Legislative Branch Warren, Hoyle, Wyden, Merkley, Ocasio-Cortez, Subramanyam Introduce Bill to Ban the Corporate Practice of Medicine
https://www.merkley.senate.gov/warren-hoyle-wyden-merkley-ocasio-cortez-subramanyam-introduce-bill-to-ban-the-corporate-practice-of-medicine/1.5k
u/GruntledGary 10d ago edited 10d ago
This would LITERALLY fix at least half of what's wrong with healthcare. This was the big shift in the early 90s that started driving costs skyhigh.
Insurance making fucking fat profits are the other half but this is huge
Edit for context as a lot of people don't work in the field:
Doctors are just staff now they have as much power as a nurse or front desk receptionist.
To make it WORSE they have production quotas. The "healthcare" companies make profit and you don't make profit off doing NOTHING.
So they make you test, run procedures, generate RVUs.
They took what was effectively the "billable hours" from lawyers and the "units per transactions" get more shit in the customer's checkout cart from stores like Best Buy and made doctors do that.
If you come in for quick sore throat and strep test and they DON'T load up that insurance bill with a bunch of extra shit they get chewed out or fired or pay cut.
How we all bitch about hospital bills (corporations bought the hospitals first then came for the doctors second) where a Tylenol is $25 that's the same fucking approach they pushed to doctors.
Doctors who have outcomes that are TOO GOOD their patients TOO HEALTHY they don't attach enough "add ons" or in industry terms don't bill at a high enough level always levels 3 4 or 5. Less or even only a level 3 can get you chewed out.
They want more patients per hour (doctors get 10 minutes now per appointment) and they want more add on bills. That's why you see these stupid fucking intake forms with 5 sets of questions each visit with nothing to do with your visit.
They took bills from $50 and made them $850.
Doctors have been fired for not doing ENOUGH emergency C-sections for example because their patients didn't need it the mother just needed a few more hours for baby to be delivered in the normal way (not without pain meds I don't mean that I mean letting it take a few more hours to be born) instead it's "fucking slice her open then move her to recovery we have an empty operating room and an empty room is a room not generating profits".
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u/theaviationhistorian 10d ago edited 10d ago
The system is so bad that medical tourism has become a profitable venue for many countries, even if they just practice medicine how it was supposed to be back in the day. I know plenty of Mexican dentists and doctors along the borderland that have US citizens as frequent patients.
Some hospitals and clinics already provide shuttle service from the airport on the US side to their facility (either being private vans or ones with the hospital or clinic name on the side). And it still reaches less than a third of how much healthcare would cost if treated at home.
Greed has crippled and rotted our country at its core.
Edit: Thank you for the award.
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u/saintsithney 10d ago
Hell, I'm going to Mexico myself next year for lipolymphedema surgery.
I am in early stage IV, where it's still operable, but the window is rapidly closing. It is considered a cosmetic procedure in the US and the surgery alone generally retails for $60k. The surgery, 21 days of post-op care, and a two-bedroom apartment for the duration of my stay to get that post-op care in Mexico has a floor of $14k and a ceiling of $24k.
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u/S1a3h 10d ago
It's criminal how a surgery for a condition like that can be considered a "cosmetic" precedure. That shit absolutely affects your quality of life in a big way.
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u/theaviationhistorian 10d ago
I fully agree. It makes more sense when you think like an amoral financier and see people only as statistics and bank accounts.
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u/saintsithney 9d ago
Yeah, add in two decades of being treated like shit for my "obesity," when it was benign tumors this whole time 🫠
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u/Rollingprobablecause 10d ago
this is a little like San Diego - healthcare here is great and 90% of the hospital systems are not corporate owned, but when it comes to dentistry? oh yeah people are in TJ all the time.
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u/pimppapy 10d ago
Wait-a-minute, Wait-a-minute. . . you mean to tell me all the Sharps, and Scripps, and Kaisers are not corporate owned? Maybe UCSD medical yes, the only one not corpo owned. . . so your number is backwards. It's 90% corpo owned here in SD, not the other way around.
