Medicare Advantage increasingly popular with seniors but not hospitals, doctors
kffhealthnews.org
kffhealthnews.org
It's very funny people were worried about ACA "Death Panels". The insurers offering Medicare advantage basically have doctors on their payroll acting exactly as people feared, except it's the free market so somehow that's okay?
In your example, the solution is not letting 9 more people die but rather having a greater number of generalized doctors, in place of some specialized doctors if need be.
Well this where you find the problem, to me and many many others choosing a medical / insurance providers from an array of medical / insurance providers seems to provide MUCH MUCH more accountability then "parties appointed by accountable representatives " who are not really accountable at all, and whom elections are based on any number of issues very rarely would be the status of medical dealth panels, for the US currently would the "hot button" topics of the day (and for the last several decades) immigration, abortion and gun control
This mythical idea that elections are how we hold the unelected bureaucracy in check has many many many examples of being completely and utterly false, unelected bureaucracy has ZERO fear of the election cycle most of the time. Meet the new boss, sames as the old boss, and almost none of them every leave.
Of all the industries government bureaucracy has some of the longest tenured employees next only to education where once a person joins an agency they never leave until death or retirement. The Rare Exception is the regulatory capture of ruling making boards and committee's where there is a revolving corrupt door between the public and private sectors.
They are accountable—directly and exclusively to capital—which is both why they are okay to the people funding the political propaganda in question and why the alternative (where that is not true, since there is, at least indirect, democratic accountability) is not.
Capitalism and democracy are different, and fundamentally conflicting, systems of organizing power. This is often overlooked because capitalism is described as “economic” and democracy as “political”, but those are different ways of describing systems of organizing power over others which is fungible between domains.
> Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs.
> Plans must be approved by the Centers for Medicare and Medicaid Services (CMS). If a MA plan changes some benefits, the savings must be passed along to consumers by lowering co-payments for doctor visits (or any other plus or minus aggregation approved by CMS).[2] Coverage must include inpatient hospital (Part A) and outpatient (Part B) services.
> Original Medicare and Medicare Advantage pay healthcare providers differently. Original Medicare typically reimburses healthcare providers with a fee for each service.[5] This fee is often calculated with a standard formula (for example, the prospective payment system for hospital services). Providers either accept Medicare's reimbursement rates or opt out of the program.[5] Public Medicare Advantage plans negotiate payment rates and form networks with healthcare providers, similar to private health insurance plans that almost all Americans not of Medicare age use.
Is it that last part that turns this into the "free market"? My lay reading of just the wikipedia page doesn't give me the impression that any part of this is subject to free market forces. What am I missing?
MA plans negotiate with providers, similar to a regular commercial insurance company, for different “deals.” As you may be aware from commercial insurance, that typically means higher rates, since everyone along the line has to get paid across the providers and the insurance companies. Much higher profit motive than a socialized good.
On top of that, MA plans have an incentive to deny coverage wherever possible, because as a for-profit entity they want to make as much money as possible, not get old people healthier.
Young people have trouble fighting insurers on denials. I know this firsthand. But it’s doable, because we tend to have more energy and less cognitive impairment; I’m generalizing here, but dementia is a thing that happens to a lot of people in old age, for example.
For older people, fighting insurance companies is just about impossible. Often, this falls on their younger family members to help (ask me how I know, lol), but that implies their family or friends are willing to help. Not everyone has that.
And it shouldn’t be that way.
[0] There is a thing called Excess Charges that providers can charge, if they don’t accept the Medicare fee table, but still accept Medicare generally. They have to tell you before the service, or you are not responsible. It is also capped at 15% of the service, and is illegal in some states entirely, and capped lower in others. Some Medigap plans also cover excess charges, but they are on the more expensive end.
I totally agree that it shouldn't be this way. I just don't agree that the way to fix it is more socialized control by the government.
