# The ethics of health insurance **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [December 5, 2024, 3:45am UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177 "2024-12-05T03:45:03Z")\ **Posts on this page:** 1\ **Showing post:** 227
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [December 12, 2024, 11:42pm UTC](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177/227 "2024-12-12T23:42:00Z")
> [@bump](#): > > Lots of people don’t really understand how this works though; they assume that since their doctor prescribed it, that _it is the right and proper treatment_ for their issue, and that it’s the insurance company being dickish if they deny it. That’s not to say that insurance companies don’t deny normal stuff all the time, but it’s not a one-way street either. Doctors can and do prescribe stuff that’s outside of the usual and customary treatments for things all the time, and it’s ultimately on them to justify that to the insurance companies. This sounds like the fiction promulgated by the health insurance industry that they are your “partners” in health care, and I vehemently disagree with this characterization. They are no such thing. They’re basically useless parasites that contribute **negative** value to the health care process by intruding into the doctor-patient relationship in order to limit treatments, deny claims, and otherwise control costs. This is a foundational problem and fatal flaw with insurance as a model for funding health care. Your doctor is the one closest to your case, knows you and your medical history and, as long as they’re ethical and competent, is the person looking after your best interests, not the insurance bureaucrat. Insurance bureaucrats are not your friend; more often than not, they’re your enemy and their incentives tend to run counter to your best interests. The following is a partial extract from another post I made on this subject: Every health care system has to control costs. UHC systems control costs through overall policy and primarily through fee schedules. Commercial health insurers primarily control costs by micromanaging each individual case, which necessarily means that they are always meddling in the doctor-patient relationship. In UHC, the physician and their patient are the final arbiters of appropriate treatment protocols. With private insurance, the insurance company bureaucrats are the final arbiters, approving or denying treatment as they see fit, often for mercenary reasons and to the detriment of the patient, and potentially costing the patient their life or degrading their quality of life. The renowned late health care economist Ewe Reinhardt made this point many times, and is quoted **[in this paper](https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/Downloads/CMS1191473dl.pdf)** [PDF] from which I provide this excerpt: > It is Reinhardt’s assertion that the absence in the United States of an overall program of budgetary control over medical expenditures, as is characteristic of the prominent European systems, results in unparalleled micro-management at the clinical level to achieve cost control unattainable on a larger scale. He writes that “…if the bureaucrats cannot somehow impose upon the healers an overall budget constraint _ex ante_, then they will sooner or later be driven to control their outlays on an ongoing basis, by monitoring each and every transaction for which they pay – that is, by second guessing both the providers’ clinical and pricing decisions” (Reinhardt, 1988). This appropriation of the clinical dimension of autonomy would be regarded as intolerable by physicians in other medical care systems. He suggests that “European and Canadian physicians would be appalled at the numerous intrusions into clinical decisions now routinely made by these external monitors in the United States. They probably would rise up in arms over that loss in clinical autonomy” (Reinhardt, 1988). > [@bump](#): > > I’d bet that some similarly large proportion of treatments/prescriptions are just not on the table in single-payer systems, because they’re not in the “approved treatments” list. Not quite the same as denied, but the same reasons. This is wrong, too. The basic principle in the single-payer systems in Canada is that, with very few exceptions, all procedures generally provided by doctors and hospitals are covered if the doctor deems them to be medically necessary. It cannot be otherwise, because the foundational principle is that no one should ever be denied medically necessary health care. --- _[View the full topic](https://boards.straightdope.com/t/the-ethics-of-health-insurance/1011177)._