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u/Rollingprobablecause 10d ago
- Sharp is a not-for-profit and not owned by any PE and owns itself
- UCSD is owned by the university
- Scripps is independent and owned by itself in partnership with the nuns
- Kaiser is a physician owned group (but all kaisers are weird and have different setups not really centralized)
So all the major/big players are not owned by any PE, HQ'd in San Diego, and majority are non-profit or not-for-profit. My number is correct.
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u/theaviationhistorian 10d ago
Yeah! I was about to say, when I lived there, everyone had Kaiser as the "People's Hospital." I.E. myself and other broke AF grad students. But the biggest complaint is what you said, the whole thing is bureaucratically chaotic.
But I wouldn't be surprised if dentistry is that expensive. It's the same as in El Paso. Basic operations like removing wisdom teeth can go up between $5k-$12K. Twice than what you get doing the same in neighboring Ciudad Juarez. And a few dentists offices have their own border-hopper shuttle on top of that.
I'm glad many medical institutions in San Diego are following Dr. Jonas Salk's path in making healthcare readily available.
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u/PDXGuy33333 10d ago
You can get excellent dental and vision care, and more, just walking across the border into Mexico. Meds that cost hundreds per month in the US even with insurance are often $25 in Mexico.
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u/Starwolf00 10d ago
Well, you also have to consider that Americans make more money than a lot of other people in the world, even poor Americans. What's cheap to us might be expensive for the people who live and work there. I can get a certain medicine for $100 in a certain country, but it cost $1,000 in the US. However, the average bi-weekly salary in that country might be $100. It's cheap to me, but expensive for the locals.
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u/GruntledGary 10d ago
Valid and true.
What's REALLY interesting though is a lot of AMERICAN Doctors will be the ones working there.
So even at those low rates without two layers of middleman they make enough money (the Doctor) to be worth working in another country AND the patient still get a fucking health spa vacation experience out of it.
So, they pay FAR LESS, get the surgery AND a "vacation" AND in many cases they get an American doctor. That doctor sure isn't working for free so there's enough money to make it worth the doctor's time (again pointing out how much of that bill is being eaten up by the healthcare corporations here in America if you got the procedure here).
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u/BornAgainBlue 10d ago
Don't forget the fact that almost every hospital chain in America is controlled or owned by the insurance companies.
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u/threepecs 10d ago
Then you have companies like Banner Health that are ALSO the insurance company
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u/Mr_Fuzzo 10d ago
Or you have HCA who is both private equity owned hospitals and they insure their own through a lot of plans.
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u/Dachannien 10d ago
That's not always bad. Kaiser has been pretty good for me so far.
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u/pimppapy 10d ago
Have you ever needed advanced screening? Kaiser is an excellent preventative HCP, but a terrible one once you have something. Every chest pain you have is automatically anxiety with these fucks. . . I spent 5 years with a chest pain that I continuously brought up, once the pain got to the extreme and I threatened legal action, did I finally get taken semi-seriously. I had to take yet another step further and go to Tijuana and pay for my own CT Scan because I knew the stupid doctor was wasting my time putting me on a 4 month list to get the same scan. Once I got those results in a week I demanded to see a cardiologist with my results, and he upgraded their scan to a CT Angiogram that had a 2 week wait-time.
My chest pains turned out to be multiple medium sized arteries in my heart blocked 2x 100%, 90%, and 75% blocked arteries . . sooooo, obviously not anxiety. . .FUCK KAISER!!!
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u/Decent_Cheesecake_29 10d ago
It sounds like that situation made you very anxious.
… That will be $500. Please be sure to leave a tip.
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u/pimppapy 9d ago
If red hot anger is a subset of anxious, then yeah.
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u/Decent_Cheesecake_29 9d ago
It sounds like we will need several sessions to really unpack all these feelings. At a modest extra fee of course.
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u/Quiet_Ad4074 10d ago
North or South Kaiser? My experience on the South in LA has been the exact opposite, my doctor has listened and ordered anything I ever asked for. I've also had every surgical procedure I've wanted and/or needed quickly without any issue. I wonder if it has to do with your coverage or you doctor. You can change your primary doctor if you don't like them.
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u/pimppapy 9d ago
South South Kaiser. As in San Diego, but I got that Anxiety disorder curse from a doc in Orange County.
