Just because you paid for insurance doesn't mean you should get it
Just because you paid for insurance doesn't mean you should get it
https://mas.to/@MikeBeas/113666556469008087
EDIT: I think you should get the service you pay for, just so that's clear.
Without realizing it, Mike Beasley makes a great argument for why private, for-profit health insurance shouldn't exist.
It's like all the media that think they are defending Brian Thompson by saying he was less horrible than the average healthcare CEO. Sometimes I wonder if they are making an argument for resurrecting the guillotine industry.
As some who has no clue who Mike Beasley is, that seems like a perfectly legitimate Interpretation. A lot of people, like the one he is replying too, knowingly or not are defending the existing system and the existence of health insurances companies.
I mean, forget about health for a second: we all know insurance companies fucking suck, and they are essentially just a symptom of a shitty system. So why are we fighting/wishing/hoping for them to be run better/more empathetically instead of wanting a different system?
I think the his comment can be seen as a call-out of how some people are missing the root of the issue.
To make it easier to understand for our short term minds, let's sketch a different scenario.
You hire a bodyguard. They're a 7"2 giant bodybuilder with armor. Then someone walks towards you with a knife, raising it up and staring you in the eyes with a frantic expression.
Your giant bodyguard steps aside, and watches are you slowly get tortured to death. Little by little, while you scream for help. The bodyguard tells you Venezuelan blood torture is not covered.
I think someone might rightfully be upset with this bodyguard company. Perhaps as much as the health insurance company that forces people to go into a year long legal battle to get cancer treatment.
At least, that's what I've been hearing about the healthcare system in the usa as of recent.
it's a business that helps you pay your bills
Quite the opposite, it's a business that makes your bills expensive.
Mike is not wrong. In fact, he's very clearly laying out why insurance companies should not exist.
I'm not sure that was the argument he was trying to make though.
he’s very clearly laying out why insurance companies should not exist.
He's laying the case for why insurance must either operate as a public loss-leader or a privatized scam. But I don't think he really understands the bottom layer of the argument.
All I'm seeing is "Insurance is business. Business need to make money. Therefore denying claims is good aktuly." There's no "ah ha" bit at the end where he recognizes their predatory nature.
Do you guys think politicians have a duty to adhere to their campaign promises? They're not under oath. They have no responsibility to improve anyone's life. They're a business to win votes to alter policy in their favour.
"It's a business" is not a justification for evil, and yet that's always how the phrase is used.
Not giving you the coverage you pay for is theft. When are we going to normalize that and start putting CEOs in jail?
Only after revolution, share holders run the country, they wont allow us to cut into their grossly unnecessary wealth, they would rather we die.
Oblige them
UnitedHealth Group is so vertically integrated that, in fact they do own doctors, hospitals and pharmacies under the Optum brand. So yes, they do have a duty to take care of people even if they act like they don't.
It doesn't have to be a solemn vow. The definition of insurance is that it's a guarantee. If it's denying claims it's technically not even providing insurance.
Any company that promises goods and/or services in exchange for money that takes your money in exchange said goods and/or services and then doesn't deliver services or goods is a scam
Yeah, similarly, Burger King doesn't have to give you the whopper you've paid for. BK employees didn't take an oath to feed you whoppers. They only have taken an oath to the managers, who have taken an oath to the CEO, who has taken an oath to Friedrich Hayek and the shareholders to make shitloads in dividends, as is their social responsibility. Everything is working just fine in our society thanks to these nice concepts.
Burger King doesn’t have to give you the whopper you’ve paid for.
The analogy breaks down because BK has an immediate cash-for-commodity relationship with the clients. If you had BK a $5 and they don't give you a sandwich, you stop going.
But insurance takes your $5 up front in exchange for assuming the risk that you might need care in the future. You keep giving UHC $5 day after day and week after week, receiving nothing tangible in exchange. It is only when the risk materializes, at the moment you need care, that you ask UHC for money back and they say "No".
This leads some people to advocate for health savings accounts as a replacement for private insurance. But then you have to deal with the possibility of a medical claim that exceeds your balance. So you get conversations about risk-pooling. But that just takes you back around to insurance companies again.
All of this is in an effort to discourage people from implementing public free-at-point-of-use health care (a la the NHS). The idea that we would simply have hospitals you can go to when you're sick, in the same way we have elementary schools to go to when you're young or fire departments to go to when you are on fire, is so totally alien to the hyper-individualist profit-fixated neoliberal capitalist that it never seems to come up in conversation.
The very concept of paying for health care through insurance is evil.
Why do we even allow a profit motive to deny health care? Should be straight up illegal.
This gaslighting won't work anymore
Insurance is defined at its core as a transfer of risk. Its that simple. If insurance denies everything I send their way while I am paying them, its no longer a transfer of risk, I am simply paying someone to tell me 'no'.
That out of the way, the whole health insurance industry does not follow the concept of transfer of risk. The insurance companies rather follow the concept of transfer of action. Basically I am not going to spend all day negotiating with a hospital. That said, them denying is because they do not want to do the work still, so in other words, I am still paying someone to tell me 'no'.
