And then there’s United Health Care, which bought into the actual hospitals and created a perfect closed loop of money production.
Using the insurance companies as protection against over-treatment is a bad idea precisely because it’s impossible to tell if they’re doing it for the good of the patient or to maximize profits. Nevertheless… that is in fact how it sometimes works out.
I ran across this thread today, which unfortunately you’ll need an X account to access:
In summary, though: some reports were released in the 80s of a new breast cancer treatment which subjected the patient to massive radiation/chemo doses but combined that with a bone marrow transplant to compensate.
Word began to spread and people and the press started demanding treatment, even though it was highly experimental. The insurance companies pushed back but patients sued and won. Eventually, several states mandated that insurers cover the treatment.
But in the late 90s it all fell apart. Several studies showed that the treatment was ineffective and actually harmful. The original study was a sham.
The patients, the doctors, the press, the legal system, and the government had all applied pressure based on a totally fraudulent treatment, with the insurance companies taking the blame.
In this case, the insurance companies were in the right. But as I said before, how could one know in advance whether they are looking out for the patient or their own financials? You can’t.
I don’t think there’s an answer. Other systems work differently but none really solve the fundamental problem. It looks to me that the primary way Canada rations care is by waiting lists. I’m not sure what they’d do in a situation like this.
And just to add a little on this point: it’s absolutely true that insurance is a significant part of high costs; it’s just nothing so simple as “record profits”. The issue is systemic and has to do with (perverse) incentives. There is no feedback loop that tries to maximize human health across the population. Instead, doctors have an incentive to overprescribe, insurance companies have an incentive to deny coverage whether or not it is reasonable, pharmaceutical companies have an incentive to push the public into demanding their latest product, doctors guilds have an incentive to lower supply and thus raise salaries, and so on. The system has a whole just doesn’t have many safeguards against gaming it.
That blog is uninformed bullshit.
The size of the profits health insurers are making is totally irrelevant. The problem is that they are the core of a corrupt mercenary health care system that happily condones gross overcharging by providers while denying critically necessary medical treatment to others. It’s all fine as long as they make money, and can use uncontrolled escalating medical costs to justify even higher premiums.
Everything that’s ethically, morally, and functionally wrong with the entire US health care system can ultimately be traced back to the root cause: private insurance as the primary funding mechanism.
You’ve missed the point completely.
When people blame insurance companies making “record profits”, they are wrong. The insurance companies are not particularly profitable.
That in no way argues that the insurance system we have is a good one. It just means that the problems lie elsewhere.
I’m baffled by how you can presume to claim that I’ve “missed the point completely” when I clearly made the following statement:
Yes, those who blame insurance company profits for the extraordinarily high cost of US health care are not correct, but what they really should be saying is that the extraordinarily high costs of US health care are due to the huge unnecessary costs and structural problems caused by the very existence of these useless parasites.
Day after day, patient after patient, people are paying large sums of money for the “privilege” of having insurance bureaucrats insert themselves between doctor and patient, which bureaucrats constantly do their best to get claims denied or treatments downgraded. That’s their basic business. It causes physicians huge expenses and frustrations, and sometimes causes even worse in their patients, like medical bankruptcy and death.
Health insurance companies are not exactly a productive contribution to society.
Yes. The person making the decision whether payment for care should be denied should not be someone whose interests hinge on denying care to as many people as possible. And while some denial is necessary - we don’t have infinite resources - when it comes to medical care we should err on the side of “yes”.
The entire concept of for-profit insurance is fundamentally flawed due to the perverse incentives innate to it, in my opinion. Trying to make it anything other than predatory is fighting against its intrinsic nature.
Almost every single personal story I see online complaining about insurance of any kind is made by an entitled dummy using magical thinking.
Just now on Rogan the guy is saying how insane it is that house insurance is 125k a year to insure in certain areas of California. Obviously at this point this insurance company probably should have told they won’t insure the house but these dummies are speaking as if they are entitled to cheap insurance.
Do you not understand how basic math works, businesses or wildfires? Is anyone forcing you to take insurance? Why don’t you start a charity to pay back people who lose their house to acts of God and state mismanagement and put your funds into it?
Moving away from health insurance but the story is pretty much the same with that, except it is more understandable and sympathetic for people to be irrational about that.
Note: I think people should be entitled to cheap health insurance, subsidized by the government.
I think the problem is Health Insurance as a concept. I think people should be able to get health care without breaking the bank. Weather that is provided on an insurance model or by something like the NHS is an implementation detail.
It is in no way ethical for a medical corporation executive to take home anything more than a modest civil service salary while care has to be rationed to the people he is supposed to be serving.
I guess that makes me a leftist.
If you owe too much of the value of the house to a bank, yes, they are forcing you to hold insurance. But of course, you didn’t have to buy that house.
Because that was exactly the point the blogger made, and yet you called it “uninformed bullshit”. And for the record, the blogger is a left-wing economist that supports universal healthcare (in the form of a national health insurance program like Medicare-for-all).
The insurance companies did not create the system. The system created the insurance companies. Yes, that was a mistake, but everyone in power has to work within the system as it exists, and simply calling the insurance companies “parasites” is not helpful.
The only way to get rid of them is to adopt a UHC system of some kind. There are many to pick from and the Canadian system is probably not the best fit for the US, but there are other national systems that would be.
If you have a multi-million dollar home, your insurance is going to be proportionally more expensive than the policy of the guy with a 300K home.
Yes, I’ve given examples from the Canadian system because it’s the one I’m most familiar with, to explain how a socialised system works better than a private insurer system, but that doesn’t mean I think it would work for the US.
Of all the systems I’ve seen mentioned, I think the German one may fit best with the US, because it relies on private insurance companies, but which are heavily regulated by the government to emphasise health care, not health care profits. Relying on private insurers in that way may fit the US political psyche better than a system like Canada’s or the UK’s.
