year to verify that I dont have any other insurance and they will stop processing claims until I do it. I typically just do the IVR and its only a couple of minutes.
It is, but our country is paralyzed by a political fallacy of "if the market is already so bad, imagine how much worse government exerting any sort of deliberate policy would make it!". And then add in the lobbying process where bills only get passed when some corporate sponsor stands to gain [0], and it's a self-fulfilling prophecy. See also the "death panel" meme, as if that isn't a term that perfectly describes the "insurance" racket we've had all along.
[0] eg one of the bullet points of widely celebrated health care reform was making it mandatory to pay the cartel!
We already spend more in the US, per captia, than any other nation on earth on socialized medcine. The reason we don't have universal coverage isn't due to a lack of resources so it has to be either a lack of ability or theft, probably both.
I mean, suppose we implemented single-payer healthcare on the federal level, and then an anti-abortion government got elected? We know empirically that the latter is a realistic possibility.
The anti-healthcare governments that have been recently elected at the state level have managed to outright criminalize reproductive healthcare, making health plan coverage moot. So this would be seemingly less of its own concern than it was say five years ago.
But those anti-health state governments are, at least, limited to their respective states. Which also makes it possible for people to seek abortion and other related procedures across state borders (I know there were some attempts to ban it, too, but none of them became law so far, and in any case this is very difficult to enforce), where the infrastructure remains.
In a scenario where the anti-abortion party takes control of the executive that is running Canada-style single-payer healthcare on the federal level, I could see them 1) defining abortion as "core service" rather than supplemental so that private providers can't offer it outside the system, and then 2) setting harsh term limits and other barriers like doctor approval to make it effectively banned in practice.
(Fetal personhood is another backdoor that can take this even further.)
My general point was that an administrative backdoor isn't really needed since the regressives have seemingly found a legal basis to criminalize reasonable and prudent medical care on its own.
But I do see your point that if the regressives take the presidency but not congress, then the more the government is involved in the more damage they will do. I'm not a huge fan of single payer healthcare, but I guess I accept it as a compromise as it's the only plan that's been put forth to reform the deeply corrupt healthcare system. I personally want less government involvement in individuals' lives in general (and it's necessary to include de facto corporate government in that scope as well). But I've also paused focusing on this line of argument because the regressive movement has used up so much of the air for it, in bad faith.
But really regardless, we're kind of screwed if the regressives take the executive any time before their social-media-fueled nonsense is run out of the mainstream by actual conservatives - that is people who believe in questioning change, not trying to drag us back in time 70 years to some imagined idyllic past.
FWIW I don't think that single-payer healthcare on the federal level is actually a realistic pathway to reform healthcare. There's too much gridlock for anything major like that to pass, and I don't think this will change for at least another decade.
State level feels much more doable. Not only that, but Canada did it that way - IIRC Saskatchewan did it first, it worked well for them, and those results entered political discourse in other provinces causing a domino effect of sorts. Then finally the feds jumped in to regulate the baseline and assist with money to help the poorer provinces keep up. But to this day, it's actually a voluntary arrangement that any province could leave at any point; it's just that even in Alberta ditching public healthcare is such a fringe extreme right position that no politician hoping to have a successful career would seriously contemplate it.
And ofc if you do it state by state, then it doesn't have to be single-payer everywhere, either. We could try that in states with a more socialized political culture, and e.g. the Swiss model in more conservative states, and maybe something like Germany's private non-profit healthcare coops elsewhere. I would probably prefer the latter for myself for the sake of decentralization.
Find me a country with the population, sprawl, and never ending consumption of processed unhealthy poison like the US.
There isn't one. I'm not saying healthcare in America is perfect or arguing that insurance companies aren't rent seeking or that this can't be changed. I'm just stating that the US is the most unhealthy country there has ever been.
"Death panels" sounded absurd in 2009, especially given who is most famous for introducing us the term. In 2023, when I look at Canada's ever expanding MAiD programs, it doesn't seem as absurd.
If you're a government bureaucrat tasked with reducing healthcare expenditures, in a society that's made the determination that suicide is an acceptable medical treatment, you are incentivized to increase the practice.
"Death panels" was absurd because it's a hyperbolic description of what private "insurers" already did. If you're a corporate bureaucrat tasked with reducing healthcare expenditures ...
I agree that Canada's pushing for classifying suicide as medical treatment is worrying. Suicide is a human right, but making it part of the medical system's all-encompassing paternalism is regressive.
In general we need less intermediation between individuals and medical care, not more. And the "insurance" cartel is one hell of an intermediary. The concept of the HMO is a complete failure, and they should be made illegal for their basic anti-competitiveness.
As Steinbeck was (mis-)quoted: "Socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires."
