I once had an insurance plan with a grossly inaccurate provider directory. This cost me a bit as the doctor they suggested to me, verbally on the phone, turned out to be out of network. They later told me it was the doctor’s responsibility to remove themselves from the directories and they often fail to do that. If they’re so incapable of maintaining an accurate list of providers on their own, how did the insurance company know to reject that claim so quickly? They are simply liars and fraudsters.
I began calling random doctors in the directory and one even told me he tried to get his name removed for three years. Anybody at the insurance company could clean up the directory once a quarter. They know the directories are inaccurate. It makes their network look bigger.
Health insurance middlemen need to be eliminated already.
Yup, I've seen it also.
None of the snail mail garbage, but I couldn't pry anything out of the portal. The first attempt with the insurance company produced an e-mail that was utterly useless. The second attempt, when I spelled out the problem with the first, produced a completely different list when it should have been a subset except with a greater distance. Of that list I could reject some based on their websites, some were utterly wrong based on calling the office (and in one case a "never heard of them") one had been in an accident and wasn't currently accepting new patients and that left one. And it was the closest one I had looked at, the distance bit was most certainly not relevant.
They need to put a much shorter timeline on the insurance coming up with a suitable practitioner. Say, maybe a day rather than 60 days. And maybe a month to actually get an appointment. And, for an existing situation the clock is set by any important scripts the patient might have. (My hunt was triggered by my getting dumped by the system--I had been grandfathered in when the practice changed. Then the doctor left and the grandfathering ended.)
It seems like insurance companies don’t care about things that burden the customer or provider. Lots of onerous forms and weird processes that are wrongly documented.
I had infuriating situations where their directory showed a provider, their phone service confirmed they were in network, but the claim was rejected as out of network. They said they made a mistake and the only way to know is to try to submit a claim. I asked the same thing “if you know to review a claim why don’t your reps or your web site know?”
It sounds like something that would be very easy to fix if the government mandated that insurance companies have a responsibility to keep their provider directories up-to-date. Software should be able to very easily identify providers that have not accepted any claims in a given time period, so that they can be flagged for removal.
The political cowardice of the Obama administration and congressional Democrats to not just deep-six the private health insurance industry as we knew it when they had the chance, Republican (and Blue Dog) whining be damned, cannot be overstated. It's been 15 years. Think how different our country could be today, how much better off people could have been, if we'd established an American NHS with even half of the money we spend.
It's a little crazy how quick we are to fire individuals who have a negative effect on a given organization, while being so loathe to "fire" the organizations who have a negative effect on our society.
It’s beating a dead horse at this point, but private health insurance is quite possibly the worst middleman I have ever dealt with.
They not only make the patients life worse but the doctors and hospitals as well. Dealing with insurance means small practices need a dedicated office staff to file the right paperwork and get paid for each patient visit.
I recently had to juggle 'do I pay out of pocket for this skin cancer surgery and save $600 on the $3000 total, or use insurance so that what I pay goes towards my deductible (would have fulfilled 30% of my deductible for the year). It was better to pay out of pocket.
In the last 30 years we went from affordable ambulances and insurance that worked to people too scared to use ambulances and insurance that our doctors encourage us not to use. Glad we are letting the free market work it's magic. Thankfully the market worked in our small town, the ambulance company went broke and we joined together as a community and now have county services that are not only better but much much cheaper and don't see peoples' emergencies as a profit center for some located elsewhere mega-corp. Weird how inefficient small town hick local government can now make work (and work better) what mega corp for profit 'big brains' couldn't.
Side note: USE SUNSCREEN PEOPLE! I wish I could go back and slap dumb 'too cool for sunscreen' Santa Cruz surfer kid me.
>In the last 30 years we went from affordable ambulances and insurance that worked to people too scared to use ambulances and insurance that our doctors encourage us not to use. Glad we are letting the free market work it's magic.
The healthcare market was arguably freer 30 years ago than it is today.
Another Santa Cruz loc
Man I miss home so much. Sadly the saying 'you can't go home again' is too true. Wish I could have afforded to stay in the town I grew up in.
Hands down the worst and most stressful part of living in America, and the only reason I - a child of immigrants who are grateful to have built a life here - would consider moving somewhere else
My wife is a doctor and dealing with insurance is one of the worst parts of the day.
Far too often, she knows that a certain treatment plan is going to be the only and most effective plan for a patient. However, insurance will require her to exhaust several other options first.
