It’s so expensive, I can’t afford cutting out the middleman so I got another middleman, my employer. I’m pretty sure they hired their own middleman to get me to the middleman that gets me to the provider. Of course, all the middlemen need to get a cut. It would be un-American not to.
Imagine if National Defence had the same model?
“You have Russian paratroopers in your yard?
Have you paid your premiums?
Good, now let’s check your coverage.
Oh, it appears you didn’t take the airlanding attack rider.
Sorry, you will have to speak up: I can’t hear you over the collapsing rubble”
For Profit Medical Insurance Companies ARE Death Panels.
Their job isn’t to manage the money you give them & provide it when you need it, it’s to keep your money, as their profit, despite your pain, suffering & death. It’s just sanctioned torture & theft.
I worked in the managed care industry for decades & completely agree, that the original intent which could have actually managed care for the better is now extinct w/for profit model. Even not for profit plans aren’t immune, they play in the same sandbox.
A really important point, I think, is the publicly traded plans only look at quarterly results. If aggressive care of your diabetes saves you from kidney transplant, they figure you’ll be on a different plan by then so doesn’t save them $. No incentive to invest in long term health outcomes.
This isn't true. I have Medicare but I buy private insurance too because it will cover my treatment. Other health insurance policies wouldn't. I have to submit it to Medicare have it refused then my private insurance covers it. I get IV infusion every 2 wks.$20.000.00 every treatment.
It's not a Medicare supplemental. I pay for full private insurance.
I have autoimmune neuro degenerative disease. It's destroying my autonomic nervous system and sensory nerves. I love my current private insurance because they actually care about helping me. I went years after diagnosis w/refusals
Had a friend once who told me why he opted to never buy insurance: "It's like a bet," he said. "I'd be putting money down every month, and the only way I'd ever get anything back on it is if something bad happened to me. I'd be continually betting against myself."
Something that's 𝘯𝘦𝘷𝘦𝘳 spoken about is the temp. agency/medical billing complex. In the past I have gone through a few temp agencies, and they were 𝘢𝘭𝘸𝘢𝘺𝘴 looking to fill data entry, medical coding, and file clerk positions. It may be different today, with so much being done online from home, but…
…in the '90s, at least, I figured that unemployment was kept low, as well as wages, but certainly not middlemen profits, by this industry alone! (As they were 'transitioning' they also employed very many IT guys, young and old, as the old languages of the systems weren't being taught anymore!)
After maxing out my OOP ($9450) last year with 2 joint replacements, and with our calendar year beginning Oct 1, and I am now afraid to look on the claims page and see how much we owe on visits since Oct 1.
Literally afraid to look
Its time for those who pay the taxes to get some relief in life. Of course this would Trump’s country club buddies would need to pay more taxes, Trump to actually pay taxes!
Medicare for all and
NOT medicare advantage (junk run by coverage deigning insurance firms)
While I believe for-profit insurance is a terrible thing, it’s not supposed to do any of the things listed in the screenshot. Its purpose is to turn individual risk into shares risk. Everyone pays in relatively little so if they’re unlucky, they can afford treatment they never could on their own.
Not necessarily true. In-network providers are required to sign a contract with insurance companies. The contract includes $$ amounts that the providers are allowed to charge their patients. Those amounts are *much* less and keep patients costs down
Depends on which insurance company, whether they are not for profit, whether they have shareholders, their medical policies when reviewing claims, etc…
There is a lot of insurance fraud & abuse carried out by facilities, providers, business owners which increases members’ costs.
As long as it costs 250-300 thousand dollars to get a medical degree, systems like this are going to exist. We want the best trained physicians, RN's, allied health and the fact is, those loans are repaid, partially with insurance money. I hate it. I profit from it. It needs to change.
In the future let's vote for people who'll eliminate all this & put that money back in our pockets where it belongs. The people who run this money-siphoning parasitic industry won't go hungry -- they can easily get jobs as migrant workers instead.
