Her Treatment Was Helping. That's Why Insurance Cut Off Her Coverage
propublica.org
propublica.org
I don't know how this isn't considered the insurance companies practicing medicine without a license.
Presumably, the guidelines were written by medical professionals.
> In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.
In medical care, the attending doctor should be the one taking final call. Otherwise, we'd all be receiving medical treatments based on a bunch of flowcharts.
Is the issue here that most patients in this slot would have just made-do with the lower level of care, so the insurance company is saving money even if a handful end up in the emergency room? Or is it that the insurance company is inept and is not even saving money in expectation?
I'm not sure whether "is too cut-throat at saving money" or "is too incompetent at saving money" is the worse problem to have, but they probably have different solutions.
This is not a system of care; it's a system of squeeze the turnip, with a parade of MBAs who constantly need to turn the screws to ensure they can climb the latter.
It's sociopathy, like the entire business capitalism. It's just that in this case, the consumers arn't directly the costumers.
If you happen to have a working spouse, you can choose between which work coverage makes most sense for your family.
My faith in things is so entirely shot that if I saw a company like the one you suggested, my immediate, heels-dug-in assumption would be, "That's cute, and in five years they'll be just like the rest of them".
Due to a weird, historic tax incentive, people get mostly get insurance through their employers. Their interests are not in opposition to, but are still different than those of the people actually being insured. So you have a situation where the people doing the insurance "shopping" aren't the ones using the insurance.
Then on the actual healthcare side, for no coherent reason, almost all prices are hidden from the patient, totally inscrutable, or highly variable. Providers and insurers collude to keep these prices astronomically high so the providers they can overcharge medicare (which is not allowed to negotiate prices) and the insurers can "give" their customers "negotiated prices."
A more normal free market would be something like: people buy their own insurance or pay providers out of pocket. This would incentivize people to make price conscious decisions and evaluate insurers and providers for quality. Providers would need be required to set and publish fixed prices for different procedures and services so the market could actually function, but this seems pretty simple.
These days the bedside manner is trash. Though I don't blame the doctors. And they are little more than privileged employees...if that. The real service they provide, and the service people are growing to expect, is to navigate the insurance system to wrangle out some semblance of coverage. Being employees the most you are going to get is a wink and a nod because as employees they cannot speak freely.
In the case of healthcare I don't think we are capable of building a system this large, prescribing every detail, while getting it right. It's like trying to plan an economy.
I am no expert, but my impression is that it would be very hard for the insurer's customers (e.g. employers) to know an insurer was better, and many might not care. There's so much opaqueness and indirection in the system, it's not surprising it's both inefficient and heartless.
That said, all systems ration in some way or another. We need to come to grips with that.
This also means that any new insurance company needs to pick up a ton of customers. This is really hard to get off the ground in a way that will make you money. You would ideally pick up a healthy population (younger folks), and then you'd have to get lucky on your actuarial tables for the population of people you pick up insurance plans for.
I really don't get, how it became like it is. In Europe, that would be illegal.
I don't mean to diminish the struggle that Moore went (is going?) through, but at least there was some kind of karmic retribution here.
The doubling of the letters (e.g., "EE." for "Estados" and "UU." for "Unidos") follows a convention in Spanish where plural abbreviations are indicated by duplicating the letters. The correct form would be "EE. UU." This practice aligns with historical Latin abbreviations (e.g., "SS." for "Sancti" (plural) or "S." for "Sanctus" (singular)).
* not really free of course, but you pay less on average than you do today and you do it on your taxes instead of to some profit chasing private company -- and most importantly those who don't pay today will have equal access to it as well.
So... not liable then.
Perhaps this is one of the concerns with the rise of index funds— fewer investors make use of their governance power and the index funds just vote according to the recommendations of the current board.
Noone should enrich themselves on others not getting the health care they need, and those who do it today are morally bankrupt -- and society should fight back.
This could've been searing satire, had you intended it that way.
https://www.amazon.com/Built-to-Last-Jim-Collins-audiobook/d...
It'll do a much better job than I can in showing why your thinking is so wrong-headed
I nonetheless agree CEOs should be held responsible.