It seems the hope is enough patients give up on treatment that they never actually seek the proper care. They'll just get chucked the "cheap" option again in the future.
This could be said for all of private insurance: they've got a literal mandate to not pay out, pay out far below what is owed, or delay delay delay because what they keep is pure profit.
I wonder if for a public provider if the incentives are better.
> I wonder if for a public provider if the incentives are better.
should be generally. the NHS in england was viewed more favorably than the queen and they loved the queen.
I think they are saying it of all private insurance
I need to see a doctor about once a quarter for an ongoing issue and ended up switching to a DPC doctor. I pay a subscription out of pocket and extras are a flat rate menu, and they simply do not take insurance. However, it's been way cheaper overall and I have had exactly zero phone calls aside from setting appointments. No billing issues, no surprises, no middlemen, no problems. Oh, and I can have an appointment as soon as this week if I need one. No 8 month runaround just to get a referral.
The reason it works is because the doctors do not have to staff a billing department. the office runs like a '2 pizza team.' Just delete bureaucracy, it isn't helping us.
If I could recover the cost of my time in small claims court, I’d be making a hefty sum from these parasitic insurance companies that constantly require me micromanaging their antics.
In CA I wonder if a PAGA claim could be viable.
It’s crazy that you put up with it.
Me, in Europe - I need healthcare, I go wherever I want, public or private. Public is free and good, but usually you have to wait a few weeks or months for non-critical care, and private can usually see you tomorrow. My insurance will cover it, no question - everyone is in network with everyone, and I’ve yet to find an exception. I pay €600 a year, and it covers all the root canals and colonoscopies I can handle. No copay. No excess, except on dentistry, which is like €25.
Where?
In my case: The Netherlands (lived there > 10 years as adult). I've also lived in Germany for 5 years, and it was only slightly worse than NL. But nothing compared to the horror stories I hear from US colleagues.
I live in Germany. 800€/month for public insurance, some dentistry services are included - a lot aren't.
Lots of doctors only service patients with private insurance, so I sometimes just have to pay it out of pocket.
Specialty Care like skin is usually massively overbooked that you can't even get any appointment, as they don't accept any more patients.
Your experience in Germany is likely >10yrs ago before the system was sabotaged for private profits by our current health minister
The horse is only dead because it didn't have the cash to pay the out of pocket, so it died from a preventable disease. And even if it had the cash, the lines are so long it would've died waiting instead.
Keep in mind that there are different kinds of private health insurance, and american system is one of many. I live in Argentina right now. I pay about $150 per month for insurance (which is pretty expensive by local standards). They operate their own hospital, which is about 15 minutes from my home by car. I buy medicine with 50% discount, which already makes the insurance pay for itself. I don't have to search for doctors, I just open an app (or website, or call them) and make an appointment, almost all of them work in the same hospital building. My girlfriend had to use an ambulance, and now is prepping for surgery — of course, all of that is completely covered. Oh, and all the doctors give your their email or WhatsApp so you can follow up and ask them stuff anytime.
I lived in Russia before, and I've had even better experience. I don't remember how much I paid (on the same order of magnitude), but home visits costed me may be around $20 a pop. (Personally, I'm buffled why more health systems around the globe don't have home visits, I'd gladly pay a reasonable extra fee). I've also used private health insurance subscription when I lived in Israel and had to see doctors in Turkey, Georgia, Serbia and Peru, paying out of pocket; in all these instances, prices were reasonable and the whole system very nice to interact with. For instance, in Georgia, my ex had to ride an ambulance and spend week in a hospital. The whole thing cost me around $300 out of pocket.
Anyway, in any of these systems where I had a subscription, I've never had to pay and then file a claim; doctors were employees of the organisation that I paid my insurance to.
Public health insurance, on the other hand, have always been an abysmal experience, with doctors and nurses not giving f about you. It was more expensive, too: you had to bribe people so that they actually did their jobs, and it didn't improve their attitude much. Nobody in that system has any incentives to help you. And, of course, it's much more expensive in the end.
I’m curious about why it wasn’t considered to switch insurers, the article has do many details on many processes and I felt this one was not investigated
It’s definitely hard to cancel them and the expense adds up to pay premiums for two
Was it a possibility?
I obviously don’t know the specifics, but US healthcare plans only let you change during specific enrollment periods or qualifying life events. It’s possible he wasn’t able to.