Ha, right? I felt like I was having a stroke here. Like, of COURSE you can say there are wildly unjust things about the way all this plays out. But calling insurance a “middleman” is like not even wrong lol. It’s just totally missing the point of things.
Yes, they outsource to other middlemen, like Evicore! It’s an entire industry built on bureaucracy, which is bad enough in itself, except that it does even more by causing actual harm to people.
This isn't true.
The main reason insurance programs exist is to pool risks. Most people, and businesses, are not big enough to self-insure.
The problem with health insurance is that without regulation, people go bankrupt when hit with extreme uncovered expenses.
I think that is where non-profit insurance organizations can be a model. We can have pooled risk without having the organization managing the pool focused on returning a profit for shareholders who don't have anything to do with providing care, administering the pool/benefits.
BC/BS were created, primarily for blue collar workers, to fill gaps in the healthcare system. It covers over 100 million Americans but may not be affordable for all, hence the ACA.
Like all private plans, benefits are controlled.
We still have large gaps, a lot of waste, and a lot of fraud.
Non-profit insurance organizations wouldn't survive. Too much capital is required to back up insurers obligations, including fluctuations, and profits are required to cover the cost of this capital. 1/3
Typically about 85% of health insurance premiums are needed to cover claim costs. It seems to me that an AI program that rejected 85% of claims either was too restrictive or failed in its purpose. 2/3
Unlike social insurance programs, non-profits don't have access to taxes to cover adverse fluctuations.
Social insurance programs have problems controlling the total costs, without higher taxes.
More competition, from many smaller companies, would help.
There was a time in the long ago times when health insurance wasn’t a thing. People paid cash or bartered with their doctor. My grandmother paid with eggs, canned goods (as in food she put up in jars), & pork products like bacon, sausage, scrapple. Not suggesting we do this but must be a better way.
I often said insurance is a complete scam, playing the “what If” game to scare people into paying for things that haven’t even happened, “But it might, you just never know.”
I’ve been screaming this into the void for years. They exist only to extract money from patients. They offer zero value and do not improve the quality of care. They are a scam.
In fact if you wanted to design a medical system guaranteed to provide substandard service, you’d put a for-profit entity between patient and doctor. Horrible.
I don't know for sure but with 22billion of profit in 2023 one might think they could have paid for all the claims and still made enough. How much is enough.
Well, we’re not going to go single payer now, are we? Maybe when the dust settles. What we have to fight for now are the protections of the ACA. And we have to fight.
America is a Bizarro World nation where politicians are deathly afraid of taking Medicare away from seniors, and equally afraid of giving it to everyone else.
Insurance companies are run by greedy scumbags who profit on our tragedies, but Congress empowers them. They love insurance companies for the personal benefits they receive. It's a mutually beneficial relationship. Ironic that taxpayers provide Congress with far better insurance than we have.
Gunning down a CEO is a horrible act, but it also achieves nothing. Another greedy mother fucker will just fill that spot. Congress is the problem. These are the people who don't even allow drug price negotiations and prevent a public option. It could not be any more obvious who they work for.
But voters are complete fools. They're obsessed with nonsense like who's in the bathroom stall next to them, and in the meantime their elected officials are robbing the store right in front of their eyes.
Wake up people, a seat in Congress is like winning the lottery and you pay for the prize.
Here’s the thing though…as long as all of healthcare is a business people will profit off it. Health plans actually do a decent job of rooting out fraud and abuse by providers, medical device & suppliers. Not defending payers just saying without a system to find abuse the greed will explode.
Yup Going through the current "open enrollment" with no clarity and outright inaccuracies with a really short appeal>resolution time. ACA definitely beats the before times, but wtf?
And we can thank Nixon for setting this all in motion. A massive slide downhill to keep the wealth at the top and keep the middle and lower income people begging for affordable health care while the CEO’s make 27 million a year. It’s shameful.
Health insurance may be more expensive than need be because of CEO salaries, but medical care costs are beyond most individuals for entirely different reasons.
