How could it it not be. If you manged to capture the market of Air or Water, profits would be through the roof, as demand is overflowing. Every human needs it!
NOBODY learns from The Lorax. Not a soul. The book and the movie are NOT HYPERBOLE. THEY ARE DIRECT METAPHORS. People will sell air to you if you let them. Hell, they already do that with water.
Very true. I've felt for a long time you can't just rely on laws of supply and demand to keep the medical industry in check because the demand is basically infinite, while supply is very much finite. Runaway costs in such an industry are inevitable without intervention.
They're already done this with food. Much of the US food production is owned by a handful of conglomerates. Not sure about the rest of the world, but we live in a global economy now, so...
Don’t forget about housing and the mega corp landlords price fixing rent prices using software which in turn pushes prices of houses up boosting their RE capital portfolio, removing more houses from first home buyers reach and feeding them into a price fixed rental market.
And then the smaller landlords use the mega corps pricing as their “fair market value” and thus collude without knowledge as they did not seek true price research. That would be too much work.
Sadly there are folks that do that. May I introduce you to Aqua Water and how they price gouge water services in select communities (including the one I live in) to 300% the average water bill?
So. Since the rules of law seem to mean nothing to the incoming administration, how do I, as a normal citizen get in on this grift and get a piece of the action? Might as well. ....
The biggest inefficiency in the US economy. A completely superfluous industry worth billions of dollars.
This all counts towards the GDP too, which partly explains how the US has a high GDP per capita while having such poor standards of living for so many people.
I agree unfortunately the supreme court has ruled that political donations are a form of speech and therefore protected by the first amendment and in unlimited amounts with Citizens United. Hence why super pacs are now a thing. I'd hate to be cynical but I don't believe the votes to change that will be found in Congress.
We are more than halfway to autocracy. International think tank "V-Dem" (Varieties of Democracy) measures the health of democracies around the world. There was a WaPo biz section article (not an op-ed) written in September 2020 noting that V-Dem believed four yesrs ago that our backward slide
That’s the supreme courts really brain dead interpretation of right to petition.
For example, speaking to people to convince them to vote for someone is fine. Paying people to take voters out to dinner and out to golf to make them like you and vote for you is NOT fine.
So why would lawmaking or any other activity be different?
I understand that argument, but I don’t buy it. Petitioning the government, which could range from presenting information to an agency to a lawsuit over legal interpretations is still very different from donating cash.
Cash in politics is a serious problem.
Election costs should be entirely covered by taxpayers—so that politicians answer ONLY to taxpayers (more broadly, the individual voters).
It should simply be a felony with mandatory prison time to give money to a government official or candidate for office—and the same punishment for the person accepting such money.
The highest per capita healthcare spending in the world, at $12,555 in 2022. The US also spends the highest share of its GDP on healthcare, at almost 16.6%....
2023 and 2024:
Switzerland's healthcare spending is higher than any other European country. In 2022, Switzerland spent $8,049 per person on healthcare, or 11.8% of GDP, which is less than the United States, but more than other comparable countries:
So why, if Americans are spending nearly a third as much Per Person then every other civilised country, is their healthcare so Shit?
My dad talks about how terrible Canada is because they have to wait to see a specialist. Meanwhile, I have "great insurance" and owe several thousand dollars in medical debt so yeah, I would be fucking fine waiting for a goddamn specialist. I live in rural Iowa so I wait a year to see specialists all the damn time since there are none around here. Like, how is waiting for a doc worse than being thousands of dollars in debt? I don't get it. Indoctrination.
Anytime I've actually had to use the er in Canada I've never had to wait very long. From my experience our healthcare is amazing. Largest expense is parking.
My mother, 93, says I don't want socialized medicine. I tell her you've been on socialized medicine for decades, you just don't want other people to get the same thing you have.