With health insurance the choices may be limited, you have very little information about what things cost and whether insurance will cover a given procedure. Most people are not educated well enough to be able to properly evaluate their options. You are only able to change your choice once a year.
This is a free market in name only. But the impact of choosing incorrectly is very expensive.
Healthcare, when coupled with a profit motive, offers misaligned incentives, period. Getting people healthier for cheaper doesn't make a healthcare company money.
That is why I believe basic healthcare should be socialized. That doesn't mean we can't have private companies offering countless other medical services or additional insurance, but nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die.
You can have fully functional almost entirely private healthcare systems (more so than in the US) which are heavily regulated like in the Netherlands or Switzerland. Of course they are still ‘socialized’ system but so is the US by that definition.
I never claimed it did. My claim is that what we call "health insurance" in the US is not just insurance; it is a bundle of insurance (coverage for high cost unforeseen events) with other things that aren't insurance, but have to be bundled with it because the government says so.
> direct primary care offerings exist right now.
Yes, they do, but they are hamstrung by the fact that the US health care system disincentivizes patients from using them. If all primary care in the US was provided by such places, and patients paid the costs directly, that would be a free market, at least in primary care. But that's nothing like what we have. It's certainly nothing like what Medicare Advantage, which is the subject of this discussion, provides.
> Healthcare, when coupled with a profit motive, offers misaligned incentives, period.
Not in a free market. Health care in the US before WW II was provided by private companies (or individuals like doctors with their own practices), for profit, and worked better, given the technology of the time, than what we have now. What ended that system was laws passed during WW II that fixed wages, which meant that companies could not compete for labor in a free market by offering higher wages. So companies looked around for other benefits they could offer to compete, and health care was an obvious one. And then after the war the government decided to regulate the company-provided health care instead of ending it and restoring a free market.
What offers misaligned incentives is the bastardized system we have in the US, which combines the worst features of for-profit with the worst features of socialism. The for-profit part is not visible to the actual patients--as I have already pointed out upthread, patients have no idea what the services they are getting actually cost, so they have no idea whether they are worth what they cost. The socialized part is what patients see--the services available to them are determined by their health "insurance", not them--but decisions are made by third parties who have no skin in the game and suffer no consequences when they make bad decisions that cause harm to patients.
> nobody should be getting denied a cochlear implant because they are deaf due to 'paperwork issues' for months or years until they die.
Of course not. And this would not happen in a free market. It happens because we don't have a free market in cochlear implants, we have a non-free market system with misaligned incentives, as I described above.
For an incredible success story see how the free markets made computing power so affordable despite last century’s “digital divide” worries.
Comparing computer and healthcare industries makes almost no sense (besides extremely superficial ways) due to perfectly obvious reasons.
> making health care more affordable
Doubtful (since there is zero evidence of this working anywhere). Try to imagine how would this work for cancer and other serious diseases (hint: it wouldn’t at all for the majority of the population without some form of ins)
I am curious why you think they wouldn't work for healthcare since: a) they worked just fine before government started intervening somewhere mid-last century and b) their mechanisms (price signals, competition, law of supply and demand, etc) apply just as well like for any other essential goods (food, water, fuel, etc).
Healthcare industry as we know it today did not exist back then (the costs and available treatments are on another level).
> b) their mechanisms (price signals, competition, law of supply and demand, etc) apply just as well like for any other essential goods (food, water, fuel, etc).
Not really or only in a very superficial way and extremely basic way.
> While regulations - brought for our own good and safety, of course - succeed in increasing costs and add delays. Just see healthcare, housing and education for some sad examples.
As far as healthcare and education are concerned this is almost entirely an American problem. Some countries like Switzerland or the Netherlands have entirely private/non-state run healthcare systems but extensive regulation has kept costs relatively low and accessibility at very high levels.
Not true - it always existed (with different costs and treatments of course) and it was rather developed and affordable in the '50s and beginning of '60s before government intervention started in the earnest.
> Not really or only in a very superficial way and extremely basic way
Why and how? Feel free to expand and provide some examples.
