Since the story isn’t entirely clear to me either, does this summarize it accurately?
You had a medical expense. You sought to get a discount on the bill. You were asked to provide rather detailed evidence of your income and assets in order to establish need and qualify for the discount.
You were – at least briefly – tempted to do something that would amount to hiding assets in order to increase the likelihood of your discount request being granted.
Because … American for-profit health care – still responsible for roughly half of all personal bankruptcies in the US.
The US has that, too. Medicare insurance becomes available when one turns 65, and for the disabled. The plans are administered by health insurance companies - the same ones that run the pre-65 business, but paid for by the government. Medicare is a major line of business for the insurance companies, and every open enrollment season (usually each fall, which is generally the only time you can switch plans) health insurance companies are vying for the business. But, if you are under 65, you either get insurance thru your employer who pays a good part of the cost, or from one of the state-run exchanges where you pay all of the cost (minus subsidies, if you qualify), or you just go without.
That’s right to an extent. I surely wasn’t inclined because I knew it would be illegal, easily argued as unethical and also for me stupid as well. The liabilities would outweigh the benefits for me.
No. Blue Cross was founded to give hospitals a steady income.
They ran on a feast or famine basis; they needed beds in case of an epidemic, but these were empty much of the time. By selling health insurance, the hospitals could get money even with empty beds.
This is a good exapmle of how insurance works. An entity wants to increase stability and limit risk, and one way to do that is to get many people to contribute a little, creating a risk pool. Sure, you’ll have some people needing to take from the pool as they are entitled, but the acutaries can dermine how much needs to be charged each month to cover those costs, plus how much it costs to stay in business, plus a “little” for profit. The health plan wants to manage outgoing costs otherwise the risk pool will dry up and everyone loses. That’s why they dont want to pay for cosmetic surgery of for expensive drugs people saw on TV they dont need. Of course sometimes they can be too restrictive. A health insurance company’s best customer is one they never hear from but pays their premium every month.
So, you can see how a large risk pool helps limit risk and increase stability, which is why the biggest risk pool would be the best (Universal Health Care).
Do we all, in fact, know that? Exactly how do you define “fraud”, and how much is “a lot.” There is more fraud in M-care/-aid than health care billing in general? Every aspect of health care billing strikes me as a complete racket, so I’d be surprised if all the various players weren’t trying to scam every way they could. I honestly don’t know, and am asking for clarification.
(I ask because in a system I have some experience in - Social Security - I often hear people say there is a lot of fraud. IMO&E, there really is tremendously little SS fraud - at least how I define fraud. Such as fake SSNs, collecting a dead relative’s benefits… Now, if you are talking about people trying to game the system in their favor, yeah, that happens all the time. But I do not consider that to be “fraud.”)
In related news, Anthem has decided to backtrack on its terribly timed announcement that they’d no longer pay the full cost of anesthesia. I assume the CEO was visited by three ghosts overnight.
And when there is fraud in Medicare/Medicaid, it’s the government that roots it out, not the companies.
I’m still not sure what it is that companies like UnitedHealthcare add to the process. So far as I can tell, at best, all they are is a passive conduit through which money flows, except that they siphon off some of the money in exchange for doing nothing.
Doing nothing? You think claims can deny themselves?
Serously, though, all insurance companies are tempted to think of the premiums we all pay is their money, and not our money being held by them for our claims. While there are legitimate reasons to deny claims, there is also a strong temptation to move the needle a bit so more claims can be denied. A well priced and underwritten policy can earn a fair profit for an insurer, but when they are trying to reduce the price of the policy to gain market share, they’re going to feel extra pressure to make the money in claims. A fundamental principle of insurance is that the claims department is supposed to be free of any financial pressures. They should simply pay valid claims regardless of the cost to the company. Profit is built in on the front end. But, as I said, they sometimes screw that up intentionally, and sometimes simply misjudge what the claims experience is going to be.
Where I live we have universal free state-funded healthcare and I’m ambivalent about it.
It’s good to have the safety net of the national health system for major health crisis and it’s an important piece of a social welfare system I believe in. On the other hand it’s horribly slow, strained, abused, inneficient and expensive budget-wise and everyone I know ends up paying twice, through taxes and also still very expensive private health insurance.
I believe there are other models that could and should help more people for cheaper than free state-provided universal healthcare.
I haven’t seen anyone saying that at all. Most of the people reacting positively to this event have been reacting out of pure schadenfreude - this guy hurt a lot of people, and they’re happy that he got some form of comeuppance. I’ve seen some sentiments along the line of, “maybe this will scare other CEOs into acting more ethically,” but nobody seems to be under the impression that this was just one “bad apple” CEO, and things will get better now that he’s going to be replaced. Pretty overwhelmingly, most people get that its the whole system that’s cooked, and taking this one cog out isn’t going to fix anything by itself.
The people that think that the people in charge of these companies are conflicted as to whether they serve the customers or the stockholders/owners are totally mistaken. They serve the stockholders, period, or they are out on their padded asses.
No health care system is perfect. What’s clear, however, is that the free-market oriented one in the US is overall the worst in terms of being overwhelmingly the most expensive and the most unequal, the implicit assumption is that the value of a human life is determined by that person’s bank account balance. That’s the nature of the immorality, and the fundamental problem stems from the fact that the essential interests of the insurance business to maximize profits are fundamentally at odds with the interests of a civilized society to provide unconditional health care for its citizens. For that reason, the private insurance industry has absolutely no business in human health care, let alone being the sole gatekeeper for access to it.
I don’t know where you live but if you say the health care system there is slow and inefficient that’s a funding and/or management issue, not an intrinsic issue like with private health insurance, where the problem is systemic – it can never be solved because the goal of private insurance is always going to be to minimize payouts and maximize profits.
There is no way that it’s “expensive budget-wise” because no health care system on earth comes even close to the per-capita cost of US health care. If you have to have “very expensive private health insurance” that’s a failure of that particular system. I’m in Canada and I have no private health insurance, and I’m covered for everything, and there’s no extra cost. Extra-billing is explicitly prohibited.
To those who say the US private insurance system may be incredibly expensive but at least it delivers the best care, no it doesn’t. It does, in many cases, certainly deliver a lot more testing, because there’s money to be made there, but overall outcomes are no better than in other first-world countries that have universal health care. The average infant mortality rate in the US is 5.36 per 1000 births; in Canada it’s 4.43, and in the UK it’s even lower. According to Statista, the average male life expectancy in the US is currently 73; in Canada it’s 80. For females it’s 79 vs 84. The difference is staggering, especially the 7 year difference for males. Why is this the case in the richest country in the world?
Once upon a time, congress actually considered a universal health bill. The AMA fought it tooth and nail and defeated it. Then Blue Cross came along and really provided a much needed service, followed shortly by Blue Shield. They were non-profit. However they are now evil and have prevented government health. I think more that half the doctors would welcome it.
No, they thought they would make money by providing people with less healthcare for more money.
In 1971, Edgar Kaiser, the son of the founder of Kaiser Permanente, one of the first big HMOs, went to see John Ehrlichman, a top aide to President Nixon, to lobby the Nixon White House to pass legislation that would expand the market for health maintenance organizations (HMOs). Ehrlichman reported this conversation to Nixon on February 17, 1971. The discussion, which was taped, went like this:
Ehrlichman: I had Edgar Kaiser come in…talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because the less care they give them, the more money they make.
President Nixon: Fine.
The next day, Nixon publicly announced he would be pushing legislation that would provide Americans “the finest health care in the world.”