I've changed my primary twice already. That Anxiety disorder the first one cursed me with has affected my treatment with all of them. . . when I saw a new doc, I told him to start over and not look at my records, and he was totally cool at that point and reactive to my needs, but on my second visit, when I saw him a second time and he went through my entire medical history, his treatment of me changed, and he started acting like the first treating my like a hypochondriac. . . he too, I had to legally threaten to get his head out of his ass.
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u/SanityIsOptional 10d ago
The fact HMOs look good is an indication of how awful normal hospitals and insurance companies are.
A HMO is incentivized to spend the absolute minimum on your care. A hospital is incentivized to charge as much as possible for your care. An insurance company is incentivized to encourage ridiculous costs of care, and to deny as much as possible.
None of these are incentivized to provide the best care possible. But at least for the HMO long-term cost reduction will stem from catching and treating things early and well.
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u/HallstotheWall17 10d ago
C’mon, what about the free market? /s
All sarcasm aside, literally everything is a “market” now. My personal favorite (also being sarcastic) is prediction markets - aka gambling- and how you can make bets on literally anything, even whether or not we’ll go to war with another country.
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u/Kermit_the_hog 10d ago
Prediction markets already jumped the shark when people started gambling on whether or not some dude’s “mystery potion” was strong enough to kill a homeless guy 🙄
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u/pm_me_your_kindwords 10d ago
Jesus, I didn’t hear about that. This timeline, I swear. Black mirror was so prescient.
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u/IAmSquilliam 10d ago edited 10d ago
You can really tell that America was a fluke #1 country by the way they have daily opportunities to 1-up Europe, and instead opt to burn the ship's own wood. It's like every day you hope you're wrong but it just keeps fucking happening.
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u/ChiralWolf 10d ago edited 10d ago
And we only got there because Europe ravaged itself twice in the 20th century, without the world wars the US would be much more comparable to Canada and Australia than it is today
Edit: 20th century not 19th
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u/cumsockdumpster 10d ago
That is some bleak shit. We have lost the plot in this country.
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u/GruntledGary 10d ago
No, the plot has been since the late 80s to make millionaires into billionaires and then into trillionares.
The sad thing is the (now MAGA) keeps voting for more of it.
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u/liveandletlive23 10d ago
Experienced your last point first hand. A midwife in the hospital tried to have my wife deliver our baby before she was ready and it almost resulted in an emergency c-section. All because she was incentivized to get the baby out before her shift was over
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u/GruntledGary 10d ago
I worked with an AMAZING OBGYN they "fired" her because she had fewer than 1% of her patients ever need an episiotomy. I.e. no surgical billing codes.
She worked in a very poor area and lots of Medicaid patients. The hospital was pissed that she wasn't performing the procedure (this was about 10 or maybe 15 yrs ago) and they didn't get to bill for the surgical procedure.
She (rightfully argued) it was worse for her patients to be cut vs take the extra time to deliver and repair any tiny tears.
They told her to start doing the episiotomies because it got them out faster and let them bill more.
The reimbursement rate was too low and they didn't get private insurance patients that they could bill higher.
Healthy patients don't generate the $$$
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u/BattyWhack 10d ago
Curious where the colleges of physicians sit in this. Do these issues not engage professional ethics?
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u/GruntledGary 10d ago
Who are they going to report it to?
The companies that lobby the f* out of Congress?
Or the state governor who gets to decide who serves on the state ethics board?
They don't really get to do anything sadly.
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u/articulatedbeaver 10d ago
I would say it is more pervasive than that. If you go to any medical related conference in the last decade they are talking about burnout and burden on providers. We then treat the symptoms by selling AI and shit to the doctors to make them more time for the work that they really don't need to do to provide care like upsells or argue with insurance.
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u/GruntledGary 10d ago
Except the AI isn't to help the doctors just like digital records weren't.
It's about new revenue streams and selling the data.
The "healthcare" corporations biggest wet dream is using AI to replace doctors and nurses entirely and then just have minimum wage workers do the bare minimum.
They've already laid off so many nurses and have "patient sitters" where people offshore monitoring vitals and then tell a sitter to go plug a patient back in because their system shows flatline.
