Insurance is, at its core, a reasonable halfway measure towards public control of a critical resource. If you need something only very rarely, but it's something that needs to exist ALL THE TIME just in case, insurance allows you to pool your resources with other people in the same boat and afford to keep an industry around just in case. Somebody will always be using it right now, and it'll be there when you need it, because you paid into the pool.
The problem is, as always, the insertion of capitalism into the solution. If someone has to profit from this set of relationships, the motivation to provide the resource is in competition with the motivation to extract more profit. This is what happened to healthcare.
Insurance is only a halfway measure because we already have an organization capable of managing common resources that individuals use only rarely but which the public needs all the time: that organization is the government, or the governments at various levels. We manage lots of things this way: fixing roads, stopping houses from burning down, pulling people out of floodwaters, that kind of thing. You don't need it all the time, but it's there when you need it because you're paying taxes to a government that has no profit motive from it. Insurance should only ever have existed temporarily while government infrastructure was debated and organized, but the for-profit industry managed to capture enough of the government to keep itself alive indefinitely.
In short, insurance isn't inherently bad, just not meant to be a permanent fix. Capitalism is bad.
When I had top surgery (getting the fat sucked out of my tits so I could put an “M” on my drivers license, funny how many jobs fell through right I9 verification…), I did a lot of research into what I needed to do to get it covered. I got letters from doctors and therapists, I’d been in hormone therapy for a while, and my policy said it covered it. I checked with a rep, they said yeah, you just pay for it up front and submit for reimbursement.
So I took out a $5500 loan, had surgery, and then attempted to file for reimbursement. Turns out that my specific policy, from my step-dad’s employer had a rider that exempted it. Somewhere buried in the fine print, didn’t come up until after I had taken out the loan.
It’s pretty common for trans people to end up turning to sex work to finance their medical care (and tbh, survival in general). That’s how I joined that statistic.
What's this "we" bullshit? You and I never had a say in it. It's not like we get to vote on this stuff.
I've been fighting with my insurance company since May. My wife had a medical emergency and I had to take her to the ER at 3AM on a Sunday. The team of doctors treating her all agreed she needed to be hospitalized and have emergency surgery. She was admitted and underwent surgery and was out in three days.
A week after she was discharged we received a letter from the insurance company letting us know they had decided not to cover the $67k hospitalization bill because they had decided it wasn't medically necessary.
So yeah, that's great. Not to mention we had finally hit our $6,000 deductible (after I had cardiac issues and ended up in the ER the previous month) so insurance would finally have had to actually pay something.
So glad we pay them $1500 a month for them to make decisions on what is medically necessary and what constitutes an emergency after the fact.
Disclaimer: I think the current U.S healthcare system is hilariously bad and should be heavily reformed.
Insurance is not a bad thing, and there is a clear product involved in it. To demonstrate, you can go to a doctor in the U.S and pay in cash for the treatment. As I've understood it, you can even negotiate lower prices than the list prices if you are paying in cash. Still, it's probably going to be expensive to the point of potential financial ruin.
This is the product that insurance offers in any domain it operates - buying your way out of risks you cannot accept. Fundamentally, the concept is sound, albeit very poorly implemented in the case of U.S healthcare.
It's basically just a bunch of people pooling their money together and having that pool of money pay in the case of an adverse event.
One of the primary alternatives to the mess that is U.S healthcare today is in fact another form of insurance - it's just that enrollment would be mandatory and as such the risk spreading would be as uniform as possible, along with subsidies for people carrying higher amounts of risk. That's fundamentally what universal healthcare is in other countries.
Same as student loan "servicers" collecting billions in interest to just keep track of peoples' debts.
My favorite is when they send me and letter in the US mail for the sole purpose of telling me they decided to cover our medication the doctor prescribed. The language they use is infuriating.
As if we should call them back and praise them, be grateful for their service, and just ignore that I’m paying them.
