Health care isn’t the problem, insurance companies are.

  1. Please remember what subreddit you are in, this is unpopular opinion. We want civil and unpopular takes and discussion. Any uncivil and ToS violating comments will be removed and subject to a ban. Have a nice day!

  2. I hate how insurance companies can determine if something is medically necessary or not. It's bullshit, none of them are doctors or specialists. They're all greedy bastards in suits who have god complexes

  3. My girlfriend has state insurance and they consider root canals to be a cosmetic procedure. I have no idea how they came to that conclusion. When I had to have a root canal it was because I had an abscess above that tooth that could’ve potentially killed me and she was in the same boat. But somehow that’s not medically necessary.

  4. For better or worse there are doctors working for insurance companies that contribute to “medical necessity” determinations related to coverage. I’m not defending the system (it sucks) but those decisions are made by (in house, obviously biased) medical professionals, not random dudes.

  5. I changed the mind of a conservative friend when I explained that while people like him who are worried about the bottom line are great in a for-profit company, they have no business deciding who gets what healthcare.

  6. As an actuary for an insurer who helps sets premiums and sometimes terms and conditions, cannot say this didn't hurt.

  7. It’s definitely more complicated. The system is messed up but there are good guys and bad actors on all sides. Insurance companies are the easy target because they essentially add no value. You need hospitals you need doctors and nurses but you don’t actually need for profit third party payers if the government would serve that function.

  8. See, the problem I have with that is while you think its not enough for a business to be earning $40 for one exam which takes less than an hour and uses little to no disposable equipment, only employee time and clinic machinery, that patient on the government insurance who "isn't paying enough"? They make $10 an hour, if that. They have to work weekends and holidays, too.

  9. The entire US healthcare system and insurance industry are so wealthy and embedded into American life at this point I don't see how it's ever going to be dismantled. The last time there was something this powerful and monolithic it took a presidential assassination and Teddy Roosevelt stuck in the VP job to keep him out the way taking over and immediately trust busting. Even then I wonder if trust busting would have still been successful had those monopolies not been helmed by controlling individuals who were at that time fairly old and looking to wind down anyway.

  10. The problem is more the people who charge $10,000 for an ambulance ride that soak up a majority of the funds for everyone else regardless of how effective and affordable their work is. Businesses charging reasonable rates should get 100% of the fee.

  11. Ambulances are kept artificially scarce due to certificate of need laws. Same goes for hospitals, which then ripples to availability of residencies, which then ripples to medical licenses, which then affects how selective med schools are, which then leads to more student loan debt.

  12. Um, healthcare in the US is already largely privatized and that shift began in the 80's. Into the mid-to-late 90's was when we started seeing a dramatic shift in insurance coverages, including substantial increases in out-of-pocket costs for patients. One could say that privatization helped get us into the mess we are in now.

  13. Yeah I completely agree that insurance is the devil but the idea that more privatization would improve anything is completely laughable. Every thing OP has identified as a drawback in government plans is just because government plans are designed to coexist with shitty private plans.

  14. If your employer wasn't covering most of the cost in the back end you'd be paying well over $500 per month in premiums. That's another issue with the way things are done. Until someone looks up the cost of COBRA much of the costs are hidden. And I think that's a big reason behind the aversion to universal Healthcare. Most universal Healthcare plan taxes fall roughly within or even below the full price premium but way above the more typical rate deducted from someone's paycheck.

  15. So get universal health care. In my country that surgery would be free for you. Or if you wanted a private experience you can pay extra yourself.

  16. Except it wouldn't cost 50k, sure it's still mother fucking heart surgery so it might still be like 5k but without insurance companies hospitals wouldn't have to bill these comically large prices, they would charge something "sane" like a 40% upcharge on everything as apposed to the current usual 200-20000%

  17. Here's the thing. You can have both privatized and government run healthcare at the same time. Let's take Czechia and Slovakia as an example.