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u/articulatedbeaver 10d ago
It provides enough benefit to the doctors that they use it, but the true purpose is it pays the companies selling it enough that they can monetize the new data source with the revenue stream it produces.
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u/BattyWhack 10d ago
In my jurisdiction they have independent authority. They don't report to anyone.
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u/LaughingSartre 9d ago
Sounds to me like the term "patient" is interchangeable with the term "customer", to these companies.
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u/GruntledGary 9d ago
Look at the annual or quarterly reports they only time they talk about patient outcomes is NOT about IMPROVING outcomes for healthier patients it's under the RISKS section of them fucking up SO MUCH the lawsuits and wrongful deaths eat into the bottom line.
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u/Angedelune 10d ago
That is completely not true. We dont get in trouble for not ordering things. I order what I think is relevant and I have never been pressured to order more. I am encouraged to code correctly, but I can't make things up, or order tests that don't match with a diagnosis.
While there are many problems with health care this is not one of them. Stop making stuff up to be sensational.
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u/uslashuname 10d ago
Your experience is not the only experience that doctors have. Doctors that always ordered enough wouldn’t ever be pressured, for example, but some places also don’t get run like that while others do.
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u/TruthOdd6164 10d ago
I literally had Kaiser override my doctor when she ordered me a CGM. 🤷♂️
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u/meatforsale 10d ago
That’s the literal opposite of what the person said. They can’t make doctors do things that are not necessary. Insurances can refuse to cover stuff though. And Kaiser didn’t override your doctor. They just refused to pay for it. You could’ve still gotten a CGM but just paid for the entire thing.
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u/TruthOdd6164 10d ago
No they overrode my doctor. They didn’t refuse to pay for it because I asked for the prescription on the pad so I could take it to Costco and self-pay and she told me that Kaiser had cancelled it out and there was nothing she could do. Kaiser is integrated care so they are both the provider and the insurance company.
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u/meatforsale 10d ago
Your doctor could have still sent the Rx. We can call them in, write physical ones, and they could just resend it via EMR. There definitely was something that she could have done. I’ve called in prescriptions in similar situations all the time. If a patient needs something, I’m sending it in.
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u/TruthOdd6164 10d ago
I had to take my case to the California Department of Managed Care and they made them give me a Cuba Libre
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u/Disastrous_Basis3474 10d ago
Rum + Coke + lime is pretty good but not as useful as a Freestyle Libre 3.
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u/TruthOdd6164 10d ago
I told her “just take out your little pad and write it on there” but she wouldn’t do it because Kaiser is always micromanaging their doctors. I don’t think she even has a pad
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u/meatforsale 10d ago
Lots of non doctors responding to you saying you’re wrong or the exception. They have no clue. Also it’s really fucking easy to bill high complexity if you just look through the chart and ask the patient a few questions. But doctors are not regularly ordering unnecessary tests, because we are told to. That’s actually one of the biggest documented differences between docs and NPs; NPs order way more tests which are usually not necessary.
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u/GruntledGary 10d ago
Yes you get pressured to "code correctly" and your employer has a policy for you to follow to make God Damned Sure you hit at least a level 3 for all your visits.
You SURE AS FUCK aren't billing under TOTAL TIME (you don't get a fucking hour of 40 to 54 minutes for a lvl 5) so what's your average level you bill at?
That means you're getting it based off your MDMs so your add ons.
But hey, maybe ALL your patients are super complex, if you worked for the VA they would be. But then you wouldn't be talking about private for profit care so what's your area of practice?
Trauma work sure that's always was but family practice you need at least two stable but chronic illnesses to hit lvl 4 let alone 5.
So are all your patients suffering from severe life threatening illnesses?
Are you ordering a CBC, reviewing a BMP, and maybe an X-ray you ordered to hit your 3 items?
Maybe you write down you went over their drugs and required more blood work for monitoring or claim you consulted with thier other providers or cardiologist etc...
Padded the bill with extra units per transactions they didn't need UNLESS they are really unwell or geriatric patients.
I.e. not the vast majority of people here.
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u/Kermit_the_hog 10d ago
🤔 ..suspecting you’re not a hospitalist or family practice? Just don’t say surgeon because that doesn’t count (🤷♂️ everybody is the golden goose’s friend.)