Maybe you missed the part where the insurance stopped paying anything. If you do nothing, the insurance wins while you still have to eventually pay or suffer other consequences.
The only trick here is tricking yourself into thinking you've won until proven otherwise.
5 years ago a woman didn't look adequately and totaled my car. No problem with her insurance (she had a stop sign, I didn't, she was cited at the scene) until it came time to pay up--and they went silent until I contacted the insurance regulators.
Improper denials or nonpayment should carry substantial penalties.
Right now, there's no cost to blanket denials, but there's a huge incentive to do it. My partner works on the hospital side of things, and several major insurance providers deny literally every claim. And why not? At worst, it just means that the insurance company can wait a year or more before paying. At best, they never pay.
Of course, it's also the insurance companies who are adjudicating the claims.
So long as the penalty is higher than the percent of claims they get out of with their improper denials it would be enough to deter the behavior. You just need to tip the balance to making proper behavior cheaper.
They have rubber-stamp clinicians. Here's an ortho doc getting a denial based on the opinion of a surgeon who put a hip replacement in backwards and is no longer allowed to practice surgery, so he works for an insurer now.
Yeah, I'm aware of this; IMO it's a loophole they've been heavily abusing. I would deem this "practicing telemedicine". We do have /some/ regulations on telemedicine (I think? I hope?) -- you could argue that they're violating those.
I've been thinking about this, but not enough to dig into the details. Is there a legal obligation for "insurance" companies to use licensed medial professionals for justifying denials (similar to how many fields of engineering require a PE stamp)? And if so, would it be possible to make an organized effort to go after their licenses with the relevant state boards?
Those tweets include documents that show doc as restricted to “non-operative office-based medicine or administrative medicine”. Clearly they thought that he is okay in this exact position.
Practicing doctors don't have the bandwidth to do this except in the most egregious of cases though.
I'm imagining a non-profit organization that solicits any denial by "insurance" companies, determines if it is based on medical reasons, determines if it is medically imprudent (including harm caused by delaying care), and files a mostly pre-prepared complaint to the appropriate medical board. Make it extremely uncomfortable to work for a death panel.
Then if the state boards start really brushing the complaints under the table to protect the death panels, turn it into a direct political issue. Right now there's too much plausible deniability to hide behind.
Sounds like something the "DoNotPay" robo-paperwork-response startup guy Joshua Browder would be interested in implementing: https://twitter.com/donotpay
There was already a baseless suit by a very sue-happy Silicon Valley lawyer -- a clear money grab -- which appears to have been largely dropped after an initial hearing did not seem to go their way. I wouldn't be surprised if this is more of the same.
Besides, I look much more favorably on a startup that is automating the filing of confusing paperwork designed to prevent middle-class folks from holding on to their money, than I am insurance companies that use boiler rooms of hack doctors to deny those same folks medical care.
If the profit from denying medically necessary care is greater than the cost of the penalties for denying that same care, then it is profitable to deny that care. A fine that is lower than the profit isn't a fine, it is just cost of business.
Our regulatory system has totally failed, which is why it is rife with these perverse incentives.
> Our regulatory system has totally failed, which is why it is rife with these perverse incentives.
Our so-called “regulatory system” works precisely as Karl Marx expected it to 150 years ago. The so-called "perverse incentives" are fundamental characteristics of capitalism.
The delusion that haunts us originated with the idea that capitalism is not a system but a set of isolated features that we can opt into and out of as we please. Karl Marx showed us 150 years ago that capitalism is in fact a complex system with many contradictions.
Are you under the impression that funding healthcare services via Medicare has even the slightest resemblance to capitalism? I can't think of any industry that is farther away from this. I mean, Medicare is be definition run by the government, and the way that the service providers deal with it is highly controlled by the government. This looks absolutely nothing like a free market, it's entirely the product of socialist control (if I can define "socialism" as "government controls the means of production" rather than outright "owning" it).
Medicare was enacted as an alternative to the nationalized universal healthcare systems proposed by socialists at the time. The capitalists in charge preferred Medicare because it could appease enough of the domestic population while preserving opportunities to exploit working Americans for a profit. It's as simple as that.
And no, your so-called "free market healthcare" fantasy was not considered an option because it was in fact the problem to solve.
So, again, is it your position that the results we see from Medicare - where the payer is the government itself, and the provider side is operating under extremely tight rules dictated by the government, can be considered representative of how things might play out in a free market?
You haven't come out and said so, so I apologize if I'm putting words in your mouth. But it seems like you're arguing toward a position: because we can see that government control of the market has resulted in the mess that we call Medicare, we should therefore stomp out any further vestiges of the market and put the government in control of that as well. This doesn't seem like a sane position.