> this is almost entirely an American problem
Not true. Health care and education are quite expensive in all developed countries, including where they are paid from our tax money then offered to us "for free".
> extensive regulation has kept costs relatively low and accessibility at very high levels.
How does that even work? I never heard of a regulation able to lower prices. Price controls only create shortages. Swiss private healthcare is quite expensive, but the competition on their (relatively) free market is keeping the costs from exploding even more.
Moreover, history is full of evidence that a pure free market begets regulation as a direct consequence of the natural desire to externalize the costs in a system. Pure free markets are an ephemerality in the world, undone by their own worst instincts soon after their creation.
Who said anything about purely free markets?! Markets are indeed over regulated around the world today. More so in Europe, than in the US, explaining why EU is lagging behind economically further and further. But much less so at the beginning of the last century where a tremendous amount of wealth and building got done in a very short time.
The truth is staring us in the face: the more we regulate (no matter how good the reason is), the higher the costs and delays. Culminating with the three broken markets of today: healthcare, education and housing.
> history is full of evidence
Please feel free to provide some then. The historical evidence I know (USSR and such) shows that countries that killed their free markets were unable to even feed their own citizens.
If you define criteria you will accept as evidence before I give you a list, I’m willing to do the work to show you that pure free markets produce outcomes that force regulation on them.
Finally, if you aren’t talking about “pure free markets” when you say that regulations are bad, then what the heck are we even arguing about? I haven’t said we should turn the US into the Soviet Union, just that free markets require some regulation. This should be as uncontroversial as stating that gravity exists. You have to go very far back in academic economic literature to find anyone arguing that free markets are an unmitigated good.
> countless times in American history
Please provide some examples then. The most widely touted, Standard Oil, was already losing marked to its healthy competition before antitrust action even started:
https://en.wikipedia.org/wiki/Standard_Oil#Legacy_and_critic...
Andrew Carnegie's Steel Co. - created a vertical monopoly in the steel industry by obtaining control over every level involved in steel production, from raw materials, transportation and manufacturing to distribution and finance. By 1897, he controlled almost the entire steel industry in the United States. In 1901, became part of the world's first billion-dollar business when it merged with a group of other steel businesses under the name U.S. Steel Corp. (ticker: X), to become the largest company in existence at the time, which remains among the largest steel producers in the world.
AT&T - operated as a monopoly in the telephone industry for many decades until 1982 when it was forced to break up into eight smaller companies, almost all of which have since become a part of AT&T again.
I am not familiar with the other 2 cases but I wouldn't be surprised if it was, again, government-granted or not an actual monopoly. Think about it, it's logical: why wouldn't competing startups attack a monopolized market? It's ripe for disruption, after all.
Monopolies can arise on the free market but unfettered competition will always defeat them.
I’m not sure that’s at all a fair comparison. Due to the technology at the time (or lack of it) costs were massively lower because generally doctors couldn’t really do too much unlike today.
MA restricts your access to doctors and sets fees. Someone on a Kaiser Permanente Medicare Advantage plan won't be able to go to the Mayo Clinic but the Mayo Clinic and Cedars Sinai do accept Traditional Medicare. In addition, you'll need preauthorization ("Delay, deny, die") from the insurance company for many procedures.
On the other hand, TM sets the fees to what is called Medicare Assignment (and also allows something else called Excess Charges). But any doctor can accept Medicare Assignment. At UCSF, I need a referral for a colonoscopy for which Medicare pays Assignment but then I don't need a preauthorization from Medicare for that.
My elevator argument for Traditional Medicare (A+B+G+D) and against Medicare Advantage (Part C) is:
why would you want to spend the rest of your life
arguing with an insurance company?It's an affordability issue so it's not as simple as you laid it out.
Some corporate-sponsored health benefit plans for retired ex-employees pay 100% for Medicare Advantage and not Traditional Medicare + Medigap.