Additionally, it sounds like he picked what appeared to be the best rated plan available to him on the market. Others may have been even worse or prohibitively expensive.
Yes I know it’s hard to cancel outside of enrollment periods, you can still have multiple
Adding in the last minute flights and commitments throughout this article, I would say for other people that at some point the calculus can be re-evaluated to find that paying the premiums would be worth it. The loved ones can pay for that instead of last minute flights and time off
> you can still have multiple
This can’t be for real. The only reason you pay for insurance is in case something happens. It has no value outside of that. That’s why it’s called insurance. And medical insurance in the US is very expensive, so much that a large part of the population can’t afford it. If you don’t get care when you need it, it’s worse than no insurance - now there’s less money left to pay out of pocket to the only places that will take you on in time. The solution to being scammed is not to sign up for another scam.
Aside from how ridiculous it would be to buy double coverage, it can just make the problem worse with both companies trying to argue they aren't the primary and that their doing anything may be duplication of coverage. But some more paper work should resolve that once you are dead.
The man in the article was living in a studio apartment. I doubt he was in a position to be paying the equivalent of a mortgage for many insurance options. Even if he could, I’m not sure that’s the system/solution we’d want.
Blame literally anything except the glaringly obvious perverse incentives produced by the profit motive.
Glad we have folks willing to do the hard work of defending negligent insurance companies <3
If he had a lot of money he could have just paid out of pocket for care. It sounds like he couldn’t afford it.
Or pay cash for therapy. Or have the parent pay cash for therapy. Options existed, but there are none now.
Most therapists don’t accept insurance. The problem then is that their services are expensive out-of-pocket.
You have the choice of a couple of large companies that will deny every claim always for any reason, and a few smaller players who no doctor in your area has heard of or can accept payment from.
So yeah, you have a 'choice'
Integrated providers, such as Kaiser Permanente, have far fewer issues related to the problems brought up in this article compared to most others.
Nothing like this would ever happen in a Kaiser hospital.
> Nothing like this would ever happen in a Kaiser hospital.
Kaiser’s mental health services were so bad that their providers went on strike a couple years ago. They’re paid a fraction of what they could make in private practice.
https://www.healthcaredive.com/news/kaiser-strike-mental-hea...
What barriers prevent them from working in private practice?
As a non-American I assume that Kaiser implements some sort of barriers to stop smaller competitors from rising up?
Yes, the healthcare industry is one of the main reasons FTC is trying to go after non-compete clauses.
That plus as the insurers vertically integrate all the way down to care providers, they’re making it harder and harder for external providers to join their insurance network.
Capitalism doing capitalism things, and we have enough rightwingers to neuter any possible intervention.
Kaiser had its own very sordid history of denying people mental healthcare which has led to deaths, fines by the state of California, and new legislation.
My family has gone through three generations of Kaiser in California and it has its own tradeoffs I promise you and mental health is one of it’s most frequent complaints.
I don't think you know Kaiser very well. Kaiser's vertical integration is really good at some things, but the other edge of this sword is that if you need treatment in a specialty they're bad at, you're fucked: there's nowhere else to go because getting out-of-network care with Kaiser is nigh-impossible. And mental health is infamously one of the things Kaiser is very bad at. Their mental health coverage is so inadequate that if I was choosing between insurance providers I'd pick a different one for that reason alone.
By "nothing", are you referring to the incident in Santa Rosa in 2015?
https://nuhw.org/therapists-demand-action-in-response-to-tra...
Or the one in San Diego in 2021.
https://www.sandiegouniontribune.com/2021/03/31/kaiser-patie... (https://archive.is/wF1bD)
Or maybe you're referring to the incident in Santa Clara in 2022.
https://www.medpagetoday.com/nursing/nursing/98534
Of course, those incidents aren't like the one mentioned in the article. The ones I linked are just a gross failure of Kaiser's mental health resources leading to three people's deaths instead. At least they didn't have to deal with a ghost insurance network though!
Public health insurance in other countries are not better.
For instance, I pay 10% of my income for it and in some cases queues just to start treatment are for few years. And it does not cover teeth, implants, vaccines.
If case is urgent, like a cancer, it can take 6+ month to actually start treatment due to all paperwork and queues everywhere.
Sounds like poor implementation, not a reflection on the concept. Which sucks - don’t get me wrong, that needs to be improved!
Private insurance has all the wrong incentives, and IMO profit should never be linked to the health of a human for that reason.