Although the CEOs pay is a mere fraction of the companies profits, it’s indicative of the larger issue. Health insurers made well over 70 BILLION in profits last year! It’s criminal that we have a “for profit” health care system. Greed begets more greed. Compassion and caring are lost.
All that profit is not from premium benefits withheld from patients however. Premiums are invested and a booming investment market fuels those profit numbers. Insurance has always been an "investment" racket first and a social safety net second.
And exist as a role model for the next ”governing officials”- no governing, no better services for the people, no sense in decision making or policies…
I love reading the claims when you get a surgery or go to hospital with insurance . You get these crazy prices they charge you . Then you get the negotiated cost . All such a scam on every level .
I don't agree. Insurers (private and public) have the ability to negotiate rates and costs, resulting in considerable savings to consumers whose ability to negotiate at point of sale is nil.
The government can do that too, eradicating a corporate entity sucking profit out of the system between me & the healthcare I need. We should have a healthcare system where all the money goes toward the care, not lining CEO pockets. Creating shareholder value out of people's lives is fucking gross.
The federal government (Medicare and VA) and some states do a good job of health insurance without profit making. But the GOP hates these programs and also hates Obamacare, which regulates the private market some. We'll likely see more of the UHC model with GOP rule.
How about the fear that if you need assisted living you will lose everything you own to pay for the cost of $5000 a month or more and your children will lose their inheritance?
The losing candidate for President proposed legislation to address this huge gap in coverage. About 1/3 of Medicaid spending covers long term care for people who have spent their savings. If Medicaid cuts are made by the new admin, expect long term care planning to get harder.
Part of a health insurance contract is coverage for "medically necessary" care. The company must have guidelines and a procedure to appeal denials. Often denied are procedures where a less intrusive or expensive alternative exists. It looks like UHCs denial rate was much higher than average.
You can see the savings if you compare what your insurer pays to a provider for a procedure you've had, to what the hospital charges for the procedure. People who lack insurance (or have insurance but lack the coverage) must pay that charge, although they can negotiate it down they're assertive.
Wonderful. Too bad the insurer is too busy squeezing the consumer (AND THE PROVIDER) to pass the savings on to them. It's kind of like if a tree falls in the woods....you know?
While I totally understand this—especially in 2024 when we are very many years after the time when insurance was injected into the system—many of us had grandparents or great-grandparents that were in a system where everybody paid the doctor directly.
My grandfather was in a wreck that hurt his knee, before there was insurance. He had to leave college and get a job to pay for medical expense from it. Many didn't go to dr or hospitals because they could not afford it.
Cash for services was still a winner for most, even poorer folks. The docs etc. would work out a payment plan while those that could paid up front. It was not horrible. Though I will agree the “can we afford this?” question would come into play. Just my recollection
Or, we normalize Healthcare being something affordable instead of a profit system. Like there should be a cap on costs for everything and the companies should be forced to innovate if they want more money. Not cut corners.
insurance is risk pooling and exists to give predictability to the party who is at risk. in this case, it's the employer, since employers _used_ to cover 100% of employee medical costs, and pool insurance existed to spread the risk over multiple employers
the problem is that the insurance pool is being run _for profit_. insurance pools (indeed, insurance of any sort at all) should never be run for profit. this is especially true when the insurance is purchased by one party to cover claims made against it by a different party
we used to require insurance providers to be run as mutual benefit societies, with the insurance provider being jointly owned by the policy providers. any unused premium was retained against future claims or refunded, not paid out to unrelated investors
one of the reasons older life insurance policies would sometimes pay out a windfall is a policyholder would die, but after paying the death benefit there was still a surplus in the fund that exceeded the retention limit, and would thus have be paid out pro rata to the other policyholders
of course this never happens now, because we now generally allow such surpluses to inure entirely to the investors in the insurance company, instead of to the policyholders
this is why there is so much discussion of "single payer health care". with a single payer, that single payer bears all of the actuarial risk of providing health care, which means that health care risk is shared by _everyone_ regardless of wealth, class or other circumstances
single payer is, effectively, health insurance with a single insurance company from which everyone must purchase a policy. the financial stability of the policy is backed by public funds.
