Government health care subsidies and purchasing programs have completely destroyed the market for services. It's an incomprehensible mess of products with a bloated middle layer that only exists to extract value out of the actual Consumer + Expert Care Provider equation to the extreme detriment of both of them.
How anyone stays alive and wealthy in such a system is beyond me. Very few, apparently, are fortunate enough to enjoy this. We need to completely rethink this entire model.
It’s almost as if people warned about this very thing. It’s almost as of anything the government touches turns to crap for most while a few, especially those in Congress, ride off with a huge pay day. I’m not sure why people continue to fall for it.
yes, things tend to turn to crap when you have half the government composed of a party dedicated to ensuring that everything government touches turns to crap or benefits the wealthy. not sure how this is a valid point or makes the case that allowing industry to police itself will work.
When that’s the game, don’t let them play. The party you’re referring to is ambiguous. Democrats seem to make an awful lot representing their constituents[0].
Health insurance shouldn’t exist. When the government mandates it, now there are two problems. If this wasn’t obvious prior to the ACA, I have a bridge to sell you.
Christ, reading Americans declare that the issue with American healthcare is "too much government" always completely floors me. The system did not work well before the ACA, the system does not work now. The only countries in the world with strong, consistent and equitable healthcare systems have government health systems.
Here in the UK our NHS is a goddamn mess, it's cracking and creaking and bureaucratic, but every American expat i have ever known who now lives in the UK has horror stories about how much worse it is over there. In our monthly social classes (PSHCE) we watched documentaries of poor Americans unable to afford healthcare, and it horrified us all.
You can't run healthcare as a profit seeking enterprise, it just doesn't work, the financial incentives of healthcare providers just fundamentally do not align with their customers. Government run institutions can often fall into a state of bureaucratic atrophy but if this and countless other stories make clear - that's an issue with institutions in general, whether they be government run or not.
This problem will not improve until you get over your ideological commitment to trying to solve every problem with markets. Healthcare must be socialised, anything less is barbarism.
Health insurance is the problem and always has been the problem. Having the government mandate insurance is far worse than a public health system. Currently we have the worst of all of the options (and if an insurance company has bought all of the smaller providers in your area, it’s even worse)!
Healthcare hasn’t been a “market” in decades. It’s completely captured by monopolies which have captured regulation to prevent any alternatives. I do know that the mashup of government mandates for for-profit entities is about as corrupt a system as could be conceived.
> we watched documentaries of poor Americans unable to afford healthcare, and it horrified us all.
A system so good shouldn't need such propaganda to justify it's existence.
> you get over your ideological commitment
The ideological commitment that are the underpinnings of our system of government and the core of our very constitution? Why don't you just "get over" your ideological commitment to entertaining that absurd royal family?
By what metric are you evaluating corruption here, other than selected news anecdotes that support your ideological intuition.
We watched videos of the horrors of the American healthcare system for the same reason as we watched videos and were otherwise taught about oppressive regimes, international poverty, bigotry and racism both local and international - to learn about global issues, to gain a wider perspective on the world, to be knowledgeable about the many ways in which a society can fail it's most vulnerable. Such as, for instance, letting your poor die and suffer from preventable, curable illnesses.
Oh, and I have no such ideological commitment to the monarchy, I and most people I know would choose to abolish it in a heartbeat. It is here, as it is everywhere, the conservative right clinging onto traditions, ideologies and policies that have long since proven unproductive, disfunctional or outright harmful.
The monarchy may well underpin much of how British law and government works, and that is something we should work to change - just as you in the US should work to change those parts of your founding constitution written almost 300 years ago that no are no longer to the benefit of yourselves and your country.
If I didn’t have healthcare on the Obamacare market today, my special needs son would be without care because I can’t afford his care myself. Furthermore, his healthcare would have been impossible to even get privately because of all that preexisting conditions BS. People like you probably don’t care about anyone else, but ACA is a life saver for so many people.
You pay for insurance, which pays for Dr’s insurance, which pays other people absurd amounts for malpractice. If you weren’t having to pay two insurance companies with awfully large buildings, naming rights to stadiums, etc., maybe you could pay for that without government assistance. Somehow people did it successfully for millennia.
As someone that used the open market plans before the ACA, it basically changed nothing, added subsidies, and removed the lifetime limits, at least from my perspective.
But this is all pointless accounting bullshit, we simply need a medicare-for-all plan.
I was on employee plans until recently. I knew I would eventually need private health insurance and watched it for 5-10 years, during which ACA took over. For most, premiums rose and coverage fell. Maybe that would have happened regardless, but that wasn’t the ACA promise. Prior to ACA, growth of per capita health care costs were slowing.[0]
The ACA was a disappointment, don't get me wrong. It should have been medicare for all but...
Fucking Joe Lieberman.
Granted, whenever democrats are in power, they rotate the "bad guy" to give in to the corporate demands and side with the Republicans, but Joe Lieberman was the reason we got a washed out reformed healthcare. Sure it could have been some other democrat senator turncoat, but he wasn't being the surreptitious underminer while the Republicans did the public PR, that a-hole was front and center hollowing out the ACA.