The UHC Medicare Advantage has some aspects of "Medigap" included in that plan and 100% of that total premium is reimbursed by the company.
So choices are:
- $0.00/month for Medicare Advantage
- $2100/year out-of-pocket for Traditional Medicare + $$$ extra for Medigap
That's the tradeoff math that some seniors contend with. Some choose to hypothetically "argue with an insurance company" because they don't have $2100 to spare.
I spend about $300/mo for A+B+G+D. My OOP max is the $240 Part B deductible (except for drugs but I only take a statin). That will go up over time, Community Pricing. I have no preauthorizations, no copays, no coinsurance.
And generally no paperwork. When I went to my UCSF PCP for a sprained MCL, I made an appointment a few days later. I showed up and said who I was. A few minutes later I saw the doc. After that I walked out. The wallet stayed in the pants and I didn't fill out a single form. A colonoscopy had a little paperwork, disclosures and actual ID. I watch the billing on MyChart, but it's a spectator rather than participatory sport. It's UCSF vs Medicare and it settles in a month or so.
A+B+G+D is by far the best health insurance I've had in my life.
I guess I don't understand what you're trying to explain. There is no "$0.00 illusion". For the situation I've laid out, there's literally no $174/month or $300/month spent.
>"Then you'll pay your Part B premium ($174.70/mo) out of your Social Security benefit." <
... that $174.70 is 100% reimbursed by the company -- but only if the ex-employee enrolls in the company's approved Medicare Advantage plan from UHC. If instead they go your route by rejecting Medicare Advantage, the company reimburses 0% of that $174.70 Part B premium. The math for out-of-pocket premiums payments is literally:
$0/year < $3600/year
Yes I understand, and that "no red tape bureaucracy" ability you enjoy costs you ~$3600/year more than some seniors have the ability to pay if they're restricted by what their ex-employer will reimburse. It's still a tradeoff.
In my case, I had a choice between Traditional Medicare (A+B+G+D) or Medicare Advantage (C). Kaiser, for example, wouldn't have been $0/mo. I chose Traditional Medicare which for me is currently about $300/mo but I can go to UCSF or Mayo or anywhere that takes Medicare.
I'm very happy with Traditional Medicare but I understand that there are retirees who've had their Medicare+company retirement benefits negotiated away. Their situation is ok but I prefer mine.
Basically its taking a subsidy (Medicare funding") and offering it to 3rd parties willing to offer equal value, but shuffled around so the benefits are "chosen" by patients who know what's best for them.
Here is the secret: in almost all cases, regular medicare is better for most patients. You may pay more upfront (coins, copay) but there are fewer surprises.
I would argue that Traditional Medicare has much more choice; most doctors+hospitals and all ERs accept Medicare Assignment. You can also go to the Mayo Clinic, Cleveland or Cedars Sinai with TM but rarely with MA.
I just went thru the nightmare.
My mom had a stroke. She was up and walking the day after and the next day. After day 1, they applied for PT and OT. Her plan delayed delayed delayed. She developed a bedsore and blood clots due to the hospital not having the resources. But it would have never happened had approval been guaranteed like Medicare. They would have moved her after day 1 to PT and OT. But with advantage plans you must get approval. Medicare never dies these things.
She never walked again after day 2 of her stroke. She died a month and a half later.
Her advantage plan tried to deny any additional resources after day 21 that weren’t send her to my home with me being the full time care giver.
I email bombed the advantage plan board of directors asking wtf they would do in my situation.
The hospital would not release her into my care because I had nowhere for her. And her advantage plan denied paying for a skilled nursing facility saying she wasn’t ill enough.
After my emails, I managed to get them to approve skilled nursing.
It was a nightmare. Fuck all Medicare advantage plans. They fuck people over and make family members deal with BS when they should just be worried about their loved ones.
No. "Having private companies do it" is not the same as "free market". Nor is "for profit".
Don’t get me wrong, as someone who saw first hand the shit show of the pre ACA, something had to be done.
