So here is a question:
A medical professional examined the person IN PERSON and has a requirement.
In comes the insurance to tell you your doctor is wrong and that you’re perfectly fine, your doctor is basically lying to you.
Question: how the fuck did any of this ever become legal?
Question: how the fuck did any of this ever become legal?
I would guess lobbying.
Politics are dumb but very important.
You do need some checks and balances because what’s to stop a hospital from profiting off the insurance companies by asking for a CT scan/whatever of every single patient just because they can.
I suppose we could have the government run the hospitals too. But noooooo, that’s never going to work out because communism or something.
Maybe we should try effective altruism and accelerationism instead? Let’s just hand over all our money to a few tech bros and then we can go beg them to pay for the scans. And if they don’t pay for it, surely someone will come up with a cheaper technology to do the same. Yes, that’ll definitely work.
If a hospital is found to push doctors to prescribe unneeded medicine or tests, the entire top staff should be questioned and jailed for fraud where applicable.
If an individual doctor does this, same treatment
We’re not just talking money here were talking human lives. If you risk health for money, off yo jail you go
You could just get rid of the for-profit medical industry entirely and then there would be no incentive to over treat patients.
Yes. Hence the rest of my comment. I should’ve probably put a “/s” at the end. :)
Yes, it’s clear why it’s legal and necessary to some extent. In a for-profit system, a doctor’s office or hospital, every procedure or test the doctor can order (and have the patient pay for) will generate profit. Doctors have an incentive to order as many tests as possible. I assume that most doctors are somewhat honorable and won’t abuse this too much, but they’ll probably still err on the side of ordering as many tests as possible not necessarily because of profits, but because more tests gives them more information.
Meanwhile, in a for-profit system, an insurance company will generate the most profit by agreeing to as few tests and procedures as possible. So, they will have an adversarial relationship with doctors and will try to arrange as few tests and procedures as possible. My guess is that the average insurance company is less ethical than the average doctor, so they’re probably more likely to refuse to allow tests that are actually medically necessary.
In a sane system, there would be a neutral referee, the government, who would resolve disputes and severely punish any actor in the system that was behaving badly. But, AFAIK that only rarely happens in the US, where the idea is that the “invisible hand of the free market” will magically make it all work.
Doctors do not directly profit from ordering tests. They get paid whether they order a test or not.
You want to know who profits from over testing? Quest Diagnostics.
https://bergermontague.com/quest-diagnostics-pay-1-79-million-settle-false-claims
These guys literally defrauded the government, but everyone points their fingers at poor people, doctors, liberals, ethnic minorities, lgtbq people, ect. The problem is corrupt businesses and their CEO’s hoovering up as much money as they can so they can shove it up their ass.
Doctors have an incentive to order as many tests as possible
This would conceivably be true for car repair as well. A mechanic is incentivized to order as many repairs as possible for a car.
So why don’t they?
The answer is many-faceted, but the main ones are (a) professional ethics, (b) reputation, and © second opinions which kinda feed into b.
Any provider whether doctor/mechanic/wedding photographer/whatever is also incentivized to serve their customers well by selling them only things that truly benefit them.
We don’t need insurance companies in all those other industries to prevent providers from using an infinite-billing hack to generate infinite money.
This would conceivably be true for car repair as well. A mechanic is incentivized to order as many repairs as possible for a car.
So why don’t they?
They do. Car mechanics have a notorious reputation for doing repairs that aren’t necessary, or for breaking something so that the owner has to come in again soon.
is also incentivized to serve their customers well by selling them only things that truly benefit them.
Yeah, there’s a natural counterbalance that means they don’t want to be seen as dishonest. Similarly, an insurance company is counterbalanced against trying to prevent every test or procedure by also wanting to be seen as honest.