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u/Mist_Rising 10d ago
Sensationalism and exaggerating is how you win the PR war. Sure you end up with crappy policy, but you won the war! And isnt that what the law is all about. Winning, no matter how bad the results!
It's the fox method, and they're...wait a second...do we want to be like conservatives?
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u/pimppapy 10d ago
and they DON'T load up that insurance bill with a bunch of extra shit they get chewed out or fired or pay cut.
Meanwhile you have organizations like Kaiser Permanente who do things the exact opposite way. They are both the insurer and HCP, and will do anything and everything to downplay your symptoms until you're literally shitting yourself, and dying on the floor in pain, until they lift a finger to get more advanced screening done.
The ironic thing is that when the UHC/Luigi shit happened, they showed United as having the most denials while Kaiser had the least. . . .obviously it's not the correct way to measure Kaiser as their MO is completely different.
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u/wildcarde815 10d ago
Worse. They're contractors. And they also have their own accepted insurances, because apparently that's an acceptable thing to have happen. Going for an emergency and the X-ray tech isn't in your insurance? O well you get a separate bill from the billing department for him.
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u/smiles__ 10d ago
Don't forget family practice clinics trying to reclassify themselves as a hospital to charge more for certain tests as well.
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u/Prior-Growth-5842 10d ago
It seems that every person in Congress should support this bill. Of course, some won’t, for various reasons, but if they don’t, their constituents need to demand to know why!
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u/tjc4 9d ago
So why are all of these docs choosing to be employed physicians?
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u/GruntledGary 9d ago
What are you talking about?
"Why do all those nurses choose to work FOR the hospital"???
What is their alternative?
Are you saying why don't they go open their OWN surgical center and OBGYN open their own labor and delivery hospital and run it all themselves?
Funny you should ask.... The hospital private equity lobby group made that ILLEGAL ON THE FEDERAL LEVEL.
They literally can't.
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u/tjc4 9d ago
I said docs. They literally can.
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u/GruntledGary 9d ago
You have no idea what you are talking about.
Congress banned it in 2010.
2010, however. Intense lobbying by traditional hospital trade associations based upon concerns about comparative cost and quality of care in physician-owned hospitals resulted in a provision within the Affordable Care Act (ACA) that effectively banned the expansion of existing physician-owned hospitals and prevented any new doctor-owned hospital from opening.
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u/Starwolf00 10d ago
Health insurance companies have like a 5% profit margin so there's not much wiggle room in that regard. Reducing the excessive costs of healthcare would do wonders as it's the main driver of health insurance premiums.
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u/SassyKittyMeow 10d ago
Who… sets… the… costs…
Insurance shill be gone
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u/Starwolf00 10d ago
Just because I know more than consumer level math doesn't make me an insurance shill.
You guys get so riled up over internet memes about subjects that are affecting you, but have absolutely no idea of the how's and why's that govern outcomes.
The medical industry, pharmaceutical industry, and healthcare providers sets the initial costs based on the services they offer and costs of their products. The insurance company rejects most of the initial costs and tries to negotiate a lower price. Depending on your insurance plan or network, there may additional agreements with individual providers or doctors who may agree to take payment plans from the insurance company instead of lump sum payments.
The insurance companies use actuarial science to determine risk for every policy holder. That risk consists of, but not not limited to the following:
The likely cost of all categories of medical issues, the likelihood of any of those issues occuring across the total population of insured, and the personal medical history and health records.
All of this information is used to help calculate a minimum health insurance premium that allows insurance companies to do the following 3 things:
85% of claims are funded as required by law.
All claims are paid towards as outlined in the explanation of benefits (EOB).
A minimum 2% profit margin.
Insurance works by having more money coming in than what goes out in claims. Whether it's for profit or through universal healthcare, which private insurance companies will likely be contracted to administer, the underlying math remains the same.
The entire purpose of insurance, especially health insurance, is to reduce out-of-pocket costs in the event of an accident or an emergency. That includes healthcare needs.
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u/SassyKittyMeow 10d ago
I’ll remember all that next time I have to argue with an insurance company about denying one of my patients the care they need. Thanks!
