United healthcare is notorious. It's 32% claim rejection rate is legendary. It's an unbelievable frustration for physicians trying to get coverage for care for their patients. You spend hours on the phone with them. You pour man-hours into the prior authorization paper work. You document. You explain. You cajole. Then they reject the claim and meanwhile while you're dicking around with this bureaucratic nonsense, your patient is not getting treatment. The patient gets the shaft while they post record profits for their shareholders.
I totally understand the emotions swirling about the CEO's murder. It's reprehensible to try and hold one person's life as punishment for an entire organization like this, or to call for his death at all. That's not moral, but I understand.
Insurance as a for-profit enterprise is a major drain on the US healthcare system. You need a profit motive to get people to be willing to take on the financial risk the business entails. That's Econ 101, but these guys have too many laws and policies that allow them too much safety from paying claims they should be paying.
Fixing it is not simple however. A scalpel is needed. Maybe one of those monstrously large scalpels they use for autopsies, but a scalpel, and not a chainsaw.
I've been on disability since 2008, had Humana. I was determined disabled bc I'd had 3 lumbar surgeries with accompanied nerve damage before I was 30. In 2023, I had a 4th multi level lumbar fusion. 4 months later, cardio wanted to do a stress test. Did the auth for a nuclear stress test cuz I can't run - on a treadmill or anywhere else. Those idiots DENIED the nuclear stress test because there was NO PROOF I COULDNT RUN ON A TREADMILL!!! Yes, I lost my shit. Not only that, but if they hadn't denied it, my co pay would have been $350. So, they weren't going to be carrying the entire payment due. It's a crock. And I'm at a loss how they expect anyone on disability or Soc Sec to pay an out the blue $350 bill. You don't get to save or really invest money when you become disabled at 38 and have 2 kids to care for. Seems to me, they should only be allowed a certain % of profit. They deny care or charge such an exorbitant co pay that you can't afford it anyway while pocketing billions in profit.
Humana's no better. I had the misfortune to require their services for a few years now. The copays are ridiculous, even on their "good" plans, and of course, just like anyone else, they like denying claims. Every time I needed a new medication, we went through several rounds of denials before the doc got on the phone and chewed their consultant doctor's ass until he approved it. They create these protocols in the way they do to make it easy to deny expensive therapies.
I think your last line is key. They bleed their patients dry while positing billions in profit. Morally, we think of healthcare as a non-profit concept. We need the business acumen to keep the system running efficiently. We need the brain in the system, but we also need the heart - and it's tough to design a system that relies on people choosing to be decent and moral people. You can't legislate that, and it's very tough to run a business like that.
Disagree. It's come to the point that the laws and policies have wrapped themselves like a cat's hairball stuck in a vacuum cleaner's roller bar. It intentionally defies targeted solutions.
Needs to be crushed and discarded in its entirety. Add new medical schools, triple the doctors and care modalities, and costs will decrease on their own. Insurance can be pure disaster coverage and ignored for normal healthcare.
Yes and get the illegals out of the equation. Free treatment for them means we all pay more when many Americans are the working poor who can't afford to pay more. It pisses me off to no end seeing them show up to our hospitals, get treatment and don't have to worry about paying because they're on some sort of facility assisted sliding scale which usually means free with or without medicaid. I've had it with my employer. They make me ill, claiming to be a Catholic institution but mandated poison jabs for their own employees. Thank the Good Lord I have a religious exemption.
The alternative to insurance is that you get the bill flat out from the hospital. Can you afford a $5K bill for an ambulance ride? A $3K bill for ER care, $200 for the lab work? $1500 for the CT-scan? $500 for the ER physician's consult? $5000 for the MRI? $500 for the surgeon's consult?... etc, etc.
Insurance is a necessary evil. It spreads out the financial risk across time and across the population making the service more affordable for everyone. But we have to understand the insurer's perspective. Their entire business is in assuming someone else's risk. The only way to do that is to give them a way to make some money themselves by doing it. If we tell them they can't have a profit, why take on the risk? Leave it to the individual to manage his own risk. So, the question here really is what is a "fair" profit for the service they provide?