  18. It uplifts my soul to read something as sensible and accurate as what you just wrote there. What we call health insurance plans in the US are really just ridiculously complex and over-priced prepaid healthcare plans combined with mediocre insurance plans. I'm really not sure why so few other people are able to recognize that.

  19. This argument is the common red herring. You end up paying less in the long run if health insurance also covers preventative care.

  20. Amen! My current Blue Cross insurance ties the hands of my GP in terms of treatments! Making the GP try different “cheaper” treatments first (against their recommendation) but they have to play the game. It’s infuriating

  21. That's what I'm saying, who are these people giving the thumbs up or down in these treatment plans? Have they reviewed my medical records? Are they even qualified to make any recommendations?

  22. Even not for profit corporations can have people with massive salaries. That’s how they avoid the “profit” portion. It isn’t profit if it becomes a payroll expense.

  23. You need profits in healthcare so we can continue to advance the care that we give you. There is constantly new technology and instruments being released and if you want the best care available, your health care provider needs to make a profit so they can afford to buy these things for their practice. Have you ever been to the VA? They have terrible resources because they don’t really make a profit. Also their employees are over worked and underpaid and it’s unnecessarily hard to refer someone for needed care if they have to go through the VA first

  24. Yes it does. What that profit is may change from monetary profit to social profit, but whenever there is a good or service that is in demand there is a profit for it. "Taking profits out of healthcare" sounds great on a poster but its honestly economically silly.

  25. Then how would you pay people appropriately for what they do? How would you run the hospital? Electricity? Research? Lab equipment?

  26. As a pharmacist, I can 1 million percent verify that this is true. Insurance companies are the richest, greediest, fucking assholes ever. Screwing over the providers and the patients they claim to have in their best interest

  27. I think insurance companies are a huge part of the problem but I think we government overreach is the real problem here.

  28. I assume you know the answer but yea the government limits it by restricting the number of residency slots in the US. If health systems could train doctors and have them pay by working there for 5 years at a lower salary to payback the cost of training them it would reduce the shortage of physicians and keep healthcare costs under control.

  29. Why don't you guys pay more taxes to guarantee an affordable health care instead? In Europe we decided to pay more taxes so that everyone can be healed, especially homeless people. There, if something happens (an accident etc.) you MUST call an ambulance and you are not charged for it. Sorry if i'm being judgemental of the US (I assume), but I think that having to pay for healthcare is ABSURD.

  30. Keep in mind most medical innovations also all come from the US. So all those risks and billions spent by private companies doesnt exist in most other countries.

  31. This is just objectively ignoring the fact that both parties are toxic and taking advantage of a terrible system. It’s not one or the other, it’s both

  32. Both are... Insurance charge a shit ton, just to provide the least ammount of service... they will do everything in their power to avoid paying coverage.

  33. The problem is how well, or how badly, you’re treated is solely based on your insurance. Many doctors feel because they’re not paid enough to treat Medicaid patients, they don’t have a reason to care about the patient and make an effective treatment plan. I’ve been on both Medicaid and private insurance, and the difference in treatment is night and day.

  34. How come we have free healthcare in Europe AND insurance companies, if it's really insurance companies that are the problem? I think your problem is legislation and the whole healthcare system. Insurance companies are a part of that, but definitely not the sole cause.

  35. Corrupted government is ultimate problem here. Pirveate medical services abrod in first world countries are much cheaper without any insurance.

  36. I agree, the government always creates more problems than it solves when it gets involved with business, and healthcare is no exception. But hospitals aren’t logical either… with all their hidden charges and ridiculous billing practices. For example, in 2017 I took a bad fall (thanks to my German Shepherd) and broke my femur. I worked for a small company that did not provide any options for healthcare, so at the time I was uninsured. The ambulance came and took me to the hospital, where I had emergency surgery to put plates in my leg. After that, I was hospitalized for 4 days. I got a bill for something like $32,000, but was told if I was self paying the bill would drop to $11,000. Then I talked to the billing dept to make payment arrangements, and was told as I didn’t make enough money they were going to write off a further $6,000, so the amount I ended up owing was around $5,000.