We don’t need insurance companies in all those other industries
You’re aware that car insurance is a thing right? Any industry where the charges are going to be extremely high is going to involve insurance. Cars are fairly expensive devices, and so there’s car insurance, and if you’re in a big accident your car insurance will pay for the repairs. But, the car insurance will keep an eye on you to make sure you’re not committing insurance fraud, and also limit how much the car repair shops are allowed to spend to repair your car.
Great example, mechanics are notorious for ripping people off.
what’s to stop a hospital from profiting off the insurance companies by asking for a CT scan/whatever of every single patient just because they can
The patient saying no. Also a system where the patient isn’t forced to use insurance.
We could have markets run the hospitals but heaven forbid people would consent to their economic interactions.
We could have markets run the hospitals but heaven forbid people would consent to their economic interactions.
“Hello! My mother is clutching her chest. She may be having a heart attack. Could you please email me an estimate for the treatment? I’m talking to two other car dealers, and I’ve read all the posts about the 4 square method online, I’m on to your tricks.”
It became legal when we decided medicine was too important to be handled by a free market, and we created a labyrinth of laws governing how medicine must be administered.
Medicine in the US is the closest we have to a free market. (Newly developed pharmaceuticals being a bit of exception due to the nature of our patent system) In a free market you work on principles of supply and demand. An important concept here is that of inelastic demand. For certain goods, up to a certain point demand will remain constant regardless of price as they are essential to life or addictive. Think gasoline, water, cigarettes, etc…
With medicine people will generally spend whatever it takes often even going into debt if necessary because they value continuing to live very highly. As a result, hospitals are able to charge as much as they think people are willing to pay before they decide that dying is a better financial decision.
You could argue that in a free market, hospitals which charge less will see more business pushing costs down. For certain areas like elective plastic surgery the whole free market model actually works out fairly well since people have the option to shop around. However, let’s say you get in a life threatening car crash. In that moment you don’t have the time to shop around for the cheapest ambulance provider and run a cost benefit analysis on which one has the closest ambulance. After that you can’t shop around local hospitals to see which can offer the cheapest solution for your procedure because first off you don’t know exactly what’s wrong until you get to the hospital. Second, you’re currently suffering from serious injuries and need to get to the closest hospital. This is why just about the entire developed world apart from the US has nationalised healthcare. Is it completely free of issues? No. Are there some markets where private healthcare can offer better service? Yes. However, you don’t have people going into financial ruin because they needed emergency medical care.
And when the patient turned out to be fine after the scan, the insurance company will try to blame that the doctors are lying so that the insurance company has to pay the hospital more It’s like they thought that the doctors must be able to see through the patients’ body as if they forgot that the reason for these equipments to exist in the first place is that because the doctors can’t really be 100% sure about what’s actual situation inside human body
There’s two sides to this coin. On the one end, you have insurance companies refusing to pay for anything because the modern industry is just six scams in a trench coat.
But on the other, you have doctor’s offices where the physician literally leases an MRI machine to the tune of several million dollars and then has to run a certain number of patients through the scanner every year or lose money. That’s because the MRI patent is held by GE and they can charge 10-100x markups on hardware that is fundamental to modern medicine.
Its the same with diabetes treatments. Insurance companies will try and refuse service or kick people off their policies if they are at risk. But then pharmacy companies will sell $3 of insulin for $75, then kickback a chunk of the balance to judicial/congressional bribes in order to guarantee the cash flow.
At some level, the only insurance companies that can survive in such a market are the ones that say “No!” to everything. The even-remotely-ethical firms just get fleeced by the for-profit industry until they get bought out or go bankrupt. That, or you’re Medicare/Medicaid and you have an infinite wallet backstopped by the US Treasury. You don’t care if you’re paying multiples of whatever any other clinic anywhere else in the world would charge on an enormous population of poor and elderly patients, because you have an unlimited money cannon to mow it all down with.
Very uninformed take, its almost laughable.
GE isn’t the only one who makes MRIs. The other big players are Siemens, Philips, United, and to some extent Canon, Fujifoto, and Hitachi.