This! Health insurance is the reason why medical costs in the US are so ridiculous. Health insurance, and IMO all insurance, is a scam. And since the "customers" (people who NEED care) can't see the price of service beforehand, there is no way for them to choose the most cost efficient option, which allows providers to charge whatever they want. Then the insurance company can come up with reasons not to pay and put the client on the line for the cost.
My ex suffers seizures. After years of bad doctors, he managed to see a neurological specialist who helped him manage his issues. His doctor informed his insurance that treatment was working and his symptoms had regressed - he even managed to earn his driver license back. His insurance took that as "he's better now" and kicked him off. They sent him a bill for thousands of dollars that he had to pay before he could try to get back on his plan. He wasn't able to afford his medication, nor his therapy, and his symptoms came back swinging. I still have a photo of his rejection letter somewhere that I keep as a reminder of how backwards and awful the insurance system is.
No no no! Their product is keeping the system operating properly. You know, checks and balances. And by that I mean check you bank balance because your medical care just cost more than anywhere else in the world.
insurancemedical mafiaI hate our healthcare system and especially the parasites that run health insurance companies, but they do provide a product.
- They pool our money together so that the ones that need healthcare can afford it. Barely anyone can afford out-of-pocket cancer treatment or a stay in the ICU after a serious accident. It could be a serious pain in ass to get insurance to pay sometimes if they even do, but overall, they do pay. If they never paid, we'd have a revolution by now. The last time they started with not paying, people started demanding change, which almost lead to the public option.
- They offer a check on healthcare providers that want to over -treat and -prescribe to charge more money, or doctors that go rogue with whacky ideas. Since the general population doesn't know much about medicine, doctors would be able to prescribe all sorts of illegitimate treatments if we didn't have a body making sure that their recommendations were legit.
I agree that they do fucked up things, like withhold on pay outs, deny interventions that may save lives, charge way too much, and lobby to maintain or even improve their wealth and power, but they do still offer a product. I'm someone that is lucky enough to have access to 100% free government healthcare in the US. Even with that, I'm often jealous of people that have private insurance because I find many benefits to their healthcare over mine.
If we want to improve our healthcare, I think it would be best to acknowledge the reality of the situation rather than exaggerate it.
Yeah no kidding. A company gets to profit off keeping us from getting treatment and it's just accepted and normal.
What is this thread? Since I got chronically ill my insurance has paid my salary for a year and is now paying into unemployment and pension for my wife, who's caring for me. And besides that they're still paying for all our medical expenses despite me not paying into them anymore.
Yeah, I had to fight for them to pay for a transport. But overall they definitely are offering a service I am greatly benefitting from.
So Tricare, one of the USAF providers pays more than CMS, , generally speaking. I was at a small community pharmacy today that has two employees, both pharmacists, both running the register, calling in refills, talking to insurance, stocking shelves, unloading trucks. They had a sign up saying they can no longer afford to fill Tricare prescriptions, because they won't pay enough for the two-owner employee team to cover the cost of medicine alone, not to mention bottles, caps, labels and ink. That's not counting store rent, utilities, and other costs.
Well said!
This is why I'd rather die then go to the doctor.
America is largely de-industrialized, it doesn't "make" much, so instead it's dominated by Usury, ie financial Capital.
Why can't we have universal healthcare or a public option?
The product is you not going broke in case you break your arm.
Doesn't mean that the american healthcare system is good, it's a disaster. But claiming insurance is a bad thing is moronic aswell. These are the people that want "free healthcare" like most oft europe, not realizing that the "free" part is because wie habe (somewhat) mandatory health insurance.
...what? Insurance companies are not a "barrier" between doctors and patients. What, do you think some sort of insurance gremlin will manifest out of the ground and kick you in the nuts if you try to visit a doctor while uninsured? Doctors don't care whether you're insured or not, as long as they get paid. Insurance companies exist to soften the blow of expensive treatment. The product is not getting completely fucked over if you get very unlucky, just like with any other insurance (life insurance, car insurance, whatever). It's kind of like bitcoin mining pools, but the other way around. Now, is mandatory health insurance justified? That's a different discussion.
