# The most insane health insurance system in the world is in the US **URL:** \ **Category:** Great Debates\ **Created:** [February 12, 2023, 12:30am UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641 "2023-02-12T00:30:53Z")\ **Posts on this page:** 6\ **Page:** 3
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [March 3, 2023, 6:21pm UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641/41 "2023-03-03T18:21:34Z")
See also: > [@Debt collection letter received after 32 years](https://boards.straightdope.com/t/debt-collection-letter-received-after-32-years/980433/18): > > In semi-related news involving my deceased first wife. She died in late 2021. About 6 months later in early 2022 I started receiving monthly bills addressed to her from the hospital / clinic about an unpaid $8K bill from early 2019. So the charges were 2-1/2 years old when she died, and 3 years old when I got the first bill. It appears that for some reason the medical insurer rejected one day of her ongoing chemo treatment. But they’d paid for the prior week(s) and subsequent week(s) promptl… I’m not much upset about this whole saga, but I can imagine lots of other people in a similar spot would be pretty upset and rightly so. ---
**Author:** ![fordgt100](https://avatars.discourse-cdn.com/v4/letter/f/5daacb/32.png) [@fordgt100](https://boards.straightdope.com/u/fordgt100)\ **Post date:** [March 4, 2023, 4:30am UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641/42 "2023-03-04T04:30:56Z")
The problem w/ insurance is that their first order of business is to take money in, and then refusing to pay it out (saw that on an old Addams Family episode and it’s true). The real issue is the high salaries doctors make, that’s where the greed starts. If health care was even nominally socialized, health care costs would probably go way down. ---
**Author:** ![MandaJo](https://avatars.discourse-cdn.com/v4/letter/m/ac91a4/32.png) [@MandaJo](https://boards.straightdope.com/u/MandaJo)\ **Post date:** [March 13, 2023, 5:26pm UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641/43 "2023-03-13T17:26:06Z")
But the high salaries are basically a requirement because of the very expensive education. Being a doctor is like buying a franchise: you have to borrow over a quarter of a million upfront to even get started. But in the case of medical school, you also have to cut off ten years of earning potential (during which time your debt is acquiring interest), and you have a debt that can’t be discharged by bankruptcy. Most doctors do well eventually, yes. But it’s a weird back-assward system where the profits are all pushed far into the future, which means they have to be pretty damn lucrative to be tempting at all. It’s also pretty high risk: one, if you hate it, it doesn’t matter, because you can’t go into a lower-earning field with all that debt. Two, if you don’t go into a high paying specialty, you may never really do that well, not well enough to make the ROI of time and debt worth it. So we actually have to start by reforming how we train doctors and who pays for it. Expand the pipeline, socialize the cost, lower the salaries. ---
**Author:** ![Alessan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/alessan/32/465_2.png) [@Alessan](https://boards.straightdope.com/u/Alessan)\ **Post date:** [March 14, 2023, 7:55am UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641/44 "2023-03-14T07:55:07Z")
I just find it interesting how in most of the advanced world, being a doctor is a solidly middle-class profession; the concept of rich doctors is very much an American invention. I know some doctors here. They’re doing all right, but the only ones I know who could be called wealthy in any way are some of the hospital department heads, or the ones with patents in their names. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [March 29, 2023, 11:05pm UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641/45 "2023-03-29T23:05:50Z")
Speaking of insanity: There’s an article today in the Wall St. Journal about how some health insurers, under pressure from lawmakers in a number of states (and on a national level), are scaling back prior authorization requirements. These regulations are detested by physicians, who have to spend gobs of time and/or detail special staff to harangue insurers so that patients can be granted access to certain medications or procedures (many times these requests are refused, and may or may not be successfully appealed). Great quote from a top insurance honcho: “The real intent (of prior authorization) is to guard clinical quality and patient safety,” said Margaret-Mary Wilson, UnitedHealth Group’s chief medical officer." Suuure. Boosting United Health’s profits at the expense of patients has little to nothing to do with it. > [@Alessan](#): > > I just find it interesting how in most of the advanced world, being a doctor is a solidly middle-class profession; the concept of rich doctors is very much an American invention. The average annual pay for a physician in Israel translates to around $140,000, while the average pay for all occupations is about $40,000 annually. The former doesn’t seem all that “solidly middle-class”, but YMMV. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [March 30, 2023, 3:32am UTC](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641/46 "2023-03-30T03:32:54Z")
> [@Jackmannii](#): > > These regulations are detested by physicians, who have to spend gobs of time and/or detail special staff to harangue insurers so that patients can be granted access to certain medications or procedures (many times these requests One of our family doctors came to Canada from South Asia. He practised here for a while, then moved to the US. He came back after a few years because he was fed up with spending more time talking to his patients about their insurance coverage than in giving them medical attention. [Previous page](https://boards.straightdope.com/t/the-most-insane-health-insurance-system-in-the-world-is-in-the-us/979641.md?page=2)