the next step is to have universal health care, which is the same thing but with no premium
I think most people overrate how much insurance companies make. BCBS makes 3-6% in profit. So even if you squeezed the profit out of the system, it hardly makes a dent in overall cost. Admin cost is the larger burden that single payer or similar may fix, RAND estimated ~18% —>6% of health spending.
it actually arose during WW2 when there were strict salary caps, and employers offered health insurance as a nonsalary benefit. for administrative reasons, they contracted management of these plans to insurance companies to administer, and then developed risk pooling mechanisms to hedge risk
I suppose it is possible that early in the 20th century costs just never were bad enough for the system to have basically experienced the kind of cost collapse that we have? But I have zero idea or expertise to know.
It sure would have been great if we'd gone directly to single-payer from that system, but our odd federalist system just left all these localities across the country to fend for themselves and "people" started looking for ways to pool costs.
Obviously it was also a way to scrape profits out.
But it isn't like this system simply came about from a bunch of rent-seekers. Everybody needed a way to socialize the costs, and having more people being able to access care presumably was seen as a net social good, even if the system was private and not public.
You can actually trace it back to the explosion of medical devices in the 1980’s. In the 1970’s there wasn’t much technology to drive revenue - we had mostly primary care, antibiotics and the main basic surgeries. Now with things like CAR-T the costs are millions to treat one patient. Its recent.
For profit, publicly traded companies are the problem.
But there was never a law requiring insurance companies to be non-profits. It’s just that the early companies were non-profits trying to be a public good. And then capitalism did what it always does.
Which is why they’re (sadly) sooting the executives. It’s a train wreck. You would think private companies would want to be free of the cost of it! In which case they should advocate for public insurance. But no …. capitalism. My health is just another place in market place.
Have to agree. By having to pay insurance premiums just so we can claim “we have insurance” at all is simply paying admission into the “gate.” Once inside, there is no guarantee that what’s inside the “gate” is beneficial to the premium payor or the payor can afford to pay for the actual healthcare.
The notion that this country even has such a thing as “healthcare” was soundly rejected when it was decided the industry would be privatized. Yeah, I’m a socialist.
If healthcare in the USA was about managing risk for the benefit of patients and providing quality care, it would be a single payer system with a single group of beneficiaries in order for the maximum distribution of costs.
Exactly. Would love to hear one good reason why the U.S. isn’t doing this. My only point about Medicare is that we’ve had the foundation for single payer in place for DECADES! It works and from what I understand, it’s great.
The only reason it exists is because of their extreme wealth, used to buy support in both parties, and spread misinformation about US health insurance compared to 'socialist health care.' Why is it hard to see that 'for profit health insurance' guarantees 'profit' over quality care?
that is why Supply side economics doesn't do anything but make them richer. They can make months worth of product, and lose nothing if it doesn't sell right away
Let’s not forget the doctors, pharma, medical device companies…doctors actually call people “lucrative patients”…they aren’t altruistic 😂🙄. EVERYONE in our healthcare system is making billions on the backs of the sick and vulnerable!
THIS is one of the basis of why Educated Youth of ALL colors and creeds must consider LEAVING THIS NATION!! Go where the system will help YOU, not drain you. Go 🇪🇺 !!!
The demise of the American Healthcare system was the third-party payer system and Tramp wants to give the insurance companies MORE power. To quote a 60s slogan, "Power to the People."
Perhaps this is the issue that could bring the country together. A national movement for universal healthcare born out of the rage against craven profiteering on the bodies of the sick and dying.
To the barricades!
Ah, but you must understand; it adds one more layer of predation to the US health predation system. One cannot get to the most expensive healthcare in the world without it.