No, that’s really how much it costs. The margin on MRI machines is terrible. I’d like to see you do it cheaper… “Just” build then supercool magnet for superconduction for 3T of homogenius magnetic field, build coils that handle KW of RF/gradients that can fit a human comfortably without artifacts, build the high power and precision circuitry to transmit and receive said RF, then control that equipment accurately and safely.
Super easy, off-the-shelf stuff.
Oh, and you can’t use any ferrous parts, nor can your power supplies generate any noise.
That’s like, senior design level stuff amirite
The other big factor in cost is supply chain. Everything has to be tracable. So the supply chains have to do a lot of paperwork, inspection audits, since a defective part can kill someone.
Six scams in a trench coat
Fucking poetry lol. I’m gonna use this.
*cough* single payer fixes all this *cough*
Sorry, cough has been acting up. I should go see a doctor with a MRI about that…
cough single payer fixes all this cough
I’d go one further and say a National Health System fixes all this. Rather than paying a guy to pay a guy, you just have publicly financed clinics and hospitals. This is the traditional way of building up medical infrastructure, btw. City hospitals used to be the norm. We only entered the era of corporate consolidation when we sold off our public infrastructure for a song during the neoliberal turn of the 70s and 80s.
Shouldn’t that patent have expired by now?
This kind of thing is why it bothers me when people complain about “free market medicine”.
A market where only one entity is allowed to build MRI machines, or license the tech to others to build, is not a free market. That’s a government-enforced monopoly.
Even the fact that a patient can’t just go get their own MRI at Scans-R-Us, but needs to get a doctor’s referral first, is a huge departure from what an actually free market for medicine would look like.
Shouldn’t that patent have expired by now?
It’s an evolving technology. We get new patents with every iteration.
A market where only one entity is allowed to build MRI machines, or license the tech to others to build, is not a free market.
If you spend a few years in Business School getting your MBA, you get an earful about how and why patent law exists. The core argument is that private investment is predicated on returns and we can’t have nice things unless we have men with guns come for the property and freedom of anyone who “steals an idea”.
But more practically, this shit is just a racket. Lots of lobbyist money changes hands to make sure the decks at the casino are properly stacked. Medical treatment is just another opportunity to apply leverage through debt to control other people.
I understand the value of a patent system, but patents should expire.
Is there some reason why previous-generation technology, like the tech being used for MRIs in the 90s, can’t be used to manufacture more competitively-priced machines?
Like, is there a law specifying that the new technology must be used for an MRI to be usable as a diagnostic tool?
patents should expire
They do. It’s just that they can be renewed under various circumstances, typically as an incentive to increase production.
Is there some reason why previous-generation technology, like the tech being used for MRIs in the 90s, can’t be used to manufacture more competitively-priced machines?
You need a certain amount of industrial capital geared towards making these machines and GE is the only one that really does (excepting manufacturers overseas). A big part of the problem is that we don’t have a good mechanism for introducing new small businesses to the market. You really need to know someone that needs a steady number of MRI machines on a regular basis to make a new MRI factory worth it, and unless you have that business connection you have no buyers.
So you’d need to have a single integrated business, just to get all that information in-house.
The same company could build the machines, and sell the MRI scanning service.
Then you’d need a lot of conversations with various doctor’s offices.
But there are probably lots of places who’d rather be able to provide patients with a lower-cost, lower-quality MRI, so it should be possible to collect a number of providers saying “if such a service exists, I’ll use it”.
My guess is there’s gonna be a lot of government money available soon for people who want to build new manufacturing capability in the US
IThey can’t even be sure after the MRI. Which again, proves your point. It took one MRI battery and one alert and skilled MRI tech to catch my brain cyst, THEN another whole set, I straight up spend a whole 8hr shift in an MRI machine, Then a TEAM of neurologists studied my custom hand made brain for MONTHS. THEN they had a really good set of educated guesses. Then they did the surgery, and only after they opened up my brain case did the actually see what in the hell was going on. Even after all that, my neurologists was like ‘‘This is what we think is happening’’, I asked what it would take to really know factually, he said an autopsy. He didn’t recommend it. The point is, Doctors save lives with these scans, and nothing is certain. That’s not a barrier to treatment, but no scans Is a barrier to treatment.