I was laid off right before the ACA took affect and couldn’t get insurance at any price because of a non life threatening, no treatment needed then or in the future preexisting condition. I was healthy as a horse and had just run my first two half marathons.
COBRA wasn’t an option because the company I was laid off from went out of business. I had a well paying contract job and I could have afforded to pay out of pocket premiums.
I ended up marrying my now wife six months earlier than we had plan to get on her insurance (her idea).
But the challenge is end of life care and you will always have to make cost/benefit trade offs.
It is true that in some situations, like emergencies or accidents, patients can't shop around. That kind of situation is indeed what insurance is for. But programs like Medicare, and indeed socialized health care in general, go way beyond insurance. Insurance is for high cost unforeseen events. Most health care is not high cost unforeseen events; it's foreseen events like physicals, shots, checkups and prescriptions for chronic conditions, etc., or low cost unforeseen events like getting an infection and needing treatment. If all of those things were provided in a free market, health care providers would be much more efficient, and it would be much easier to negotiate reasonable terms for insurance for the truly high cost unforeseen events that insurance is for. Medicare Advantage (and Medicare and socialized health care in general) is of course nothing at all like that.
Let’s imagine (unrealistically) that through some technical breakthrough, patients knew the cost before making their purchasing decision. They still do not know what it is worth, because they have no idea what the risks of not being treated are. There is a problem that your doctor also probably does not know the cost, but they are the only person in the decision making process with the information necessary to make a rational recommendation. (And, unfortunately, they usually have a conflict of interest.)
Healthcare is different from buying cars or groceries - even if you know the relative costs, you are unlikely to know the relative benefits.
I disagree; I think that in most cases patients do have a reasonable idea of the risks of not being treated. Where I think risk information is often not communicated very well to patients is in the risks of being treated--what the actual success rate of the treatment being proposed is. That is because in our non-free-market system, doctors have a strong incentive not to let patients know what their actual success rates are, and there is nothing that can counterbalance that. In a free market, they might still not want to, but they would have no choice, because that information is valuable enough to patients that if doctors don't provide it, someone else will. (Other parties try to do that even in our current system, but they are limited in what they can do by legal restrictions imposed by the government.)
> [Doctors] are the only person in the decision making process with the information necessary to make a rational recommendation
I disagree with this as well. My experience with doctors has been that I usually know more than they do about my particular condition. (My wife, who has several chronic conditions, has had this experience even more strongly than I have.) I may have less overall knowledge of all medical conditions in general, but that's because I don't treat any patients other than myself, while they have to treat lots of them. But I have a strong incentive to learn about my particular condition that my doctor does not have, and that usually beats the doctor's general knowledge.
except your experience is not really generalizable across the entire population. Some people are in no position to do this due to the severity of their issues and many other would never feel as confident as you about knowing more than their doctors.
> In a free market, they might still not want to, but they would have no choice, because that information is valuable enough to patients that if doctors don't provide it, someone else will.
Right you’re implying that most people are capable of judging the quality and accuracy of this information which they are clearly not. That someone else might be a scammer selling some magic healing crystals or whatever. You do realize the inherent flaw in this whole concept? Often there is no way for clients to evaluate the effectiveness of the treatments they receive until it’s too late (this is why healthcare can’t function without extensive regulation).
Is that really true total cost wise?
> Food stamps just give people a monthly sum they can spend on food;
So you’re saying that this approach (giving people a fixed sum) certainly wouldn’t work for healthcare due to perfectly obvious reasons you’ve described?
Not taking away from your general argument, but only some food assistance programs are like that: an allowance you can use on any approved item; others are more like a coupon for a certain size container of (a specific type of) milk, butter, eggs, etc.
As far as I know, food stamps, which work the way I described, are what the vast majority of people in the US who get a food subsidy at all have. I'm not familiar with the other programs you describe; can you give some examples?