In cases of public healthcare the problem is almost always a shortage, doctor shortage, bed shortage, nurse shortage, tech shortage etc.
The perfect system is a public healthcare with true abundance.
This could be a tech-heavy lens, but I feel like some of the innovation in healthcare is driven by a profit motive (and funded by same in a lot of cases).
I don’t know if removing all profit from the system results in an optimal outcome, but I suspect it does not.
My understanding is that most early stage medical research on finding specific targets for drugs, and often drug discovery itself is publicly funded. Private funding only really takes over once you start trialling the drug in animals and then humans.
However the trials in humans are really the primary source of cost and risk in drug development. It’d be great if there was some mechanism to push royalties back to the public agencies that funded the basic research though.
It’s not just drugs; look at the difference in medical equipment now versus 40 years ago.
I’d sure rather pay a little extra and have 2024 equipment than 1984. That 2024 equipment exists because someone imagined they could make a profit if they successfully created it.
The only real incentive to provide good service in any industry is money and competitive free market.
What country is this?
I've dealt with ghost networks too, with BCBS of CA. They provide you a directory with a thousand options, and I was already planning to go with the first provider that would have me. Had to call 15 before I got one that wasn't out of business, not accepting new patients, or not actually accepting the provider that gave me their number. So I can only assume that roughly 6% of their providers are actually real.
Had a similar problem with Aetna in NJ. I thought my situation was unique
I assume BCBS is Blue Cross Blue Shield; which is one of the largest insurers.
Can I ask how big is the city you live in (or near)? It seems like big cities have options, but small towns starve for medical help.
I wouldn't assume based on your sample. Most people start at the top so more of those would be filled. Businesses that add AAA to their name to appear at the top of the yellow pages are more likely to close.
Working in a psych unit trying to improve this process is really eye opening. Some key doctors have put in the effort to turn the inpatient floor from weeks of being trapped to identifying these situations where people simply need actual support established. There's even a special 72 hour turn around program recognizing this situation where the system has failed and what we need is rapid stabilization and setting up the proper support for the person to have therapists, medicine, and support groups while still living their lives. It still has flaws, but there are people that care and are working overtime to fix the system. It's just a very slow process.
Health insurance in the US sounds like such a scam. Is it not possible to pay for a psychiatrist directly or to renew prescriptions without seeing one?
I'm paying $250 per week out of pocket for a therapist in NYC.
As far as psychiatric health goes, its highly variable. I have a friend that I talked to last night that is working with Medicaid to revamp how they bill this kind of stuff because a lot of it is rejected by insurance since it doesn't fit within a clearly covered area. Getting small areas or sustainable coverage established like this can sometimes be a path forward to broader adoption. But that's still pretty optimistic thinking
The former, yes, but they’re far more expensive. The latter, kind-of. You have to have regular check-ins, dependent on the type of medication
It's crazy that you can't get a prescription for under 379$. Something is seriously broken with that system. I'm pretty sure I could get one for 1/10 that price where I live, without insurance.
When I first moved to the Netherlands, I had to visit a pharmacy to purchase insulin. I was prepared to spend nearly half my paycheck on a months supply and deal with the headache of not having a prescription on file before I’d established insurance.
I walked out the door with a box of Lantus pens having spent 80€. That would have cost me about $600 in the US at the time, if they’d even dispense to me without a prescription.
The leaders at ambetter should be in jail. The world would be better off if they didn't exist.
This is messed up. Feels ripe for a wrongful death lawsuit at the minimum, and likely some regulatory enforcement against this scam insurance
Perhaps you've never attempted to sue your once and former insurer for contract breach... You probably get the implied frustration and futility, but remember to include the impact of same on your yet-to-be treated illness.
It depends on how you got your insurance.
There's a law limiting liability with employer-provided stuff to the amount in question. It wasn't that bad a law as originally intended: retirement accounts. But it also limits liability with insurance. Liability is capped at the amount of the denied claim--which means that in most cases it would cost more than the recovery.
I'm not sure what the legal situation is when there's no employer involved and you have an exchange plan.
I know how hard it is from that non-fiction work, The Rainmaker.
No I have not sued anyone.
But my point is now that he's gone, maybe his family could sue. Not sure that'll really fix anything though. Laws and regulations with real enforcement could though.
Man, American healthcare sucks.
Who came up with this "network" idea? I hope they are burning in hell.