This is why we need transporter tech from star trek.
Beam yourself into the copy buffer, kill the copy, and do an autopsy.
Prior authorization should 100% be outlawed. It’s either insurance adjusters practicing medicine without a license, or insurance doctors making diagnoses without examining a patient, both of which are unethical or illegal.
Though I think the real solution is a system where every time a prior authorization denial is overruled by the DOO or a court, the insurance company has to pay punitive damages of at least $200,000 to the patient.
My $7000/mo medication has a bunch of “cost relief” programs so they can pretend that they give a shit about affordability, then when you actually try to use them they make you do like 20 phone calls over the span of several months until they finally let you enroll and when you do it only lasts for a short amount of time before they kick you off and you have to start the process all over again. I’ve had to miss multiple doses of the medication which is dangerous for my physical health because I don’t have the money to pay for it and this process takes so fucking long.
Recently, they signed me up for some super shady thing where I pay for the medication upfront and then they pay me back after showing me the receipt. What they didn’t tell me is that it has a limit for how much it will pay for, so I pay for the medication, and what a surprise, they rejected my claim and now I lost $5000 to the medication, which could have paid for a car or a semester of community college. Our healthcare system does a great job at making dying sound like a decent alternative to healthcare.
American health insurance in a nutshell: https://youtu.be/llx-SaGq4Fs?si=eDIny0fqcGYFkB2a
And before non-Americans ask, yes, that’s actually how it is. The humor in this video isn’t from exaggeration, the comedy derives from the unexpectedly clear way the absurdity of the system is explained.
it seriously blows my mind that the overwhelming majority of my fellow americans tolerate this system, that is if they don’t downright approve of it. The issues mentioned in that video are not isolated incidents. They are common, everyday, business-as-usual practices that almost all of us deal with.
Yep! The last bit is more of a joke, but the rest is pretty spot on with how the stupid system works. Here’s another example of a video explaining US Healthcare.
The episode of South park where they walk into this 22nd century insurance building and ask to make a claim. They get sent to the “claims office” and it’s like they went back in time to the 1980s with dot matrix printers, rotary dial phones, and fax machines.
Here is the link if anyone is interested: https://www.youtube.com/watch?v=VAfy26xs6e0
I love BDG, everything he makes is fantastic
They hire doctors who can’t handle being practicing doctors to prop up their delusions. I’ve only had one on the line in a dispute and he acted quite offended when I asked for his license to prove he was a real doctor. Turns out he was barely a doctor at all. He decided instead of practicing medicine and killing people he would work for a insurance company and kill them that way.
So like did he complete his residency then head straight for insurance field?
From what I remember he was so bad he had trouble being employed. I looked him up and gathered information for my lawyer.
Wild. With how gnarly residency is you’d THINK most of them would be ground out, but guess some folks just see those dollar bills working as a corporate doctor.
My insurance that I pay a ridiculous sum of money for has started doing this neat new thing. When the doctor orders imaging, they mark it as “requested more information but never received any”, and reject the claim. They don’t actually request any additional information, and they ignore me when I contest their decision. So glad that I pay like $400 per month for this coverage.
Yes, I think that’s exactly what my doctor was trying to describe. He said if they’re at that point, they basically have to guess what information they’re looking for other than “I’m a qualified physician that has run diagnostic tests and determined this is the best course of treatment. Here are those tests and why it indicates X and therefore requires Y.”
I’ve had to do unnecessary labs to prove an ailment wasn’t something else that some person hundreds or thousands of miles away thought it might be.