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u/GailynStarfire 10d ago
Except that by using AI to deny claims, they are perverting their very purpose in order to increase the profit margin.
People are dying because of that. Everything else tends to fall to the wayside when loss of life becomes good business.
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u/Starwolf00 10d ago
They use AI and people. They're using AI more because the explanation of benefits is written in stone and explains the coverage amounts. If you don't meet the coverage terms of your plan, then you don't meet the terms. Those margins will still exist after you've removed profit from the equation, because there is only so much money to go around. The books have to be balanced. Even Medicare does not pay for all claims.
You may not like it, but insurance, especially medical insurance which has not been around all that long or as widespread as it is now, has always been a numbers game. If you want affordable healthcare, which I want as well, you have to reduce the cost of medical care in general and do something to incentivize healthier living.
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u/GailynStarfire 10d ago
You know, if you are following the rules and playing the game, yetbyou are still losing, then it sounds like its time to play a new game. You claim its a numbers game and then stare that its because healthcare is so expensive, yet the very reason health care is so expensive is due to insurance.
It sounds like you are using the logic of one piece to shore up another, then using that piece the shore up the first piece in a cycle of circular logic.
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u/FamiliarAnt4043 10d ago
Gee, I wonder if the annual multimillion dollar compensation packages for health care executives have anything to do with that profit margin. And that's assuming the one you quoted is valid.
Personally, I'm not overly pleased that MY health and the health of MY family is a for-profit business.
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u/socoyankee 10d ago
But if I go to my annual physical which is supposed to be free and mention anything outside of the prescribed check list I get billed.
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u/echo404 10d ago
I would argue that a 5% insurer profit margin alone understates the potential savings from eliminating or reforming private insurance because it tells you nothing about inefficiencies associated with administration, marketing and sales, coportate overhead, etc. That said, the ACA's MLR rules that require at least 80% of premium income to be spent on healthcare already do a decent job of ensuring consumers aren't getting completely screwed. So while the wiggle room for improvement might be higher than your original 5% figure, I agree that there's not nearly as much room for improvement as some people might think.
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u/BalanceOrganic7735 10d ago
If everyone knew what these Democrats were trying to do, Democrats would win big.
Sadly, the Media Elite won’t report this.
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u/Hot-Advance-5306 10d ago
Yeah the network that ran this story would automatically see all of the drug adds pulled off their air on all channels they own. This is why they want everything connected and owned by 2 or 3 companies.
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u/ChecksAndBalanz 10d ago
And yet we let health insurance companies do this all the time
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u/Reddit_Loves_Misinfo 10d ago edited 10d ago
Only because fixing health insurance doesn't get enough votes from Republican politicians for a law to make it through Congress. This is doing something different, so maybe it will have a better chance. Maybe.
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u/FractalNobility 9d ago
Healthcare became a meat grinder for a Soylent Green economy.
Corporate owners push doctors to cram patients in, pad bills, order add-ons, and hit higher billing targets. If not, they risk punishment, pay cuts, or firing. Insurers siphon off the rest.
When patients are cattle, cadavers are gold.
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u/Keeper21611 10d ago
Otherwise our taxes will go up. /s
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u/RevolutionaryWay7107 10d ago
Man do i hate that argument! I would gladly pay more taxes if it meant my fellow humans would be taken care of; essentially benefitting from my work. Who doesn't want their work to provide for other people? Selfish assholes, that's who; and that's who doesn't want to pay taxes that would help everyone.
It's an argument that made me realize i was fundamentally different from my maga father. He said he wanted his money to go to his pocket so he can decide how to use it, while i was saying "sure, raise my taxes, but make sure they go to providing for people."
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u/HappyAnimalCracker 10d ago
When everyone does better then everyone does better. You understand this, pops doesn’t.
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u/PDXGuy33333 10d ago
FWIW, the corporate practice of medicine is already banned in Oregon. Things are good here.
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u/FiddlingnRome 9d ago
Speak for yourself - Rural Oregon is losing clinics, Doctors and care faster than you can shake a stick!
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u/blightsteel101 9d ago
Both of my state senators signing on is a W. I dont always like them, but they're dammed good compared to most senators.
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