Joe Lieberman probably killed hundreds of thousands of Americans as a result. Maybe a million. Maybe more.
Hold up, how does this type of fraud require any government action at all? (Except for prosecuting the fraud after-the-fact, of course.)
The core situation isn't specific to healthcare either: Someone's offering you a long-term contract service based on the strength of a menu of available services and options, but their offering is effectively fake.
It's a similar concept to subscribing to a mostly-fake library of repair manuals or something, only the popular/cheap ones are there, and the others are permanently temporarily unavailable.
Why are you putting the word "government" in there? The main perpetrator of this particular problem is the health "insurance" cartel with their closed "networks". This regime was directly created and nurtured by government-based regulatory capture, but that does not mean that removing government from the equation will cause the "insurers" to spontaneously dismantle their lucrative positions.
So directing the ire at "government" seems like it's directly detracting from focusing on the problem, which is a complete lack of sensible regulation of these "private" corporate extraction machines. At a minimum this "network" nonsense needs to be outright banned for the restraint of trade scheme that it is, and "providers" need to be taken to task for shaking down patients with fraudulent bills not based on any sort of contract (the latter being the main thing driving people into the arms of these "insurers" to begin with).
The "problem" can be fixed relatively easily: when an "insurer" fails to cover a loss of one of its insureds using its own providers or network, the insured can simply go to anyone they can find and they or the third-party provider can submit the claim. This is how proper indemnity insurance works, and it would instantly fix the "technical problems" and "out of date directories" that this insurance company in question is suffering from.
In any case, this company is now the target of multiple class-action lawsuits, including one under RICO. It would be interesting to find out in discovery if publishing bogus provider directories was intentional on the company's behalf. If it is, this opens a great deal of liability for them. We are fortunate that 11 states outright ban mandatory arbitration by insurers with another 3 where the courts de-facto ban it. This means insurers can't get away with this forever.
It sounds like this is already the case, somewhat. The article says:
> Ambetter was obligated by state law to provide one outside of its network if Ravi couldn’t find one in a “timely manner” — which, in Arizona, meant within 60 days.
> when an "insurer" fails to cover a loss of one of its insureds using its own providers or network, the insured can simply go to anyone they can find
A variation of this is in effect, though you have to know, and you have to push. If you as a consumer are given reason to believe by the insurer that the provider is in-network, then they are required to cover that provider as if they were in-network, even if not.
Specifically, if the carrier's "Provider Directory" lists that provider...
Challenges - this may not stop the initial out of network billing from the provider that you may have to pay and be reimbursed for, the tier 1 support representatives will stare blankly at you and have no idea what you're talking about, and when and if you get it escalated you'll have to fight for it.
(Also, admittedly, it's only really good for one 'encounter'. After that, the insurer will say that now you have a confirmed belief that they're out of network, so...)
The concept of "in network" is so foreign to me as someone from a developed country that isn't America. We don't have public coverage for mental health services unless you're below the poverty line, but you can pick any therapist and send the receipt to your insurance company to get coverage (up to a limit).
I had Ambetter for dental insurance when I damaged a tooth and experienced this first hand. I think spent between 30 and 40 hours over two weeks calling Ambetter and dozens dentists all over my state. The worst part, besides not being able to see a dentist, was that to Ambetter, you are always calling for the first time. The system has no memory of your issue or even that you have called five times already that morning. The rep always asks a long list of pointless questions like who your primary care doctor is and if you are still living at your address. (No, I have not moved since I last called 20 minutes ago.) You repeat the same numbers and answers over and over. Then you have to describe your problem again, and plead for help. Even after communicating how many times you have tried, the reps only have one solution and that is to give you three more dentists to call. One time I asked the rep to stay on the phone while I called the numbers so that I wouldn't have to call back after they didn't work. That made him very angry and he hung up on me. The numbers didn't work.
I did finally get to see a dentist though. Near the end of the second week, one rep's voice seemed more empathetic and hearing her listen made me chock up as I described how difficult the process had been. She gave me a line to say to the other reps to have them transfer my call to her and told me to call back the next morning. I don't know what she did, maybe there was even something broken with my account, but she found me a dentist within walking distance of my house.
article alleges Ambetter failed to provide care to a patient despite best efforts of patient and family, laws and decency. The purpose of the system is what it does. CEO seems to be paid $18M/yr. And so it goes.
29 comments
[ 3.3 ms ] story [ 73.9 ms ] threadHow anyone stays alive and wealthy in such a system is beyond me. Very few, apparently, are fortunate enough to enjoy this. We need to completely rethink this entire model.
And why is your criticism reserved for the government and not the perpetrator of the fraud, namely Ambetter?
Health insurance shouldn’t exist. When the government mandates it, now there are two problems. If this wasn’t obvious prior to the ACA, I have a bridge to sell you.
0 - https://ballotpedia.org/Changes_in_Net_Worth_of_U.S._Senator...
Here in the UK our NHS is a goddamn mess, it's cracking and creaking and bureaucratic, but every American expat i have ever known who now lives in the UK has horror stories about how much worse it is over there. In our monthly social classes (PSHCE) we watched documentaries of poor Americans unable to afford healthcare, and it horrified us all.