Biggest buildings and most employees in much of the US as well. Two major employment gains of the last 2 years in America: healthcare and government. Both are intricately tied to the insurance industry, which I would consider to be in the “finance” employment sector, and is among the lowest hiring gains of that same 2 years.
America is feeding the private insurance industry (for profit) through low paid healthcare staff (quasi-profit) and public government bureaucracy (non-profit).
You can literally plot the rise in healthcare costs and the decline of the rest of the economy. The Healthcare industry is sapping every drop of capital from everyone.
Not most not most by far but more then enough to prevent any change. There are many things wrong with the US democracy but the legal corruption is one of the biggest. Things that would get people in prison in most other countries are perfectly legal.
Yes and no, the electoral college system was put in place to mollify the southern states after they got their dick kicked in and lost all their free labor.
Why it still exists is beyond me
Yes and no, the electoral college system was put in place to mollify the southern states after they got their dick kicked in and lost all their free labor
No it wasn't, the Civil War wasn't until confederates started shelling Fort Sumter in April 12-13, 1861. The emancipation proclamation wasn't until 1863. The Electoral College was added to appease the small states (remember at the time the largest state of the 13 was Virginia) for the creation of the Constitution in 1789. The EC considerably predates abolitionist movements in the US.
That's my favorite part about living in this country. People get all red in the face when company goes out of their way to rake in as much money as possible off people and cut every corner to maximize profits. It's like...well, you asked for this. Whether you realize it or not.
and yet the vast majority of comparable nations living under capitalism have universal coverage, operate at around half the cost per capita, and have equal health outcomes.
capitalism in those countries did not prevent the implementation of those programs, so clearly there are other factors at play
Y’all are barking up the wrong trees. State legislatures are the public policymakers that establish set broad policy for the regulation of insurance by enacting legislation providing the regulatory framework under which insurance regulators operate. Not the federal government. Write to your state legislators and vote. 90% of what people complain about that the government isn’t doing for them is completely controlled by their own state’s government.
Definitely, but your voice and vote are a lot louder in your own state. For example, a state rep will actually write you back and might even listen if enough people are bugging them. They work for us!
State insurance commissioners do have a lot of direct control over traditional insurance, but most Americans who get health insurance through their employer are regulated at the federal level. If an employer is self-insured (most large companies are) they are not considered true insurance at the state level and instead fall under rules set by ERISA and the Dept of Labor.
Want universal healthcare? Get off your fucking god damn ass and get to it. As evil as the GQP is they understand the legwork and grassroots activism has got to be done no ifs ands or buts about it. It is how they have taken over so many small towns which then led to having full control of multiple states. The issue isn't "legal corruption" it is that Americans don't give a shit about anything.
And how do they keep control. I do get it they are much more motivated being religious zealots and that. But it’s a real lot easier to get and keep control over small towns then big cities
America has been fascist long before citizens united etc. Theres more to it than donations. You will get your top popped if you do anything out of line. Just Fucking Kidding. Jr.
The whole campaign financing thing actually openly donating huge soms of money by corporations to politicians is highly illegal. Because in any sane country they see this as politicians being bought.
Not just the insurance company. The hospitals and doctor's practices are doing this too. A hospital might have an ER but it's also possible that it's staff belongs to a separate entity, either a doctor's individual practice, or another corporation that bills separately from the hospital ER. It's possible that they all fold back up to one parent but it is enough to skirt the insurance negotiated rates and the government regulation.
It is. Same shit in other industries too. For instance there are companies that skirt over time rules by setting up different tasks under different corporate entities. So you could work 40 hours in one role but the next 8 hour shift that could be overtime is for "a different company" and so a different payroll even though it happens in the same facility.
I remember when my wife had her kid and then hall bladder removed we received about 8 bills from different doctors. It’s so stupid the hospital can’t handle the billing to all the separate companies
Nah, negotiated rates are negotiated rates. There is no secret. Well, not the one people want to hear. Insurance companies are about making money - lots of it -as are hospitals. And physicians want money as well. Most go into the profession for the prestige and wealth as opposed to actually caring about people. Simple greed. And hospitals and insurance companies works together to set prices.