For perfectly good and valid reasons. Consumers are inherently incapable of evaluating the quality of healthcare they receive in many cases. This is perfectly obvious.
If the insurance company can put off your procedure long enough you might die and then they don't have to pay for it. Family friend who has lost so much hearing he can't participate in conversations anymore has been strung out for 6 months by his insurance on a cochlear implant. The final hurdle was them denying because of incomplete paperwork, that they did indeed have said paperwork which was part of the initial submission.
If Americans find this unacceptable, they will need to adjust the laws to change the incentives to the insurance companies.
https://www.propublica.org/article/your-right-to-know-why-he...
Reminder of the orthopedic surgeon whose recommendation for surgery was denied from insurance citing an insurance-paid doctor who is lifetime banned from doing surgery for installing a hip in backwards
Edited to add:
> Studies show that Medicare Advantage costs taxpayers more per beneficiary than the traditional program. But the plans enjoy the backing of many lawmakers, especially Republicans, because of their popularity.
Ugh. Ugh. Of course they're popular, the upfront costs are small, and the united states has literally over 10% more food insecurity in the past year alone[0]. Americans literally can't afford medicine, not because they just really really love Medicare Advantage!
0. https://www.cbpp.org/blog/food-insecurity-increased-in-2022-...
So the insurer can directly pull up the patient's chart and use discrete data elements for claims processing.
Source? I believe you, I just really want to read about this.
For the same cost ($175/month) as traditional Medicare, I get the following extras: free tier 1 drugs, $1,000 in free medical supplies per year (everything from band-aids to heating pads), $500 toward fitness or weight-loss programs and $1,000 in dental care coverage. My out-of-pocket maximum is $5,600 if I do get something serious.
If I go with regular medicare and want to limit the downside I have to buy a Medicare Supplement plan for an additional $196/month. The major benefit of this route is that I can be anywhere in the US (and internationally although I'm not sure what level of care that is) and get treatment without having to jump through hoops or travel back home.
It's hard to turn down the Advantage program's $2,500 of free services and instead spend $2,350 to get the additional coverage. Yet the Advantage program costs taxpayers more, hurts providers and gives off an increasingly sleazy money-grabbing vibe. Ind the end it seems to me like the insurance companies are using tax money to pay seniors to help the insurance companies siphon more money out of the system.
[edit: clarified that medicare supplement plan cost is additional to the regular plan cost]
Yet many of the same people can't reognize that the systems we live under aren't that different. As long as someone has a smartphone and a PS5, they seem to become oblivious to their chains.
Every aspect of your life is designed to extract wealth from you, primarily through debt. Student loan debt, medical debt, end-of-life care, housing debt. Many of these things used to be free or very cheap.
The US health care system is just wealth extraction and rent-seeking.
[1]: https://www.antislavery.org/what-we-do/past-projects/india-d...
Now, the worse problem is there is no (ethical) way around the issue. Modern medical care as well as strict workplace safety regulations and the downturn of heavy industry (that caused a lot of people to die of silicosis, asbestosis and whatnot) allows for far longer life times, even with mentioned severe illnesses that would have taken out earlier generations before they had even hit pension age, and there haven't been wars to take out a decent part of the population either (which had been the norm prior to the end of WW2). At the same time, we can't just give poor elderly people a gun and tell them to off themselves out of ethical reasons, and we don't want to pressure them to "look for a way out" on their own either. We also can't rely on women to do the care labor as they did prior to the 70s, for both ethical and economic reasons (we need women in the work force). And we also can't import cheap labor from overseas to fill the gaps in staffing to drive down wages, because we already did that (good luck finding nurses and other care staff in Eastern/South Eastern Europe - all bled dry and burned out!).
Right.. you do realize that Europe is not a country? And anyway that’s not really true in many places (or anywhere to be fair if you want to enjoy a decent QoL).