And it gets more complicated than that because then we have to deal with the value judgement about what's being purchased. If you walk into a Walmart with a greedy toddler, they'll tell you they "need" every toy in the toy section. Maybe he's got a rich, doting grandparent who he expects to pay for it. Who actually makes the decision about what the kid needs? Not the toddler (our patient). Maybe the parent (our doctor) gets a say, but really the decision is made by the grandparent (the 3rd party payer). We've got a system that separates the people with the biggest stake in the value assessment (ie 'is this worth the price I'm being asked to pay?') from the decision to pay or not. In fact, in our scenario, Walmart figures out the game and takes all the price tags off the products knowing that the rich grandparent is going to pay regardless, then jacks up the prices. That whole scheme has to be changed.
I think we agree fundamentally. In a free market, insurance can be a viable product and a sensible purchase. But it isn'ta free market at all: not for insurance, and not for medical care.
Medical costs are too high, because it hasn't been a free market. In particular the supply of doctors and nurses is limited. Best evidence is that medical schools turn down huge numbers of qualified applicants each year, and the number of graduating doctors each year is fully controlled by a monopoly, the ACGME (Assoc of Collegiate Graduate Medical Education). The costs should be much lower.
Insurance is also not a free market by any stretch, starting with the fact that it's a mandated purchase for most corporations, and for most individuals thanks to Obamacare. It's more like a regulated utility with an insurance component than actual insurance.
Add in the fact that medical bills including hospital bills are only incidentally related to actual cost. There's a huge cost bubble that doesn't reflect true costs at all.
There are ways it can be reformed, if the government approaches it in good faith. But I've lost confidence in gov't's good faith. I'd much rather see a totally unregulated market.
Not to mention that most doctors can't cure anything anyway; they're only trained in symptom suppression, culturing a chronically ill population. But that's a whole 'nother can of worms.
United healthcare is notorious. It's 32% claim rejection rate is legendary. It's an unbelievable frustration for physicians trying to get coverage for care for their patients. You spend hours on the phone with them. You pour man-hours into the prior authorization paper work. You document. You explain. You cajole. Then they reject the claim and meanwhile while you're dicking around with this bureaucratic nonsense, your patient is not getting treatment. The patient gets the shaft while they post record profits for their shareholders.
I totally understand the emotions swirling about the CEO's murder. It's reprehensible to try and hold one person's life as punishment for an entire organization like this, or to call for his death at all. That's not moral, but I understand.
Insurance as a for-profit enterprise is a major drain on the US healthcare system. You need a profit motive to get people to be willing to take on the financial risk the business entails. That's Econ 101, but these guys have too many laws and policies that allow them too much safety from paying claims they should be paying.
Fixing it is not simple however. A scalpel is needed. Maybe one of those monstrously large scalpels they use for autopsies, but a scalpel, and not a chainsaw.
I've been on disability since 2008, had Humana. I was determined disabled bc I'd had 3 lumbar surgeries with accompanied nerve damage before I was 30. In 2023, I had a 4th multi level lumbar fusion. 4 months later, cardio wanted to do a stress test. Did the auth for a nuclear stress test cuz I can't run - on a treadmill or anywhere else. Those idiots DENIED the nuclear stress test because there was NO PROOF I COULDNT RUN ON A TREADMILL!!! Yes, I lost my shit. Not only that, but if they hadn't denied it, my co pay would have been $350. So, they weren't going to be carrying the entire payment due. It's a crock. And I'm at a loss how they expect anyone on disability or Soc Sec to pay an out the blue $350 bill. You don't get to save or really invest money when you become disabled at 38 and have 2 kids to care for. Seems to me, they should only be allowed a certain % of profit. They deny care or charge such an exorbitant co pay that you can't afford it anyway while pocketing billions in profit.