I have to disagree. The purpose of heath insurance and ins more generally is to pool risk. By doing that, it enables someone with a very expensive medical condition to be covered bc most others in the pool won’t need such an expensive treatment. Doesn’t mean they haven’t abused it to our detriment.
In a single payer system, someone with a very expensive medical condition would be covered without other people with a very expensive medical condition dying while waiting for an appeal decision because of an entity sucking profit out of the system between them and the Healthcare they need.
In a single payer system you will have the likes of Marjorie Taylor Greene and her ilk deciding how much to fund that system on a yearly basis from tax revenues. It's not as perfect a solution as you promise given their propensity to not agree to budgeting the government.
You're really bad about putting words into people's mouths. I never said it was a perfect solution or promised anything. I'm done with this pointless exchange.
You are not wrong. Just want to add by pooling risk it inflates costs associated with providing insurance to many. I think the bloated costs to support balky system is greater evil than trying to sculpt a single entity to operate more efficiently (I understand this is probably highly aspirational)
“No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means” - Aneurin Bevan, founder of the National Health Service (NHS).
They can work in the hospitals and see that people are directed to the right doctors and care workers or train as nurses, mortuary assistants, security etc. etc.
If everyone paid a set amount monthly it could pay for a service for all. This is not communism it's unselfishness and regard for all.
Yeah, the Democrats moved heaven and earth twice to defeat a candidate that supported universal healthcare in 2016, and 2020, even admitting that they’d rather lose to Trump than let Sanders win. They got their wish, but four years later than they anticipated this November.
Depends on the country & system.
In Australia we have medicare as a basic start, covers saving your life.
If you want you can take out private, ranges from splitting the bill certain % for anything Medicare doesn't cover to full on cover for elective surgeries.
Then why does the UK, with cradle to grave NHS, still have a market for private insurance? This is not an argument to maintain our current system but those who wish to do away with all private insurance in the US need to answer this question.
Optional private insurance is actually great as a complement to a strong public system. For 70 euros/month (deductibles don't exist here), it can be a convenient way to avoid long wait times. The problem is the dystopian, deregulated, dehumanized US model for which there is no public alternative.
This combined with the AMA which seeks to limit the number of doctors not to ensure better care but to limit competition to artificially inflate income.
What if they did ? I could care less what "the right" screams.
Our failure this cycle was not getting enough of our people to the polls. Part of that problem is the flaccid response our Dem leaders had to the fascist threat, and to NOT prosecute those criminals in a timely fashion.
It's easier if we lose the flaccid part. We need to realize it's past time to fight fire with fire. I don't mean lies, and propaganda, but education, clear and beneficial policies, and the courage of our convictions. We should have crushed MAGA this last election.
Yeah you are right that playing to the middle has proved completely ineffective. But I don't think that is because of policy. The right has culture war and corporate tax cuts as a platform and somehow how have been able to label the left, wokeness, and illegal immigrants as the country's problem.
No status quo sucks beyond belief. I just think of it as what is achievable under the next democratic administration. Probably a federal sponsored solution like expanding Medicare to all with affordable premiums as an alternative to private insurance.
I am ok with that but one must accept that Medicare taxes on income will rise as a result. And, the budget fights over funding will include everyone's health care costs. If we get a healthier society fine, but it's foolish to believe anything and everything will be "free."
Private insurance has potential inequities (as not everyone can afford it) and inefficiencies due to profit motives. Some argue that the existence of a robust public healthcare system can achieve better health outcomes for the broader population and reduce the societal cost of poor health.
yeah no shit it ain't even insurance if everyone needs it, insurance is supposed to be where everyone pays a little so the unfortunate FEW can be compensated, ya don't see people whipping out insurance cards at the grocery store
oh crap now some Rep gonna see this and go 'hey, there's an idea'
There is NO logical reason for private health insurance companies to exist — they’ve been scamming us for decades! Most people don’t realize that we already have the foundation for national healthcare in place — it’s called Medicare and it’s excellent!