In both concepts, the insurance companies are not doing what they ascribed to. Along with the laws that congress stripped away affordable care to its basics that we all are required to have it - read an extra tax but to corporations who give kick backs to their congressional lackeys - and the fact that insurance companies basically are price fixing all the rates and such, it becomes a lose (you)/lose (you)/lose (hospitals)/only ones who win are the companies.
Late stage capitalism hard at work.
I think that if money exchanges hands, it's part of a deal that must be honored by the other party.
They're getting very close to saying the quiet part aloud, and the quiet part is...
"Everyone except for the .0001% exists for the service of said .0001%, and the fact that you have any self-respect or value for your lives is a failing on your part peon!"
I don't care what that guy thinks.
That why insurance should not be for profit.
We should stop calling it "insurance", it doesn't ensure anything. We should call it what it is - a protection racket. Either that, or we could refer to it as "medical loans" - of course, it's all paid in advance, in many installments. Oh wait. That's just defining a protection racket again, isn't it?
Loans pay out.
Oh no, each claim is a new loan application. You pay in your premium to have the right to apply.
It’s a protection racket similar to the mob, except the mob has scruples and will actually protect you if you pay up. If you don’t pay up, broken kneecaps.
Health insurance is just paying for broken kneecaps. If the mob ran healthcare we’d have better outcomes than we currently do, let’s be real.
insurance is a fucking scam that preys on the most vulnerable segment of the population in order to enrich themselves and their shareholders. and the vast majority of people think that's just the way things are in america, therefore it's the best possible way for things to be. what's not to understand?
The free market is excellent at producing, at a reasonable cost, myriad voluntary luxuries like large televisions and speedy cars. These prices are naturally constrained by the consumers' willingness to do-without. When the consumer cannot rationally choose to do-without, the elegant self-regulation intrinsic to the free market evaporates.
So well worded. I struggle to get this concept out when discussing the concern about grocery prices and why homesteading / community gardens are the only protection we can reasonably have right now
If that's the tack he wants to take with his argument, than in fact that opposite is true.
They're a business. You provide them money and they provide a service. So in that respect, there should be no such thing as denial of service for ANYTHING because you've already paid for it.
What about the contract?
Well, what about the contract? Traditionally, contracts have three main elements: Offer, acceptance, and consideration. That is, one party offers something, the counter-party accepts the offer, and there's an exchange of something of value between them. It ought to be obvious to even the most casual observer that there's a lot to unpack about acceptance. Clearly, the party accepting the offer should understand the offer in order for the contract to be valid.
If I offer the neighborhood cats treats in exchange for not digging up my plants, and they accept, that doesn't give me a cause of action to sue them (or their owners) for breach of contact when they still dig up my plants. A cat cannot lacks the understanding of the offer, and cannot accept, and therefore no contact exists.
Similarly, if a human lacks the mental capacity to understand an offer—say, a person deep in dementia agrees to a reverse mortgage without knowledge of their legal guardian—a court can rule that no contract existed, because the person did not understand the offer.
Health insurance contracts are anything but clear. In fact, the Byzantine details surpass the ability of most people to understand. (Part of my job in the past was getting paid to read and interpret health benefit statements for other people. Quick— what's ERISA, and what are the legal implications of health insurance vs. health benefit plans?) Is it really a valid contract, if people can't even begin to understand the offer?
One might say that people should get an attorney to look it over. Yeah, and then what? Counter-offer? We don't have much leverage to do so, because the terms of all of the offers are bad, and opting out of health coverage entirely is not a good option. (Even the healthiest person could get hit by a car and be financially ruined for life.)
That's the source of the anger. We can understand how insurance is supposed to work: Pay premiums to mitigate risk. Instead, these companies hide all manner of gotchas in contract terms we have no hope of understanding. Traditionally, that would not be a valid contract, but the legal system seems to exist to serve the powerful, so it enforces them anyway. (Even then, the insurance companies try to avoid fulfilling what seem like their clear obligations because sick people lack the wherewithal to fight them.)
Funny how life insurance always pays, no problem. Because if they get a bad rep, people will go elsewhere. We can't do that with employer-covered healthcare!
These tricks are many, this is just the tip.
You know... that kinda vow would be a great idea! Doctors take an oath like thing too, right?
Insurance is a racket. Is that what Lil Mikey is saying?
I would assume that I actually get a coffee when I go to Starbucks and pay for it.
Worse than that they staff doctors in name only. The type of quacks who couldn't make it in the real medical world. I really don't understand how they can't be sued for malpractice when they argue a diagnosis with your doctor. At that point they are acting as your doctor.
That's why you have to request the documentation and proof of specialty to confirm whether they're acting out of scope.
From personal experience, the vast majority are practicing out of scope. It would cost them a ton of money in overhead to have a cardiologist deny a claim for cardiology related testing or treatment so they just wing it. In some cases it's not even a physician, it's a nurse, NP or PA.