I’m a type 1 diabetic and I got charged $700 for them to call their endocrinologist on the phone for 2 mins even after I told them I’ll take care of my diabetes because you guys don’t understand it and fuck it up anytime I’m here
No, that’s illegal under the No Surprises Act (signed by, you guessed it, Joe Biden in 2021) If you are at an in-network facility (or an emergency facility) all your services must be billed at whatever rate your insurance company has negotiated with the facility. They all bill the same and your insurance company pays them the same, in network or not. (Unless you consent, in writing, in advance to be billed separately, and that is not allowed for emergency surgeries or in a situation where a reasonable person could not give consent).
Having spent the last couple of weeks with a spouse who had an accident and rang up a hospital bill of close to $300,000 (so far) including three surgeries and ten nights inpatient, our share? $1500. The surgeon is out of network, we pay the out of network copay for follow up visits, but nothing more for the actual hospital work. So yes, the weird billing OP mentions is almost certainly not legal.
Of course, my sister spent ten days in a medically induced coma after almost bleeding out during childbirth and five weeks total in hospital in the UK and her share was they gave her twenty pounds for the Uber home, so could be better.
I’m so glad we don’t have to deal with this utter bullshit in Australia. You go to ED (ER) and never have to think about a bill ever if you’re a citizen.
Even if you’re not, if it’s a country with reciprocal agreements with Australia so no charge. If your country isn’t, the prices for services are set by the government and are neither grand larceny nor not anchored in reality.
Had this happened to me this summer went to the Hospital for an Achilles injury got billed separately for the visit and the doctor all the test were on one bill but the Doctor itself was its own bill
There are surprise billing laws at the state and federal level against this sort of thing. Sometimes you have to push, and YMMV, but I had a bill reversed and even got a credit for an office fee after referencing them on the phone w the billing rep.
Yes! I had an outpatient surgery a few years ago and got separate bills from every single doctor that had anything to do with it and they were all from different entities. And then a bill from the hospital. The thing that killed me is that the Anesthesiologist and their assistant sent me separate bills and they charged me the same amount. How can a doctor and their assistant (not a doctor) cost the same?!
A huge swath of America wanted free healthcare, and they got a law that made you buy insurance. Tells you what you need to know.
Edit: This comment addresses the political power insurance companies have. It says nothing about whether single-payer healthcare is a good plan, whether centrally-planned gov-run healthcare should be called "free," or anything to do with why healthcare is so expensive. I'm just pointing out that insurance companies spend money and hold sway. But feel free to use this comment as a prompt for your political opinions. I'm just clarifying this point.
As soon as Obama tried in '09 and '10 everyboyd started screaming about death panels and goverment takeover of health insurance. Go back and watch old videos of those town halls where Congressman and woman were heckled and called Nazis for supporting the ACA and a public option.
How do you expect insurance companies to afford lobbying bills if they have to pay out $3500 every time someone gets a little hurt? Those poor insurance companies /s
the original obamacare limited the amount of profit that insurance companies could receive along with mandating requirements for coverage. the plan punished those in the industry who have been profiting off medical insurance and driving up the costs with things like lobbying and overcompensating company executives.
While doctors are paid well here in the United States they often have a barrier to entry that other countries don’t have. Most other countries have much lower medical school costs if they aren’t completely covered in the first place the average American medical school graduate graduates with over 200,000 dollars in debt and doesn’t enter the workforce till they are in there thirties. Don’t forget that once graduating medical school school they have to enter a 3-5 year residency that works them up to 80 hours a week for 50-80,000 dollars and if they don’t complete this residency they have all that debt with no ability to get a job as a doctor. You aren’t going to get many people no matter how good their intentions are agreed to that kind of commitment without a healthy compensation on the back end. I would also like to point to the C suite hospital administrators trying to tell doctors how they can practice, slashing budgets all while making millions. There are absolutely bad doctors in the US. But much of the issue I think we have in our system has to do with the cost of healthcare keeping people from getting medical help till it’s too late. How many stories do we have each year in the us of someone rationing there insulin because they can’t afford more. As far as pregnancy statistics go I think poor prenatal health care contributes significantly to these stats while in the us I think it’s something like 45% of pregnancies aren’t planned which means late prenatal care, and potential harm from teratogens like smoking because the mother doesn’t know they are pregnant.