Which is why I believe it makes sense to expand that model to all! It makes sense. Health care shouldn't be tied to employment. Employers hate it as well!
Comments
Of course, universal healthcare does that, for everyone.
That's it. Biggest scam in the history of scams.
Brought to you by...Republicans.
“You have Russian paratroopers in your yard?
Have you paid your premiums?
Good, now let’s check your coverage.
Oh, it appears you didn’t take the airlanding attack rider.
Sorry, you will have to speak up: I can’t hear you over the collapsing rubble”
Their job isn’t to manage the money you give them & provide it when you need it, it’s to keep your money, as their profit, despite your pain, suffering & death. It’s just sanctioned torture & theft.
Fake doctors without Empathy.
I’ve typed numerous times:
USA HASN’T A HEALTHCARE CRISIS
IT HAS A HEALTH
INSURANCE CRISIS
I have autoimmune neuro degenerative disease. It's destroying my autonomic nervous system and sensory nerves. I love my current private insurance because they actually care about helping me. I went years after diagnosis w/refusals
No health care should be for profit and protection should be there as a safety net for all.
Pretty much sums up everything these days. 😞
Literally afraid to look
I’ll happily insure your Honda Civic. Or your house. If a claim goes sideways or is denied I’ll explain why and make sure there’s no gaps if I can.
But I shouldn’t be asked to insure a human body. It’s a form of playing God nobody has the right to do.
Its time for those who pay the taxes to get some relief in life. Of course this would Trump’s country club buddies would need to pay more taxes, Trump to actually pay taxes!
Medicare for all and
NOT medicare advantage (junk run by coverage deigning insurance firms)
There is a lot of insurance fraud & abuse carried out by facilities, providers, business owners which increases members’ costs.
Socialist healthcare is the only kind of healthcare that works.
The main reason insurance programs exist is to pool risks. Most people, and businesses, are not big enough to self-insure.
The problem with health insurance is that without regulation, people go bankrupt when hit with extreme uncovered expenses.
It could be worse, if there were no insurers at all.
Like all private plans, benefits are controlled.
We still have large gaps, a lot of waste, and a lot of fraud.
Social insurance programs have problems controlling the total costs, without higher taxes.
More competition, from many smaller companies, would help.
The problem in the US is that you have nothing as a baseline to compare them to, and so they become a manager of your health, printing their own money
#Medicare4All
Wake up people, a seat in Congress is like winning the lottery and you pay for the prize.
Paid to not be robbed.
While being robbed.
If they could afford one. Not a great system.
sadly, it no longer works this way
the next step is to have universal health care, which is the same thing but with no premium
The profit issue is ~1/4th the size of the excess burden from operating the system this way.
Obviously it was also a way to scrape profits out.
I have no idea, but I would assume the answer of "right away" is probably not far off the mark. It is insurance after all!
But there was never a law requiring insurance companies to be non-profits. It’s just that the early companies were non-profits trying to be a public good. And then capitalism did what it always does.
https://www.snopes.com/fact-check/healthcare-profit-1973-hmo-act/
#ForProfitSchools
#ForProfitPostalService
They Want It All.
You shouldn’t see this in healthcare or any other industry crucial for society (or at all imho)
To the barricades!
Giant fuckung money grab
Full. Stop.
sucking leeches. 🖕🏻🖕🏻
If everyone paid a set amount monthly it could pay for a service for all. This is not communism it's unselfishness and regard for all.
In Australia we have medicare as a basic start, covers saving your life.
If you want you can take out private, ranges from splitting the bill certain % for anything Medicare doesn't cover to full on cover for elective surgeries.
It offends their world view to consider there might be a societal problem that the government can address more effectively than the free market.
Our failure this cycle was not getting enough of our people to the polls. Part of that problem is the flaccid response our Dem leaders had to the fascist threat, and to NOT prosecute those criminals in a timely fashion.
We were defeated by weakness.
The programs will reach solvency in perpetuity, overnight.
oh crap now some Rep gonna see this and go 'hey, there's an idea'