This is where government needs to step and regulate but we all know that isn't going to happen.
... This dude needs to understand how other types of insurance work
Not a meme.
Oh, look, it's the guy who doesn't know what a meme is and insists on spamming it all the time
And the guy who proved that their bio:
I say unpopular things but never something I know to be untrue. Always open to hear good-faith counter arguments. My goal is to engage in dialogue that seeks truth rather than scoring points.
Was a lie yesterday.
The customers of insurance companies are shareholders.
That's not what a share holder is
You misunderstand. The service that insurance companies provide is one that is for shareholders. It's a way of allocating and rationing medical care while also keeping business going.
Poor people don't own hospitals. Poor people can't develop medicines and medical equipment. Can't train and hire doctors. That stuff is extremely expensive. The capital class owns that stuff, right?
They aren't just going give it away are they? But they do need a labor force that, though desperate, isn't too sickly that their labor can't be exploited.
The service that health insurers provide to their actual customers, the capital class, is to reallocate the aforementioned expenses back onto workers by way of premiums and limiting care to the bare minimum.
This is why health insurance is tied to employment in America. You (most likely) didn't hire your health insurer and negotiate your insurance contract, your employer did. It's not for you, it's for them, and really, for their owners, who extract the value of your healthy labor from your employer.
And this isn't come an-cap or communist hot take, this is just the economics of how healthcare works in America. You're getting the care, sure, and if you're covered hopefully you're in the road to recovery and won't become insolvent due to medical debts, but this system is not for your benefit. It's not out to save you money. You are at best an afterthought, a concept of a customer. More of a number.
The OOP described is, in different terms, as if health insurer was nothing more than a risk pool cooperative.
Here are the customers of UNH:
They also own the hospital groups, the device makers, and the pharmaceuticals.
Not a fan of the smug liberal aura this post has.
I feel like every time someone uses the word "liberal" on lemmy, the meaning of the word shifts slightly to the right.
You can point out someone is wrong but still agree with the spirit of what they're saying...
It rarely goes over well, but I do it all the time. And I'm pretty fucking progressive.
Like, if people honestly thinks their insurance took a vow to protect them, it needs to be corrected. They're not saying it shouldn't be changed, but the first step to fixing it is understanding where we're at.
Like this guy has a point they dont have a duty of care, they didnt take an oath, they are a private for profit company with shareholders. They will absolutely take as much as they can, give you as little as they can and be as cunty about it as they can get away with.
Its fucking WRONG but its not surprising.
To be honest, I hadn't interpreted the quoted toot (man I do hate that they are called toots) as trying to educate people on how insurance works. In that light I do agree with what you are saying, people should be aware of how these systems actually work.
Apologies if this post is coming off as overly 'smug liberal'.
Crowd sourcing heathcare funds and taking bets on who gets sick sounds great but only if it's some capitalist Rube Goldberg Machine. Otherwise that's communism.
Beasley kind of has a point that it's a stretch to call monetary debt as murder, but I really hope more people start voting for politicians who will end privatized healthcare.
Even if a claim gets denied the fact that it was submitted means you already got the treatment.
Even if a claim gets denied the fact that it was submitted means you already got the treatment.
That's quite often not true. There are tons of procedures/tests/etc that don't get run until a "prior authorization" has been granted by the insurance company. Also medications and durable medical equipment are not dispensed until insurance has been approved. If the prior auth is not granted or the medication is not covered, they usually will not be performed/provided unless the patient pays up front, and without the negotiating power of the insurance company, the patient will be paying 5 to 10 times what the insurance company would have paid.
I've personally been dealing with medical issues the past 3 months and the amount of prior auths I've seen go by is astounding. Tomorrow I actually go in for some more tests that they couldn't do a few weeks ago because these ones in particular needed some prior auths that are harder to get.
Generally speaking, uninsured medical costs and medication are cheaper than what the insurance company pays. SOURCE
Hospitals and Insurance companies do this because it's a write-off for the insurance company and it makes the patients feel better about their coverage plan.
You likely could get the treatment without the authorizations if you pressed, I sincerely doubt the hospital would try to stop you, but that would put you into debt so obviously don't do that.
Denied treatment is murder. Social murder. Stop simping for these companies they don’t give a fuck about you.
The worst part is, they actually hire doctors to analyze claims and they're the ones making the decisions whether the claims are accepted or not.
Edit: clarification
I'm sure the doctors stick with reviewing claims for which they have a lot of experience, spend the time to actually review the patient's specific scenario better than the doctor who saw the patient, and aren't financially incentivized to deny as many claims as possible.
Shouldnt a doctor be "reviewing" the patient before making decisions?
Like wtf is is this middle manning. You go see doctor, then another insurance doctor is checking his homework but only based on paper work and with a financial incentive to deny as many claims as possible.
Also, I bet they explicitly state they are not rendering care when they review a claim, CYA legal shit. So are they even acting in their capacity as medical professional or just paper pusher with an MD. I don't think it even requires a licese.
Exactly.