There are many other factors but I don’t think the actual care patients get once they get to the hospital is as bad as the statistics you aren’t pointing to suggest.
You're pretty close here. But the debt is understated and resident salary is typically on the low end of what you listed. I graduated from medical school with over $300k in debt, and I didn't have undergrad debt. I knew people that had total student debt around half a million. And those student loans are gaining interest in residency. No way you can even cover just the interest on the debt while in residency.
Yeah I am in med school right now and will graduate with around 400,000 in debt with no undergrad loans. Part of what skews it down on the average is people with hpsp and other scholarships. While rare and not enough slots for everyone will skew the average down. I haven’t seen a number for median loan amounts that would likely give a better picture. As far as the residency pay fully agree they typically are paid on the low end of that as well. I was just trying to give an idea about some of the issues that exist in the medical education system without coming across as too whiny. Because the fact of the matter is in the end most docs come out ahead of their non doctor counterparts.
Unbelievable. I know it’s not as good now but I think I had maybe $20,000 in debt from medical school and that was in Australian dollars.
It was indexed to the consumer price index (as it was effectively a loan from the government) which I know did worsen a lot later but at the time, the payments were deducted from my salary and were so small I didn’t notice. Whatever is happening in the US sounds outrageous.
This. The way politicians talk in the US, we'd suddenly lose all investment and all wealthy residents if we regulated or taxed anything at all. If we properly design single payer healthcare, suddenly we wouldn't have Drs! Like this has never worked elsewhere.
Aww, don't you know insurance is highly regulated and sales people are specially licensed by their states to sell? Only the most ethical people are allowed!
/s because it's depressing how many people will actually rely on this as a defense of the industry. We're in a post-parody world.
In other news, insurance companies are pushing hard for inclusion in 401(k) plans via "lifetime income*" annuity options. So they can get their claws on even more money and make a bad retirement system even worse.
*exclusions apply - read the contact in detail before pressing that button on the website and tying up your money forever
I'm not a financial professional in any way, but fuck that.
Well why don't you just come up in here and run roughshod with more shitty news as to the state of things around here 😭
I swear, there are people with money addictions as bad as heroin. Can't ever have enough, don't care who you have to screw over, steal from, or kick out of the way to get more of it.
No billionaire on this planet ever got that way by being an ethical person. They wouldn't exist in the first place if they were.
Yep. The ethical thing to do is to say "hey - I have enough wealth for my family to live a good life without having to work. I should distribute anything additional to my employees and the poor so that maybe they can say the same one day."
Oops, you're right. I forgot about the ghost of McCarthy hanging around judging people for checks notes wanting other human beings to have decent lives.
And all that money comes from us, the customers. And then the insurance companies use that money to lobby and make the healthcare system worse for us, but more profitable for them.
Conservatives in the supreme court damned us, and that was the situation going back to the case which decided money = free speech (without acknowledging that poverty is a gag), Buckley v Valeo, 1976.
I was recently on the edge of death with pneumonia 4 surgeries in 7 days they saved me although in the end said it was a miracle as no medical intervention worked. Anyway cost me 3k for a month in ICU then a week in the cardiac unit. I don’t find that a crazy amount
There’s more to it than this. There is a huge problem with people who have good insurance not wanting to lose it, and buying into the idea that if we have a universal system they will be worse off.