  37. Here in Canada, it's similar but different. We have universal health care which is amazing for a list of reasons. The only down side is that people in charge don't understand the pressures of understaffing, shitty supplies, BEYOND mismanaged, severely under paid. they all want to save money, which is good to a degree, but its coming at a cost of not having enough and I believe it's the government's way of coxing the public to believe more in private health care. They all hail the holy dollar.

  38. Thank you for explaining to people that universal health care is not perfect! This is the point I’m trying to make. The more another party is involved, the quality goes down. The government isn’t great at managing most government sponsored things. In theory the idea is amazing, but then you have this high officials deciding where the money goes.. and it doesn’t go to health care

  39. As long as Healthcare is a for-profit capitalistic industry, it'll always come down to who can afford it. Privatization is not going to fix the main issue, which is access. The quality of care in this country in top notch. People just don't have access. I agree that insurance companies need to go. For most of my adult life I didn't have insurance. I would always have to pay out of pocket for any services. I would ask what the cost with insurance would be and it was always at least double. Health care providers most charge more when insurance is involved.

  40. We are required to charge a certain amount to everyone, including the insurance companies. However, most health care providers provide a “sliding scale” which generally means if you show us (and it’s very easy to do, I also did it a lot through college) that you can’t afford health insurance that they can charge you less.

  41. Well, a hospital ER would never turn someone away for not being in network. It's a violation of federal law.

  42. My problem with the universal health care by the government, is that the government will decide what healthcare you receive. Have you ever been to a VA hospital? This is a prime example of what health care by the government would look like.

  43. So the government deciding would somehow be worse than insurance companies deciding? No. Plenty of medical services deemed necessary by providers are already denied by insurance companies.

  44. Doctors who work at Va hospitals actually like it because they don’t have to deal with insurance companies. If the doctor says you need an mri you get an mri. Health care is provided by doctors at the Va and is payed for by the government.

  45. Actually, third party payment is the problem. By having a third party in charge of making decisions on a service you almost always guarantee worse outcomes at a higher price.

  46. They're connected to the hip and nobody in America knows any other way. Healthcare and insurance are already in bed with each other, so I'll keep my opinion as a negative against healthcare and insurance. But you're right!

  47. The healthcare itself, as in the medicine, doctors, nurses, etc… is incredible in the USA, the USA constantly leads in innovative medicine. The problem is insurance companies imo.

  48. Actually healthcare in the US ranks around 36-37 worldwide, according to the World Health Organization. Medical errors are still too frequent, care for certain populations is subpar at best (women, especially POC, and especially regarding maternal care), while we spend the most per capita.

  49. What I’ve learned through the years is that Insurance companies actually want the most expensive healthcare possible. Think about it, if all your procedures and dr visits only cost $100 a year, insurance companies wouldn’t be able to make squat because they work off a percentage of your total. If you have $10,000 or $15,000 in medical expenses, then they can make some real money. My insurance gladly let me use my hospital for some very basic blood work and a scan. The charge? $3,500. I had to do the same 6 months later but heard of an independent clinic that could do the same. Their charge was like $700. My group insurance never said a word either way but my company plan premiums went up by 10% that year because of all the “higher prices”. BS. They profit when prices go high.

  50. Or you know.. those tax dollars that we pay so the government can provide essential services could go into something as essential as our healthcare, in line with most other developed countrys. That would be nice. At least we have 11 aircraft carriers though, guess were even.

  51. We already pay enough in health care taxes to get a universal European style system—we would actually be able to buy more aircraft carriers (or schools or trains or whatever) if we adopted universal health care. With just the money we waste on unnecessary healthcare spending (approx 8-10% of GDP, half of the total of 20% GDP we spend on health care), we could buy 2 or 3 extra US militaries for the hell of it.

  52. Insurance companies are also required by the states in which they operate to make administrative payments to those states. The states, in turn, use this money to administer programs which will pay, at minimum, 90% of all uncovered expenses for all medically necessary treatments (including prescription medication and equipment).