Here in Germany I can just go to any doctor/care provider. The insurance companies don't have networks I need to worry about. I have always considered that normal, and think the American system is horrible and perverse.
How do you know if someone is a care provider or they just say so? ... and that's the problem with the patchwork of states, certification boards, semi-regulated honor systems interconnected with a fuckton of money.
And instead of sufficiently driving out scams[1] from the whole country (or at least from states) there are these mythical "allowlists".
[1] but then muh freedom! and MLMs and religious crazies and spiritual-woo-whatever crazies masquerading as religious crazies, and ...
>How do you know if someone is a care provider or they just say so?
We have central authorities for that and as a patient I don't have to worry about it.
In the case of public insurance (which over 80% of Germans use) the care provider bills the insurance company, not you. And people can't just pretend to be medical professionals because the insurance company can easily check if you actually have a valid license to practice medicine in Germany. Again there are central authorities for that which maintain registries.
This is so bad : we can measure a country's strength by its weakest link. There are some major loopholes here.
I've never heard of them.
Then I read the bring in more revenue then "Disney, FedEx or PepsiCo".
Wait, what? Oh, right, subsidaries.
And, of course, a giant in Medicare Advantage.
That company sounds ... very bad and needs to start doing what they are supposed to be doing and stop playing games. People are looking for help and they are looking for ... well, how to squeeze out more money I suppose.
"You need psychiatric care? Sorry, we're a bit busy trying to make more money. Priorities and all."
"Someone died due to our lack of caring about any of that? Sorry to hear that. Listen, gotta go. (click)"
Sue them into the ground.
I don’t think the article is right.
>One of the 25 largest corporations in America, Centene brings in more revenue than Disney, FedEx or PepsiCo, but it is less known because its hundreds of subsidiaries use different names.
https://companiesmarketcap.com/largest-companies-by-revenue/
By what measure is Centene one of the US’s 25 largest corporations? Its way down at #519 in global market cap rankings, which means it is nowhere near top 25 in the US by market cap. It has $157B in revenue, so maybe that gets it close to top 25, though I still doubt it. It has less than 70k employees, which is not near top 25 either. And there are 5 other managed care organizations (aka health insurers) doing more business than Centene (UNH, Elevance, CVS, Cigna, and Humana).
It has miniscule profit margins (1.56%) because it is paying out almost all of its revenue to healthcare providers (90% medical loss ratio).
https://www.macrotrends.net/stocks/charts/CNC/centene/profit...
https://www.healthcaredive.com/news/centene-medicaid-redeter...
If this business approved more claims or paid more for the claims, it would either go out of business or become a charity. Or it would have to increase premiums.
It's because the article uses a different source than you for total revenue. If you look at the wiki page titled: "List of largest companies in the United States by revenue" [1], it lists Centene as 22nd with a slightly outdated ~$154B in revenue.
You should know the author was referencing American companies because your second line of your post reads, "One of the 25 largest corporations in America, Centene brings in more revenue...". If you look at your 'Companies Market Cap' site, you'll actually see that it includes a global set of corporations including, but not limited to, Saudi Aramco (KSA), Sinopec (CN), Petro China (CN), Volkswagen (DE), China State Engineering (CN),Toyota (JPN), JBS (BRA) etc. And those were the only ones I saw without scrolling.
I have issues with the way that author wrote her article, but I have even more of an issue with commenters like you who don't actually take the time to read or comprehend the matter at hand. You just come into a comment section with the intention of trying to prove your preconceived perspective.
The point of this article, if it's not clear, is that certain health insurers do not do a good job advocating for their insureds and do not fulfil their end of the contract. In this scenario, it seems like one could make a good argument that this lead to the death of a young man wrestling with alcoholism. It's obvious, if you read the other comments here, that the real story are the sweeping complaints of the private healthcare system in the US in general as many others seem to have had similar issues.
I'm not sure what exactly their NPM has to do with this discussion. Other, seemingly better insurers (both larger in scale and fewer complaints by customers) post margins that are more than double of Centene so it seems like Centene should take your advice and either go out of business or do a better job running their existing business.
1: https://en.wikipedia.org/wiki/List_of_largest_companies_in_t...
It's 25th on the fortune 500 list
> bring in more revenue then "Disney, FedEx or PepsiCo".
> Sue them into the ground
Good luck with that :-)
True, they are too big and have their tentacles in too many things to make them go away.