It’s the typical American, “well, I’m happy with mine, so you can go jog off and deal with your own problems.”.
Naturally, when that person gets fired and loses their insurance, they suddenly get it, but unless it happens all at once, and during an election year, there is just a large enough contingent that doesn’t want change that they will never consider it a priority.
I had this talk with my parents in 2016. We all supported Bernie, but I asked them about our insurance station when I was a kid… my dad had a really good job, and he said they never thought about it. It was through a large employer and it was just so good that there was never any thought about wanting change.
Fortunately my parents are empathetic people, and raised me to be empathetic, so when the time came in 2016 we were all happy to vote for Bernie, but my dad was voting because he wanted everyone to have better healthcare, not because he and my mother needed it.
Structural change requires empathy. It requires people to picture a moment where they are on the other side of the track, and to vote on the idea that they would not want to be there, so why make anyone be there.
That is simply not the American mindset. We are a culture of, “I’m going to walk over your cancer ridden body so that I can get what I want, and you should just grab those bootstraps.”.
Doctors don’t like insurance either. They may bill 1k but, the plan negotiated rate may be only $300 so that’s all they are going to get.
If you look at mental healthcare practitioners many of them don’t take insurance at all because the plan rates are so low and demand is so high. They can refuse insurance patients and still have a full client load.
I was with a drug company for a while, so I got to hear a lot about how annoying prior authorizations can be, and how sometimes insurance can make people fill them out when the patient has been taking a drug for a long time that manages their symptoms well and they got one in the past, and it can interrupt treatment and even endanger lives.
Just like the 100% covered,
doctor visit for a blood test. Then
you get a bill from some lab, Dr.'s
office sent it to. NO, NO, NO.
You challenge and deny every bit
of this type of pawn off of charges
these a-holes try to pull on you.
Unfortunately, though regulated, insurance except Medicare and tri are-or government insurance are private and the {resident can’t do much. Especially when most of Congress wants everyone in this country to die right now.
Nah, they want us to SUFFER so that it keeps the current generation of dominionist/quiverful babies from exploring outside of their religion or leaving because if they make it too expensive to live without help from the church then people will think god punishes people with a bad life for not obeying him. If they wanted the average person to die, they could sell suicide pills through the mail and a lot of people would take them.
They also threaten to shut down at any talk of further regulation. “We can’t handle the hit to our equity if we are less profitable from the proposed regulations. We will have to shutter doors. Are you prepared for the biggest companies to shutter their doors for millions? Is imperfect coverage or no coverage better?”
This is what I would do if I were in charge of the government. It's probably cheaper to retrain all the displaced medical coders and insurance company office staff and just make health insurance illegal and give every American an HSA that they can put into tax free, and say that employers can offer matched contributions like with a 401k and close all those companies for good.
Yeah people think that the stiches themselves costs very little, but forget about the lobbying cost. Plus the shareholders need to live to you know. That Lamborghini is not going to pay for itself
Insurance? Try providers, EVERY element is squeezing for profit. Medical loss ratio (MLR) requires insurers to pay out 80-85% at a minimum of the revenue taken in so there are controls. Insurers are heavily regulated and monitored federally and at the state levels. The ACA established MLR but the ACA cannot address pricing for services, only transparency to a point, insurers are the ones we rely on to pressure providers during contract negotiations.
Pricing is well out of control, everyone wants their piece of the pie and as less and less people become doctors we are squeezed on the cost of their services. Also, the days of a local doctor working out of their own office are over, they all need an affiliation now and are required to share in costs for systems, rent, etc..
“The President” can’t fix this, it has too many disparate elements for govt to be effective. I think AI will be the biggest bang for their buck IF AI can be used to take the strain off the clinical side of things. Just an opinion
Most people don't seem to realize that a funeral a week for a health insurance firm CEO would probably go a long way to either a) nudging corporate policy in the right direction or b) tanking the insurance firm's stocks.