  53. I respectfully disagree. Healthcare shouldn’t be a capitalist venture, it should be government controlled considering many people living with certain conditions and people that suddenly develop an illness should be treated without having to worry about their financial future. That’s a real issue for many people. Many countries have insurance companies for those that want expedited treatment on non immediately life threatening illnesses through the use of private clinics, yet still have cheap/free healthcare. The majority of people (90%+) are not able to afford the treatment for their illnesses without insurance due to the exorbitant prices. It’s unfortunately become a luxury. This needs to change however looking at how the government has been passing legislation the past few decades, the opposite is happening. It is to benefit the rich as much as that sounds like a broken record. Serious change needs to occur not just in the healthcare field, but in every other government body to ensure the quality of life for the masses is improved. People are truly suffering but society has been made accustomed to suffer in silence and not speak about the injustice. I’m not from the US I’m Canadian and healthcare is an issue but not for the same reasons (wait times).

  54. Hmm what if necessary healthcare wasn’t made to be a business that people are trying to profit off of, something that is successful in many countries? I think that solves the issues much better and more easily

  55. Its both... hospitals instead of being ran by doctors are ran by executives with business degrees doing EPS calculations and "stream-lining employee efficiencies" (ie making 10 nurses do the job of 50 nurses, [same for doctors]) and then lining their pockets with big-fat-bonuses once they reach their annual target return metrics

  56. Insurance companies are the most obvious symptom of greed, stupidity, and waste. But they are just one symptom of the dysfunctionality in making a free market of a product that is not subject to the rules of the free market.

  57. A big issue which people do not understand is the EMPLOYER. Your employer chooses what services they want the insurance company to cover. But insurances companies are not supposed to tell you that to protect the company and keep them as a client.

  58. Absolutely on point. And thanks to President Donald Trump there is no more penalty for not having Health Insurance. Not going to say that you shouldn't have it but if you can't afford it then you must be careful to not go to the Hospital and opt out of being transported there.

  59. If you nationalized all healthcare you wouldn't have to worry about growing your business. 🤷🏼‍♀️

  60. just embrace the aussie model where our taxes cover most healthcare so that NOBODY gets turned away from life saving procedures for petty bullshit like being "out of network" (FUCK THAT). Rather than your taxes paying for the worlds most overfunded military they should be paying for your healthcare (as well as improving the standard of living for all its citizens)

  61. I don’t consider vision insurance to be in the same ballpark as health insurance. All vision insurance is is a third party trying to get a share of optical profits while offering little in return to both the providers and the patients. I wish the optical profession would just not accept vision insurance. Health insurance on the other hand, while hardly innocent is not the reason for ridiculous healthcare prices, I used to make that assumption as well. We wouldn’t even need health insurance if the cost of medical procedures and medicine wasn’t priced exorbitantly high. That is the fault of greedy hospital systems and medical provider groups that just keep growing larger.

  62. I don't understand why you think privatization would be better? It would be more likely to drive up prices after a time just as anything else that gets privatized (insurance is privatization). The better option is fully government funded Healthcare to control prices.

  63. The idea is transparent pricing. Like in other industries, people would then balance the cost and quality and choose, forcing hospitals and clinics to compete with pricing.

  64. Healthcare is part of the problem. Friendly tip especially if you don't have insurance. Ask for an itemized bill. You will see your price drop substantially.

  65. It’s sad that this is an unpopular opinion because it’s basically a fact that insurance companies are the vast majority of the problem.

  66. this is why everyone has the misconceptions of why american healthcare being so expensive, hospitals charge 4-5x more than what it actually costs simply because insurance companies are greedy as fuck and will only pay up to 20-30% of the “asking price” of the medical bill

  67. I think your opinion falls in one of the traditional 3 categories: 1) universal govt healthcare, 2) government subsidized healthcare, 3) fully private healthcare.