If you think you hate insurance companies, find an honest doctor and ask them what they think of the US Healthcare system and health insurance. I’ve never seen a doctor so worked up and angry than when discussing the current medical system.
Edit: this guy is fun to watch on this topic: https://youtu.be/s33AVskz3T8?si=Qqx2nAJjguMOxnNL
It’s like calling your ISP and you can see the fucking wire dangling down from the pole but they won’t continue unless you turn the modem off and on first.
I worked in Pharmacy claims remediation for a while. Fun times. Never again. Why the fuck is my barely-above-minimum-wage-ass the one that has to tell medicaid that little Timmy is gonna die if he doesn’t get his chemo?
Because it’s more profitable if Timmy dies. Why would they want effective, highly paid workers doing the job of trying to cut into their bottom line?
It’s a modern war for a modern economy.
Instead of pitting the poor and destitute soldiers of opposing countries against each other in bloody combat, we have opposing corporations (in my case, the pharmacy and the insurance company) pitting their minimum-wage phone-jockeys against each other in a battle of wits when death is on the line.
Fortunately for our patients, I’m part Sicilian.
Fortunately for our patients, I’m part Sicilian.
Thank you for your service o7
No, unironically though, helpful folks in the healthcare industry despite the system’s labyrinthine and hellish construction have kept me from several major breakdowns. You going to bat for the patients has likely saved at least one person from a psych ward visit.
I file a complaint with the department of insurance instantly when they deny anything. I don’t negotiate with them for 3 months first, I jump straight to sicking the Feds on them and my doctors have always provided me every bit of data I need and cheered me on.
And I’ve won every time. It annoys me that I have to do it, but I enjoy that it costs the insurance extra every time.
I didn’t even know that was an option. Thank you! I will do that from now on.
tl;dr: It doesn’t.
Had surgery to correct an underbite a few years ago after prepping for it with braces for years. For context, I was still young enough to be on my parents’ insurance. The surgery involved moving my upper jaw forward and my lower jaw back because the underbite was so severe. The insurance denied the claim. My parents (I love them so much for this) decided beforehand that, if the claim and the appeal were denied, they would instead “gift” me the money out of their own retirement savings and have me pay for it. The procedure alone cost, I believe, $16k out of pocket. (I don’t remember the specific reason why they gifted me the money instead of paying for it outright.)
It might be that you HAD to be the one to pay for it. When I hit a certain age, all the insurance cheques were made out to me, and I had to deposit them and transfer the money to my parents.
(Though this was insurance for therapy, so maybe it’s different?)
Insurance wasn’t involved when it came time to pay for the surgery. By then, they’d already denied the claim and the appeal, so they were paying completely out of pocket for the surgery.
Right, but it might still have to be you paying, insurance or no.
Sure we could save lives by listening to doctors! But who will save our dollars, huh? The REAL value!
Fuckingcapitalists
Capitalism is based on free markets.
Deviations from free market status in this scenario include:
- The MRI machine is extremely expensive because it’s from a government-enforced patent monopoly
- The insurance is expensive because it’s mandated by government
- The MRI requires a doctor’s prescription because that’s the law
If we had capitalism in medicine, OP would be paying $150 out of pocket to buy an MRI scan from a private company, and that would be that.
Where did you pull $150 from?
America is one of the richest countries, but life expectancy is so low because of all these inequalities and shootings.
Everyone should also remember that it’s going to get worse. People, especially nurses, are leaving the medical field. GPs are becoming scarce, and boomers are taking more and more of the medical resources available as they age. It’s going to get harder and harder to get timely medical care at all, let alone getting it without bankruptcy.
No way ? insurances have a say against the word of doctors ? I must be hallucinating, I thought I knew all about it
Well. No. They have a say about whether they’ll pay for what the doctor has decided is best for the patient.
Think we could make Lemmy a household name by having the C suite of companies that do this SWATed? The government doesn’t work so we’re going to have to do this ourselves.
don’t joke about that, you might cut into their profits if it happened. /s