However, when you are dealing with people who are supposed to be helping people, and they are staring at how much money is currently coming instead, just do what needs to be done.
Any single law they broke? Sue them.
People are asking for serious help, and they aren't helping them. And people are dying. That is beyond unaccepable.
I hate these types of companies.
It's like the companies that buy the land under hospitals, make them pay to stay on what is no longer their land, squeeze out as much as they can, bankrupt the hospital, and do it again to another one.
Especially brutal when they do that to rural hospitals where now patients are pretty far from the other one still standing.
I have a very strong dislike for any companies in that category. The people don't matter, as long as we can extract the money, we're going to do it. Greed on steroids.
I almost teared up.
I did as well. My cousin passed away in his early 30s from alcoholism - this story hit close to home.
It's common to hit similar road blocks when trying to get a primary care physician around here (and the in-network specialists won't see you without a referral from a primary care physician, rendering your health insurance worthless for non-emergency care).
The US really needs to get rid of the health insurance industry. Single payer would work as would standardized pricing combined with "if the doctor is licensed the insurance company must accept the bill".
Barring that, there should be SLAs regarding for one-shot online searches or one phone call lookup of in-network care providers.
For example, there could be a guarantee that the top three hits of at least 99% of such attempts each contain the phone number of a doctor's office that is accepting new patients and provides relevant care. If the insurance company falls below that bar, then it should have to refund all the premiums they collected that month (since there's no way to know which customers deferred care due to this bullshit), or be hit with some other fine that'd actually be material to their earnings.
Afraid single payer system would just be hollowed out by conservatives (funded by PE), as it has been in the UK. Doubtful the US has the buy in and the discipline to maintain such a system.
Sadly our private insurance market is an oligopoly that can obscure pricing and collude to increase prices. So it's the worst of both worlds.
Not to get too ideological, but libertarian proponents tend to claim that businesses with poor service will just naturally be outcompeted. Those who go as far as to suggest that fraud need not be prosecuted by statist regulation will say that dishonest companies will have bad reputations and customers will naturally not patronize them.
Makes me wonder what trying to build such a reputation system would look in practice. Consumer Reports manages to hang on as a publication but not everyone consults it, and there are so many more review sites these days of varying quality, impacted by AI/outsourced copywriting.
And when you deal with an industry as dominated by a few monolithic oligopolies like health insurance or phone service- what is more bad publicity going to do to AT&T? You can’t even boycott that, especially when they lock in customers to prevent them from easily switching away.
Right you could go against the rest of the world and continue with privatized care. I’m sure it could work much better if free markets were enforced, but it’s very much the opposite. US markets are extremely entrenched, especially in highly regulated sectors. Markets are cornered by PE, by acquisitions, by frivolous lawsuits, any means possible to get dominance. And there’s no functioning anti-trust law, so you get the opposite of free markets. Even Milton Friedman claimed that governments have a necessary obligation to interfere to preserve free markets.
“Interfere to preserve free markets” is odd. The entire issue in the USA is regulatory capture and bribery of the government. The government has such tremendous lucre from taxing and such authoritarian power that every entity that can exploit it will exploit it. The government’s money and power is the one ring. The idea that the government should interfere is the entire problem. Just things like preventing insurance, a financial product, from being sold across the nation or around the world gives insurers undue power. Don’t get me wrong, in this case, breach of contract is a legal issue and the insurance company should be prosecuted, but Milton Friedman was off on this one by a mile. A government that has been purchased by banks, insurance companies, drug companies, and defense companies cannot act in the market fairly and therefore should not act at all.
So what can the average citizen do about it? Start funding Consumer Reports and other watchdogs until they have literal armies of lawyers and mercenaries? Stage acts of consumer-led industrial sabotage until these corporations are driven out of business until presumably better actors rise up in the market? To go back to my original post, neither business reputation nor customer boycotts would seem to have any effect. So if you were to deny the government the ability to regulate, then all you’re left with is vigilantism.
It's not a free market if you're forced to participate in it. Which we all are, by virtue of being alive.
This is more than a free market vs state argument.
This type of thing is a characteristic of any large system - there will be gaps. (I’m trying to explain but not defend these gaps).
Unfortunately, some things only work if it’s a large system, like insurance, government, and AT&T.
For instance, in countries with state health care, there are also serious failings like this kind and of other kinds. For example, by keeping prices low, some of these systems restrict supply. This means long waiting times & lower rates of innovation.