  68. If there was no insurance, I don't think these healthcare workers would get paid as much as they do. Insurance companies are there to take the heat off the health care system, physicians, mid-level providers, nurses and everyone up and down the healthcare system. They get away with their robbery and just say, we are as much victim to the insurance companies as are you. I don't buy it for a second. It's like a big conspiracy. If you could only charge the sick for the services rendered, you'll never be able to make that kind of money. So you invent a whole system to charge the healthy and convince them to pay up with the fear that they may need to utilize some of these services. Now if these services were semi-affordable on paper, people would just shrug and say we'll take our chances. So then they come up with these hyper-inflated prices that would convince us to believe insurance is such a great deal and value.

  69. Nah, free health insurance is should be a basic human right. Other countries do it successfully and it would actually be pretty damn cheap.

  70. Which is why, again, The US should have universal healthcare. And insurance companies should be heavily regulated. The free market had its chance and its not working, nor is it really a free market.

  71. healthcare is bad for different reasons. doctors frequently ignore patients’ concerns, or aggressively push life-prolonging treatment at the expense of QOL. 500K americans die each year due to “hospital error”

  72. No, it's definitely both. Every other first world country has done a better job of figuring it out and it's not all about insurance. They're definitely an obstacle, to be sure, they lobby constantly for making everything worse and getting rid of them, or overhauling them would be a great first step.

  73. I heard something about pharmacists in agreement with insurance companies cannot mention when the drug is cheaper than the copay when asked. So insurance companies 100% steal.

  74. Tbh privatisation gone mad in America is a lot of your major problems. Private prisons that need to maintain a certain amount of slaves. Insurance companies that don't pay out and never provide what they ask.... I'm sure there's more

  75. Both are. Modern healthcare is ignoring issues until they are a problem and then dumping medication on them that you need forever.

  76. It's greed. Greed so that hospitals pay their ceos great sums but their floor staff shit. Greed for insurance ceos charging large amounts and covering little. Greed for pharmacy ceos charging large amounts of money for a drug that cost pennies to make. Greed from our elected officials so this system doesn't change and the payouts they have to pay are crap. This leads to a healthcare system has no drugs, staff, supplies or relief. Who does? We do. Wealthy people can buy their care to a point. The rest of us can't.

  77. The argument is these drugs cost a lot to make, and they do. But that's why as a world we should invest in science research jointly for stuff that will be free for everyone.

  78. Health care in the US is also the problem. Compared to the rest of the western world it is ridiculously expensive. Not just the fact that you have to pay for it, but what it actually costs is astronomically more

  79. If all Healthcare was publicly funded then your clinic would get 40 dollars per visit but they would inevitably see more patients because the patients are not paying at point of use. By volume you would make more or the same amount as if you were charging 120 to only those who could afford it.

  80. That leads to lower quality care. You want to be able to spend time with your patients so you can discuss their concerns and investigate them. The more patients you have to see in a day to cover overhead actually degrades patient care. We keep a full schedule right now and I’d say about 1/4 pay out of pocket, 1/4 Medicaid, 1/2 other insurance plans.

  81. Not unpopular. Insurance companies are middle men between you and healthcare. They cost a fortune and it’s ridiculous. Medicare for all / single-payer gets rid of the nonsense.

  82. It's almost like the average person would be better off with a publicly funded health system that many other countries have. But I guess this is America and that's too socialist... Yeah that thing you confuse with communism.

  83. The issue with privatizing healthcare is the same as the issue with privatising water, accommodation, etc. Things which are absolutely necessary to survive are price demand inelastic. Because they are so important to people, usually life or death type of important, the consumer doesn't have much a of a choice regarding the price they pay.

  84. If you don't have health insurance, health care is too expensive to access. If you do have health insurance, your premiums and/or co-pays may still make health care too expensive to access, or it isn't, but medically necessary treatments get turned down anyway. (Which means pay out of pocket or go without if you can't afford it. Or have the time/energy to jump through a lot of extra hoops while sick or hurt.) From an end user POV, it doesn't make a difference if the problem is health care, health insurance, or some combination of the two - they're inextricably bound up together and the end result is people who are left suffering or even dying because they can't afford to not suffer and die. I know health insurance companies are a problem and I know that the majority of the health care systems are inaccessible to me when I need them. I really don't give a fuck if the doctor is a nice dude or not - I don't know him, and if he won't treat me because I don't have hundreds of thousands of extra dollars to drop at a moment's notice, what do I care about him? I want to not die from a treatable illness and I'd like to be able to see and hear into the bargain, that's not all that much to ask for, and the healthcare system as a whole is more barrier than help with any of it. That's a problem.

