Anthem Is Cutting Access to Out-of-Network Doctors
jacobin.com
jacobin.com
After going through that experience, which is by far the most I've ever had to deal with insurance companies and the healthcare system, I can safely say I'm even more convinced the whole god damn system needs to be thrown out and rebuilt from the ground up.
I empathize with the struggles from the hassle and bloat. But what is it about socialized healthcare that is so dynamically opposed to insurance? In my experience insurance has a lot of attributes that mimic socialized healthcare: exclusivity to actual care, (intention of) spreading risk, and very very regulated.
Seems to me insurance is "socialized health care, lite version." But I'm willing to be persuaded otherwise.
Costs aren't covered. They are obfuscated. Which is why in the US, socialistic health care is not a good alternative to our current insurance situation.
Money goes from patient (or patient's employer), to government, to insurance, to health care provider. With a lot of opaque mechanisms and transfers in between.
You're describing our current system in the US. It's so complicated to navigate a fucking cottage industry has sprung up to help navigate it.
Couple that in with laws that hamper the effectiveness of health insurance (can't negotiate drug pricing, denial of necessary care, absurdly high deductibles) and many quickly see that health insurance really just feels like a scam.
The regulations are in the favor of the insurance providers and major healthcare corporations. There have been decades of erosions to regulations on both the patient and healthcare provider side.
Couple that in with the recent announcement that many nursing and healthcare degrees are no longer considered "professional degrees" and are therefore now further restricting access to these career fields, US healthcare is about to get a lot worse.
Turns out unlimited money from bad actors flowing into the pockets of those that write the laws isn’t a great system!
There are 2 routes of providing socialized healthcare - either create a top down centralized model like the UK NHS or like the usually general EU model of creating an ecosystem of private and public players with heavy regulation.
The first model is expensive, prone to bloat and administrative spend and inefficiencies of scale, but allows for healthcare to be institutionalized. Any political party can try to weaken the NHS, but dismantling it even 80 years after its formation is political kryptonite for that party (Tories or Reform). Just like defunding Social Security or Medicare or Medicaid would destroy the Republicans perpetually.
On the other hand, you have the regulated model, which works much more efficiently compared to the former, but if regulations are weakened (which is much easier), the entire model becomes ineffective. Take a look at Swiss healthcare model, one of the best examples of a regulated private market with an insurance mandate, but slowly turning into USA-lite, as insurance premiums creep up and become unaffordable for growing families and low-income residents, because the SVP has been captured by insurance interests.
Obviously, because of the above inherent natures, the first model is often much more preferable than the latter model in hindsight, especially in a country like the US, where regulations are constantly weakened.
The fundamental problem with insurance as a concept, is that their entire business model is structured around not providing the service you pay for. By design they want to payout as little as possible to the insured, otherwise their model falls apart. That's not limited to health, that's insurance in general.
In the health industry that means they are incentivised to pay for as little actual healthcare as possible. In the last they balanced risk by just simply not covering certain people. Essentially excluding segments of the population from quality healthcare to keep it affordable for the relatively healthy segment.
Post Obamacare they can no longer deny coverage for preexisting conditions. In order for this to work in a profit driven structure, that means either the government had to massively subsidize the industry, mandate everyone get insurance so healthy people can help offset the cost of the unhealthy, or the insurance companies have to raise their prices. Thanks to the slashes made to Obamacare we ended up with a pretty shitty version that had elements of all three.
It's an utter waste, and entirely inefficient. At best the insurance companies are just a middle man between the government and healthcare providers and add a shitload of red tape. What's covered, what's not, who's in network and who's not, premiums, deductibles, max spends... And all that gets duplicated three times since medical dental and vision are all separate.
The system could be massively simplified if absorbed by the government. Taxes pay into a large fund to pay for healthcare. You get sick you go to whatever Doctor you want. End of story. Obviously it won't be that simple, but we can eliminate huge swathes of red tape and bs.
> “Across the country, [independent dispute resolution] filings have skyrocketed, many for nonemergency, planned procedures that should never qualify for arbitration,” a spokesperson for Elevance Health wrote in an email to the Lever. “Certain providers are using the process as a backdoor payment channel, driving up costs that ultimately impact patients, employers, and taxpayers.”
Perverse incentives and American Healthcare, what a classic.
Unfortunately, there doesn't appear to be a great way to have a profit driven motive to make the population generally healthier.
I don't agree with the take about "good faith negotiations". The non-surprise bill legislation is literally about making sure patients don't get surprise bills. It's not about helping hospitals or providers get more negotiating power.
Anthem is merely regressing to the prior status quo by making hospitals share in a cost they now have. This was entirely forseeable. Providers weren't magically your friend because they give you a healthcare.
Your insurance company is negotiating to keep costs down, which should help you too. Out of network anesthesiologists were never on your side.
I want to be able to put pressure on hospitals to accept a whole set of insurance and I'm glad insurance companies are doing so.
There SHOULD be a guy saying "we should make sure his providers are all in network" at the hospital and not just make the insurance company write blank checks to anesthesiologists.