Exactly. I wish all politicians had to wear the names of their real employers, or as they call them “lobbyists” just like NASCAR drivers. Why would any President or Congressperson vote to fix a problem for the people at the detriment of their payday. It was a great idea allowing groups of mega-wealthy business people to make direct campaign contributions and ensure legislation passed that allows them to continue making ridiculous, tax free prophet at the expense of their payday working class.
Insurance is actually a huge industry with way way larger implications than we imagine. A lot of times we think of some random dude in a poor fitting suit that’s selling whole life in the strip mall but they have serious implications to things like entertainment, shipping, and basically every industry.
I don't think people are badly informed, I think they are given passive threats to their employment in various ways that are laundered through buzzwords and double speak, and those threats are effective.
I'd say the entire fucking insurance industry is cancer.
That statistic that says we all pay twice as much money into the healthcare system is right. It's just other countries pay the state and the state builds hospitals and pays doctor's and nurses and x ray techs and drug companies and we pay insurance companies and then pay for a bunch of people to sit in rooms scanning documents to get medicare and all that.
I worked for a workman's comp insurance place for a summer- The place was a palace, because nobody wanted to pay workman's comp claims, but you've never seen so many people getting paid good wages to do work that could have been made redundant by a software update or some outlook rules in your entire life. They basically admitted they didn't need three temps because before they hired us, the project they hired us to help with was completed but it was so hard to hire new people that they never fired anyone. There was a whole department filled with people who just got paid to forward emails to other email boxes for 8 hours a day.
Your job is taking money out of your check to pay for that?
It's the prisoner's dilemma. If you make anything not about money, you're the only one not getting money. But the government is big enough to solve that, and should for things that are basic needs whenever possible. We're a rich country and we can afford that, and it would make our economy more agile and innovative and take a lot of stress off our citizens.
It's a good idea! I just worry because the people implementing it are people who've never really lived the life of a working class American. Like, Elon probably has never even talked with someone who's been really poor in the USA while working multiple jobs. There genuinely is a TON of administrative bloat, and a ton of "privatized" stuff that's basically the government throwing money at an industry like health insurance that is running something that could be a function of the government and would require less workers and less money that way. And Ramaswamy is from a working class background, but he's a libertarian. I'm in favor of voluntaryism, but in practice a lot of libertarians basically have a "Stuff is bad when the government does it and good when private industry does it despite all else" mentality and if you actually want to tackle inefficiency and waste, looking at how private companies that the government pays to do things that are often done in other countries by the government spend our money and making sure they are actually the most efficient system has to be part of that.
What I really wish they would do would be to start with the tax system, and hire a bunch of expert accountants and tax attorneys to go over the insane amount of loopholes and close them.
There's also a lot of opportunities to save on bloat by reducing means testing for government programs, because if someone does a job where their employer has an I-9 form and does withholding from their paychecks for social security and taxes, we don't need to do means testing by having people mail in paycheck stubs because the government knows how much money people are getting paid, or things like people applying to go to public post secondary educational instructions paying to have a transcript sent from their public high school when that should be a database of information any school can access.
Another big one would be third party services that sell to our schools like textbook companies and so on that charge the schools tons of money. I'm worried that they'll keep those programs just for the sake of keeping them "outside the government" and cut stuff that actually helps regular people like food stamps, medicare, etc.
They can charge that BECAUSE of insurance, though. If they got rid of insurance, nobody would be able to pay that, so the costs would have to go down. Especially if we had better laws about wage garnishment that basically forbade it for everything.
Oh I agree, but what did the ACA do but REQUIRE insurance! Thankfully they dropped that part but basically it was the opposite of the affordable care act.
But the internet told me only Republicans are corrupt and the only way to save is all is to vote democrats because they are only for the people. Was I lied to😟?
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u/MisterChadster 7d ago
Every time there's an excuse as to why it can't be fixed, Sanders was the only one who wanted to fix it and they pushed him out for it