  85. Health care is sort of to blame. The cost of some of these medical services, procedures and drugs is outrageous. Guy I work with had to take an ambulance to the hospital but could have drove himself they just pushed the issue, he was charged like $2k. They can get away with charging ridiculous prices for things because people will pay out of desperation in a lot of cases. We wouldn't need insurance companies if the health care was priced reasonably but that will never happen.

  86. Private healthcare, creates greedy insurance companies. It's the root cause. You can't have the latter without the other

  87. Clearly the examples of Eli Lily jacking insulin prices for "reasons" or the left-right and centre rejections by private insurance aren't clear enough that privatization makes healthcare worse.

  88. I get what you’re putting down, but soft pitch you could move to Canada, we’re big chilling up North bud.

  89. The entire system in the US is fucked. I can go to any hospital, any doctor and won't get a bill, nor will they not accept me. I just go. They help me. I leave.

  90. Both of them are the issue. Healthcare should in no way be that expensive. Shit like being charged 20$ for a glad of water, being charged thousands for being put in oxygen for a few hours, being CHARGED TO HOLD YOUR NEWBORN? (I know we've all seen this by now but it's still gross and baffling to me)

  91. the real issue is crony capitalism. insurance is fine if it has to compete, but their money in politics gets them laws to protect their monopoly.

  92. The problem is that "healthcare" and "insurance" are two peas in a pod, as far as America is concerned; they're both just systems designed to work in tandem to maximize profits for some rich CEO at the cost of the patient.

  93. There is a lot more to health care than just hospitals. I feel like these are the CEOs you are mentioning. CEOs are out of touch and there for money. Small business owners, like some guy who runs your local clinic, aren’t out for money, because they meet the people they are charging for a service every day. Small clinic owners aren’t gutless human beings out to make money. They care for their patients. At least for the most part, there are always bad seeds.

  94. I think complacent government officials are the real problem as they have the power to regulate. But we all know that lawmakers are lured by loot lobbing lobbyists who await them lustfully in the lobbies of law.

  95. Actually it's the whole system and since most of the billing for medical claims is based on Medicare's system you can blame the government.

  96. Those codes are dictated by the insurance companies. I actually have to bill different codes for different insurance companies for the same exact exam. Very easy to have an accident.

  97. Then you are relying on government funding to research new drugs. Could work but I have a healthy fear of the government looking out for my best interest.

  98. Shhhhhhhhh don’t talk too loudly your phone is listening, and when you say things like insurance is a scam making the rich richer and serves absolutely no purpose, you’ll pay hundreds of thousands in premiums and copay and never use a fraction of it, and by that I’m including the absolute gouging that the whole industry does because they can, the billions in dividends and pay outs come from your premiums, yes absolutely you can loose everything if you don’t have health care, but the reality is you probably will even with it, if you have a catastrophic health issue, whenever anyone tries to fix the system, it gets chopped apart, it will eventually change but pretty much everyone over 50 will be gone, the younger generations see it, but the power is still with the older generation and they’re hanging on to the ole, “I had to pay for it so should you” attitude, I’m older and I know these premiums are absolutely out of control, with what you get and end up still paying out of pocket, what the hell good is it! No more rant, just saying it’s a corrupt broken system and it’s not because of the healthcare professionals, it’s way above them

  99. I just cant get that if you pay for private health you still have to pay a gap fee. It is expensive so it should cover 100%. I think this is why people rely on public hospitals and medicare. Though doctors clinics can't afford to offer bulk billing alot of the time now it has made some people to go to emergency departments which causes ramping with ambulance. Our health system is going backwards. Such a shame.

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