Humana's no better. I had the misfortune to require their services for a few years now. The copays are ridiculous, even on their "good" plans, and of course, just like anyone else, they like denying claims. Every time I needed a new medication, we went through several rounds of denials before the doc got on the phone and chewed their consultant doctor's ass until he approved it. They create these protocols in the way they do to make it easy to deny expensive therapies.
I think your last line is key. They bleed their patients dry while positing billions in profit. Morally, we think of healthcare as a non-profit concept. We need the business acumen to keep the system running efficiently. We need the brain in the system, but we also need the heart - and it's tough to design a system that relies on people choosing to be decent and moral people. You can't legislate that, and it's very tough to run a business like that.
Disagree. It's come to the point that the laws and policies have wrapped themselves like a cat's hairball stuck in a vacuum cleaner's roller bar. It intentionally defies targeted solutions.
Needs to be crushed and discarded in its entirety. Add new medical schools, triple the doctors and care modalities, and costs will decrease on their own. Insurance can be pure disaster coverage and ignored for normal healthcare.
Yes and get the illegals out of the equation. Free treatment for them means we all pay more when many Americans are the working poor who can't afford to pay more. It pisses me off to no end seeing them show up to our hospitals, get treatment and don't have to worry about paying because they're on some sort of facility assisted sliding scale which usually means free with or without medicaid. I've had it with my employer. They make me ill, claiming to be a Catholic institution but mandated poison jabs for their own employees. Thank the Good Lord I have a religious exemption.
The alternative to insurance is that you get the bill flat out from the hospital. Can you afford a $5K bill for an ambulance ride? A $3K bill for ER care, $200 for the lab work? $1500 for the CT-scan? $500 for the ER physician's consult? $5000 for the MRI? $500 for the surgeon's consult?... etc, etc.
Insurance is a necessary evil. It spreads out the financial risk across time and across the population making the service more affordable for everyone. But we have to understand the insurer's perspective. Their entire business is in assuming someone else's risk. The only way to do that is to give them a way to make some money themselves by doing it. If we tell them they can't have a profit, why take on the risk? Leave it to the individual to manage his own risk. So, the question here really is what is a "fair" profit for the service they provide?
And it gets more complicated than that because then we have to deal with the value judgement about what's being purchased. If you walk into a Walmart with a greedy toddler, they'll tell you they "need" every toy in the toy section. Maybe he's got a rich, doting grandparent who he expects to pay for it. Who actually makes the decision about what the kid needs? Not the toddler (our patient). Maybe the parent (our doctor) gets a say, but really the decision is made by the grandparent (the 3rd party payer). We've got a system that separates the people with the biggest stake in the value assessment (ie 'is this worth the price I'm being asked to pay?') from the decision to pay or not. In fact, in our scenario, Walmart figures out the game and takes all the price tags off the products knowing that the rich grandparent is going to pay regardless, then jacks up the prices. That whole scheme has to be changed.
I think we agree fundamentally. In a free market, insurance can be a viable product and a sensible purchase. But it isn'ta free market at all: not for insurance, and not for medical care.
Medical costs are too high, because it hasn't been a free market. In particular the supply of doctors and nurses is limited. Best evidence is that medical schools turn down huge numbers of qualified applicants each year, and the number of graduating doctors each year is fully controlled by a monopoly, the ACGME (Assoc of Collegiate Graduate Medical Education). The costs should be much lower.
Insurance is also not a free market by any stretch, starting with the fact that it's a mandated purchase for most corporations, and for most individuals thanks to Obamacare. It's more like a regulated utility with an insurance component than actual insurance.
Add in the fact that medical bills including hospital bills are only incidentally related to actual cost. There's a huge cost bubble that doesn't reflect true costs at all.
There are ways it can be reformed, if the government approaches it in good faith. But I've lost confidence in gov't's good faith. I'd much rather see a totally unregulated market.
Not to mention that most doctors can't cure anything anyway; they're only trained in symptom suppression, culturing a chronically ill population. But that's a whole 'nother can of worms.