Here in Canada, we have government insurance, not health care, and though it’s been good to me, it’s not perfect. Central control is not some silver bullet, and neither is the free market.
Just wondering, is the dire state of Canadian phone providers (Bell, Telus, Rogers, etc.) a product of government regulation or private cartelization?
> what good another detox would do if it didn’t help him combat the root causes of his addiction through therapy
that’s how I feel about suicide hotlines and the random placement of suggesting people call them
People are not going to therapy if they're dead, and those hotlines are for helping people find local resources
I've encountered this in the Pittsburgh area with AHN. Trying to get a provider results in printed lists of outdated numbers, practices not accepting patients, etc.
Frankly I think we need to start breaking laws. A startup needs to offer straight up good care and fuck the web of infinite regulations which support America's for profit health failure.
Doctors can lose their licenses pretty easily so it's going to have to be a straight tech play. Offer as-good-as-possible care entirely outside of the medical profession. AIs are getting good enough that despite the obvious errors they make they are still better than the nothing-burger of care we get here.
I don't see how the law is the problem here. The problem sounds like insurance companies that dodge their duties. We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down - which they are partly responsible for due to throwing up so many barriers for them to actually pay for anything.
Steelmanning the OP (which I’m not sure I agree with), it’s possible they are alluding to regulatory capture, implying the laws are crafted to benefit for-profit companies first and patients second.
However, I’m not sure going in the direction of less regulation would help. It’s like saying “The for-profit healthcare companies have too much power, so let’s just give them more power.”
It's not so much a capture as a hodgepodge. There are a great many interests, and even in a good faith environment it would be a challenge to get everything right.
Add to that the fact that it's not a good faith environment. There are many forces, not even connected to the industry, who fight to lower prices at any cost. Even if it means finding out too late that you're not actually buying anything at all.
The laws and regulatory environment are "the best compromise people were able to get at the time" rather than any kind of cogent plan.
> We need them to be held accountable. We likely also need the general cost of doing business in healthcare to go down
These two statements are at odds with each other.
> responsible for due to throwing up so many barriers
To me, it's obviously lack of competition that's the problem, you don't want to punish crappy providers, you want to subsidize new ones so the market is flooded with options.
Which can be done right after we solve the monopolization problem in health care service providers, medical equipment providers, and "pharmacy benefit managers."
It's not like starting up a food truck. A health care operation is vast, and no existing providers are going to break the law and risk losing their licences.
You would need to create an entire parallel network. It would cost tens of billions, possibly hundreds.
> offer straight up good care and fuck the web of infinite regulations which support America's for profit health failur
they'd get immediately sued out of existence by the large vested interests
> Frankly I think we need to start breaking laws.
Who's stopping you? I don't pay my medical bills by default, unless it's my dentist or my primary care provider.
Everyone else can go to hell until the system breaks.
Most large systems can absorb a certain level of free-loaders and remain stable by shifting that burden to other people. What you’re advocating is a collective action problem and will just make matters worse for everyone else. Unless you have a way to create a critical mass of similar behavior, it’s tantamount to a selfish action that benefits you to the expense of others.
Unless the system gets worse, there will never be enough willpower to change it for the better.
As it stands, the system is already awful for the majority of people, with outcomes like this that become commonplace.
> it’s tantamount to a selfish action that benefits you to the expense of others.
Not unlike having great insurance paid for by your company, while others (just at the cutoff of govt subsidy for the plan) suffer the most and have to pay thousands of dollars for routine care.
It's the ultimate "fuck you got mine", only applied to something that most people can't live without. And while "fuck you got mine" is okay in the context of luxury items, it is not in the case of medicine/housing/food.
So maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment. But again, keeping the status quo is just letting the wound fester at this point.
>maintaining the status quo is just as, if not more, selfish than protesting the system with a non-payment.
The point was that your approach won’t change the status quo, just makes it a little more expensive for everyone else.
It's easy to blame the insurance companies, but doing so misses the more important detail: There aren't enough providers. No amount of complaining or regulating the insurance companies is going to change this.
They should still be blamed by misrepresenting the lack of supply in their network. But certainly, medical professions probably need reform to alleviate supply, then of course you get into knock-on effects ranging from malpractice suits/tort reform to medical school tuitions.
On the subject of mental health, it almost feels like we need a Manhattan Project of sorts to deal with the mounting crisis.