> However, a family that already has 2, 3 million € in liquid assets? For them, even two or three people in elderly care won't make much of a dent - the interest earned from these assets alone is enough to pay for their care
If you have 3 million and need 360k a year that not really the case at all unless you make some relatively risky investments and/or don’t pay taxes.
> which had been the norm prior to the end of WW2
It certainly wasn’t the norm outside of the 30 year period between the start of WW1 and the end of WW2 (also on the whole it disproportionately affected young men).
If you wouldn't say it's silly how much of society's expenses and taxes go toward child care and education another population that can't work to support themselves, then you're really just saying you don't care about old people because their "value" is already spent. This isn't even really an uncommon view, people will just openly say this about anyone with a disability that needs accommodation rather than saying it's our job to help them.
God rugged individualism is such a cancer on society.
The deeper problem is that pushing so many resources towards old, retired people means that a huge chunk of the economy and jobs are forced to orient towards elder care. To be darkly blunt, elder care is a deeply depressing kind of work, especially when it's for strangers rather than family.
A society with an increasing percentage of the population as old people who don't do anything interesting is an increasingly depressing society for young people to live in.
It really seems like a downward death spiral.
It doesn't have to be this way, and the "solution" isn't a baby boom or Logan's Run.
There are a lot of older people who are capable of working, but society presents many barriers to this: 1. Age discrimination; 2. Employers overworking employees; 3. Lack of flexibility in working conditions (part-time, work-from-home, etc.); 4. Lack of educational and job training resources for older people
Society tends to push the majority of people toward retirement, both because it wants older people out of the workforce and also because working life tends to suck for the workers (hence the desire to retire ASAP). But a lot of retirees are actually bored and would welcome becoming useful again, if society provided better opportunities for them.
Instead of "work hard until you retire", we could all perhaps "work easy until you die". Older people are forced to make the choice between working hard and retiring, but younger people are presented with similarly bad choices, for example, working hard or spending time raising your children.
Healthspan is woke.
Living decades longer in a state of in incapacity and pain in a nursing home, lucky if anyone cares to visit once a year, is hell on earth.
You can't store labor in a vault. They didn't save or make any investments worth giving them a cut. They demand no expense speed in their government-funded care while cutting services young people use (child care, college, k-12 education, etc).
Edit: I think we should do something about it, but money = speech so there's nothing to be done as long as the status quo benefits people with money.
"Rich people," as a group, do not somehow benefit significantly from insurance companies being garbage to those they insure.
I don't really see a champion for patients in this fight.
While my parents who are in their 80s aren’t rich, as an only child, I stand to gain something. I wouldn’t be upset if they couldn’t leave me anything because they needed it to be comfortable at the end of their life.
Part of the issue is that doctors use clinical guidelines as baseline best practice document (but then have to care for patients who do not fall neatly within the parameters of the guidelines), while insurers use clinical guidelines as a ceiling for care (but then use the attributes of patients which don't fall neatly within clinical guidelines as a reason to deny coverage).
Yes for 80% of situations, the effect is the same. But for the 20% of situations which fall outside of that it's a rough scene.
That is a lot lower than I expected based on the rest of the article. Maybe still a bit too high for false positives, but it's not outlandishly high. Those numbers make it seem like the insurers are doing a lot better job at avoiding unnecessary treatment than the doctors and hospitals are doing...
87% of denials aren't fraudulent does not mean they caught all of those and Medicare would have missed them.
Also remember that counting claims is weird, they could literally be making their "profit" off these incorrectly denied claims.
And since cheaper is a good thing, I don't think you can call them a "cartel", unless you mean a "cartel trying to lower prices".
https://english.mathrubhumi.com/amp/news/kerala/kerala-cm-sp...
[1] https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abr...
The highest cost industries in the US are the ones that had reasonable costs until the government stepped in to reduce those costs:
1. education
2. health care
3. housing
On the flip side, had we extended equal rights and opportunities from the drop, our GDP would have grown that much faster. IIRC > $1.5T per year.
In other words, not paying up front cost us more long term.