You can't run healthcare as a profit seeking enterprise, it just doesn't work, the financial incentives of healthcare providers just fundamentally do not align with their customers. Government run institutions can often fall into a state of bureaucratic atrophy but if this and countless other stories make clear - that's an issue with institutions in general, whether they be government run or not.
This problem will not improve until you get over your ideological commitment to trying to solve every problem with markets. Healthcare must be socialised, anything less is barbarism.
Healthcare hasn’t been a “market” in decades. It’s completely captured by monopolies which have captured regulation to prevent any alternatives. I do know that the mashup of government mandates for for-profit entities is about as corrupt a system as could be conceived.
It wasn't nearly as corrupt.
> we watched documentaries of poor Americans unable to afford healthcare, and it horrified us all.
A system so good shouldn't need such propaganda to justify it's existence.
> you get over your ideological commitment
The ideological commitment that are the underpinnings of our system of government and the core of our very constitution? Why don't you just "get over" your ideological commitment to entertaining that absurd royal family?
We watched videos of the horrors of the American healthcare system for the same reason as we watched videos and were otherwise taught about oppressive regimes, international poverty, bigotry and racism both local and international - to learn about global issues, to gain a wider perspective on the world, to be knowledgeable about the many ways in which a society can fail it's most vulnerable. Such as, for instance, letting your poor die and suffer from preventable, curable illnesses.
Oh, and I have no such ideological commitment to the monarchy, I and most people I know would choose to abolish it in a heartbeat. It is here, as it is everywhere, the conservative right clinging onto traditions, ideologies and policies that have long since proven unproductive, disfunctional or outright harmful.
The monarchy may well underpin much of how British law and government works, and that is something we should work to change - just as you in the US should work to change those parts of your founding constitution written almost 300 years ago that no are no longer to the benefit of yourselves and your country.
No, they didn't. People with unusual medical needs just died. Heck, people with what we now view as pretty routine medical needs just died.
Many states now cap malpractice insurance. Also, malpractice insurance is not as crippling to physicians as some would have you believe.
That is sarcasm if you can't tell.
As someone that used the open market plans before the ACA, it basically changed nothing, added subsidies, and removed the lifetime limits, at least from my perspective.
But this is all pointless accounting bullshit, we simply need a medicare-for-all plan.
0 - https://www.healthsystemtracker.org/chart-collection/u-s-spe...
Fucking Joe Lieberman.
Granted, whenever democrats are in power, they rotate the "bad guy" to give in to the corporate demands and side with the Republicans, but Joe Lieberman was the reason we got a washed out reformed healthcare. Sure it could have been some other democrat senator turncoat, but he wasn't being the surreptitious underminer while the Republicans did the public PR, that a-hole was front and center hollowing out the ACA.
Joe Lieberman probably killed hundreds of thousands of Americans as a result. Maybe a million. Maybe more.
The core situation isn't specific to healthcare either: Someone's offering you a long-term contract service based on the strength of a menu of available services and options, but their offering is effectively fake.
It's a similar concept to subscribing to a mostly-fake library of repair manuals or something, only the popular/cheap ones are there, and the others are permanently temporarily unavailable.
So directing the ire at "government" seems like it's directly detracting from focusing on the problem, which is a complete lack of sensible regulation of these "private" corporate extraction machines. At a minimum this "network" nonsense needs to be outright banned for the restraint of trade scheme that it is, and "providers" need to be taken to task for shaking down patients with fraudulent bills not based on any sort of contract (the latter being the main thing driving people into the arms of these "insurers" to begin with).
No it hasn't. People will happily take cash. Some of the offices called in this article suggested they only took patients who pay cash.
In any case, this company is now the target of multiple class-action lawsuits, including one under RICO. It would be interesting to find out in discovery if publishing bogus provider directories was intentional on the company's behalf. If it is, this opens a great deal of liability for them. We are fortunate that 11 states outright ban mandatory arbitration by insurers with another 3 where the courts de-facto ban it. This means insurers can't get away with this forever.
> Ambetter was obligated by state law to provide one outside of its network if Ravi couldn’t find one in a “timely manner” — which, in Arizona, meant within 60 days.
(They didn't)
A variation of this is in effect, though you have to know, and you have to push. If you as a consumer are given reason to believe by the insurer that the provider is in-network, then they are required to cover that provider as if they were in-network, even if not.
Specifically, if the carrier's "Provider Directory" lists that provider...
Challenges - this may not stop the initial out of network billing from the provider that you may have to pay and be reimbursed for, the tier 1 support representatives will stare blankly at you and have no idea what you're talking about, and when and if you get it escalated you'll have to fight for it.
(Also, admittedly, it's only really good for one 'encounter'. After that, the insurer will say that now you have a confirmed belief that they're out of network, so...)
The whole system is so broken.
I did finally get to see a dentist though. Near the end of the second week, one rep's voice seemed more empathetic and hearing her listen made me chock up as I described how difficult the process had been. She gave me a line to say to the other reps to have them transfer my call to her and told me to call back the next morning. I don't know what she did, maybe there was even something broken with my account, but she found me a dentist within walking distance of my house.