It would work for the US. It’d sure work better than the current non-system. There are, however, even BETTER systems that might well work better for both the USA and Canada.
There’s a bunch of stuff to unpack here, but to be brief, yes, there’s an answer. The answer is best understood by first understanding that in broad philosophical terms, in a properly functioning universal health care system the gatekeepers are always impartial physicians making decisions based on the patient’s medical needs. At an individual level, it’s a collaboration between patient and doctor, with no meddling by insurance bureaucrats. At a policy level, it takes the form of an impartial expert advisory panel whose only concern is medical outcomes, not cost or profit.
The way that single-payer works in each province in Canada is that the schedule of covered procedures, which basically spans all procedures normally provided by physicians and hospitals, is established by an advisory panel of medical experts, and then fees are assigned in consultation with the province’s medical association.
Quackery of the kind cited in your example would presumably be recognized as such and never approved. You ask “how could one know in advance whether they [insurance companies] are looking out for the patient or their own financials?” Easy. They’re always looking out for their own financials. That’s what they do. And they do it even if it causes the patient to die. If their propensity to deny claims in some cases protects the patient from quack treatments, that’s basically coincidence.
You also say “It looks to me that the primary way Canada rations care is by waiting lists.” That’s a bit misleading. Queuing is a natural function of finite resources and exists in all health care systems, being basically a matter of funding. But the important thing about the Canadian system isn’t the presence or absence of queues, but the triage system that prioritizes access based on urgency. I have limited direct experience with health care in general but having cared for my elderly mother and having had a heart attack one time myself, I can assure you that when the need is urgent, there is no waiting list.
I’ve posted before about my own experience but it bears repeating. I was seen both by a cardiologist (a fantastic doctor who I’m fortunate to now have for ongoing care) and a heart surgeon, and their recommendation was triple bypass surgery. Which caused me to freak out and ask for something less drastic, like stenting. After consultation with the head of the catheter lab, it was agreed that this was an acceptable tradeoff.
But here’s the key point. The decision was made jointly by the head of the PCI lab, the cardiologist, and the surgeon, taking into account my strong preference – no one cared what anything cost, there was no insurance bureaucracy involved – the decision was 100% medical, made by medical experts. This is how health care decisions should and must be made. And at the end of it all, it cost me exactly $0. This is what health care procedures should cost the patient.
Canada does have the distinct property of being next to a large, wealthy country that has high quality (but expensive) providers. What this means is that there’s a kind of relief valve for rich people that would otherwise be put on waiting lists. When Canadians use health tourism, they also take some of the load off the Canadian system itself.
Americans use health tourism as well, but it’s for the poor, not the rich. And it’s more difficult since we have to go farther afield. So there’s no similar relief valve. Any system we adopt would have to account for this.
Just to follow up on @wolfpup 's analysis, this quotation makes it sound like wait lists are an intentional part of the system. They’re not. There will always be a finite amount of care available; the important part is to match access to that care to the need for that care in a particular case. It’s a system of triage, which is standard in medical decision-making (except in the US, it sounds like).
That’s why way up-thread, I gave my personal example of skin lesions. They weren’t life-threatening, but my GP has said that some of them need to be looked at. He gave me the doctors in town that handled them; I picked one myself, based on prior experience with him. My GP then sent a referral letter. Took about a month to get in to the specialist, but that was because the lesions weren’t life-threatening or needed immediate attention, in the opinion of my GP - ie the decision for time to access that particular specialist was based on the professional medical judgment of my doctor, not a bean-counter.
That’s quite different from wolfpup’s example of a heart condition, which could have been life-threatening so he got immediate attention from cardiac doctors.
Governments are always working on getting wait lists down. It’s not like they plan on having them. But there will always be some wait times for a finite resource.
In Canada, access priority is dealt with through systematic triage based on physicians’ professional judgment. In the US, access is dealt with through systematic refusal of care, based on Wall Street’s profit demands.
My interest is in systems in an abstract sense. Well-functioning systems of any kind–whether a healthcare system or a steam engine–must have some kind of feedback loop so that the output doesn’t run away from the input. If there is no feedback loop, nature will provide one for you. If you eliminate the governor on a steam engine, it will speed up or slow down until something bad happens (friction takes over, the engine blows up, etc.).
In every thread like this I get explanations about how only the doctors are gatekeepers, and they don’t make decisions based at all on cost, etc. My takeaway is: fine, so that’s not where the feedback happens. But where does it happen? What is it that matches the demand to the supply?
And as best I can tell, Canada pushed that job to the waiting lists (which are among the highest in the developed world). If the waiting list grows too much, it disincentivizes people to pursue that treatment. Some people undoubtedly drop out. Some use medical tourism. And in the worst case, some people die before getting treatment.
The triage system sounds like it works reasonably well, and helps ameliorate the worst effects (so maybe people dying off the list isn’t common), but that is nevertheless just another form of denying care to some people. A waiting list can’t, by itself, improve throughput. It’s like a ride at Disneyland: it only handles so many people per hour, and the line grows until the people at the back can’t stand it and go somewhere else. You can add a “triage” system to that so that important people go to the front of the line, but there are still people that never got served.
To be clear, I’m not saying any of this is necessarily a bad thing. It works better than the US system, at least, where we do have runaway costs due to a poor feedback loop. Long waiting lists would arguably be an improvement.
We have Kaiser and it is great.
Look, even Medicare rejects some claims. The fact that an Insurance company rejects claims doesnt make them evil- it is WHY they reject the claims.
Maybe one reason, but there are many more.
No. Only the Medicare Advantages plans.
Yeah, read sometimes complaints about the UK system. The users are loud in their complaints.
Regular Medicare also