The Product is . . . Comprehensenility

It's supposed to be that insurance converts inherent risk into a predictable cost, but health insurance is not really doing that. The costs remain unpredictable.

The costs remain unpredictable.
I wholly disagree. I predict that the costs will be unnecessarily high.
- Ahhh, but when
But they know that, which is why healthcare costs have consistently increased higher than inflation.
Healthcare is one of THE MOST demand inelastic commodities or services. People do not say “oooh that’s a lot of money - is there a worse doctor who is cheaper?”, instead they say “100% yes I will remortgage my home and sell assets to pay for the cancer treatment my child needs.” Nobody is at the free clinic by choice, they’re there because they cannot afford or borrow to pay for better care.
Capitalism is incompatible with ‘rational consumer purchasing choices’ that apply to clothes, food, TVs, etc. because when there’s death or life altering negative outcomes, the only rational decision is to pay WHATEVER the price demanded is. Healthcare has a demand wall, not a demand curve.
- People do not say “oooh that’s a lot of money - is there a worse doctor who is cheaper?”, instead they say “100% yes I will remortgage my home and sell assets to pay for the cancer treatment my child needs.”
  I can't believe how many times I had to make this exact point to dipshits I worked with any time they uttered the term "free market".
  What am I going to do in an emergency in the back of an ambulance on the way to the ER? Hey, can you guys pull over for a sec? I need to check if the current ER doc is in network. Fuuuck ooooffff.
  I then recount the time I needed a non-emergency procedure (MRI for my back) which affords me plenty of time to shop around. I proceeded to call around to try to get prices (LOL) and then I got my insurance and MRI place on the phone all at once and I STILL couldn't get a solid number for how much it would cost me. Who the fuck else needs to be on the call to get a number???
- For mathematics wall is a curve. But yeah, completely agree.
Indeed. They have a product. They are withholding it from us.

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.

Private insurance should only exist for things that are both a) completely optional, and b) not inevitable (so... evitable?).
Auto insurance? Well, if it's the law to have it, why is a private company involved whose sole model is to collect money and deny payments?
Health insurance? Well, it's optional, but you will absolutely need to pay for Healthcare at some point (or you die early). Why, again, should we put an institution in charge whose sole purpose is to make the average person pay more than they get out of it?
Famous athlete leg insurance? High value possession insurance? Have at it, private insurance.
- Auto insurance being mandatory makes sense in that the wronged person shouldn't have their life destroyed because someone can't drive and afford to replace a car.
Tonight, on Saying That Last Little Bit that John Oliver Can’t Say…

And these cunts get to say 'doctor is wrong you don't actually need that'

I just thought of a funny concept which is that when you're born in the country you're automatically given life insurance. Then when a doctor says "you need this operation" and the health insurance company is like "your doctor is wrong" your life insurance company can come in and be like "you can't kill my guy, because he'd be owed a gigantic payout!" and then go to war with each other.
It would never work in reality, but I find the idea funny.
- What would predictably happen is that the health insurance company would still withhold care, and the life insurance company would deny the payout based on the care being withheld. Then they both would be like "sue me".
  And eventually they would merge and be just one company.

Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.

well there's the whole telecom industry too
- And car insurance. And wall street. And Google with Pixel Pass. Actually I think capitalism just fails to deliver in general.
I think every industry strives to be able to not deliver something after being paid, they usually just can't get away with it.

Want to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.

I had an issue with my foot and the doctor requested an MRI as an ultrasound wouldn't show them anything they needed to see. The fucking insurance company says no, do the ultrasound... So I paid for a fucking useless ultrasound and then they refused to move forward with anything else... The issue kinda went away thankfully but there's still something odd with my foot that I guess I just won't fix until I can pay completely out of pocket.
I'm so fucking happy that at least $1,200 monthly is taken out of my potential pay to cover a fucking useless insurance scam, because remember even if your employer "pays" it's factored into your total compensation so you're still the one paying.
- it’s factored into your total compensation so you’re still the one paying.
  I never understand why so many people assume insurance is "free" from the employer or that they pay 0-1000 per week/month. What we see is the tip of the iceberg. Insurance companies are perfectly lucrative and they pay tons and TONS of money to workers that make sure they make as much as possible.
  80% of premium revenues must be spent on treatment, the other 20% is what they have to profit off of. If they don't spend 80% of the premiums on treatment they MUST refund excess earnings. See: https://www.healthcare.gov/health-care-law-protections/rate-review/
  This means if they took in 100 billion in premiums in a year, they MUST spend 80 billion dollars on treatments. The 20 billion left over is where they can make money. So they will make sure 4/5ths of everything they make goes into treatment so they never give refunds and they maximize potential profits. If they can convince companies to raise premiums 10% next year, costs will rise 10%, profits will rise 10%. It's so obviously designed to raise the cost of premiums and treatments at the expense of all else it's insane.
  They also don't spend a dime over 80% of what they make if they can help it. There's where claim rejections come in. They have mathematicians figuring out the ideal numbers and those guys make stupid amounts of money.
I'll do you one worse. Sometimes, they do have doctors. In cases where people are trying to get coverage, especially for a severe workplace injury with lifetime effects, the insurance company will send you to a doctor who barely passed med school. They'll have you do a "physical" that's basically turn your head and cough. Then they write up a report that says you don't need coverage.
Since they are technically a licensed doctor, this is still considered "expert" opinion in court (if it comes to that). The doctors involved can make way more money at this then they can working their mediocre asses in any real capacity.

their profits only exist when human beings are denied care. humans have to suffer for that stock price.

Well, they also profit from healthy people who don't use their insurance much.
- nope
No, they make a profit if your premiums are more than your care+overhead. Preventative care is sometimes offered with no co-pay --- presumably because you end up costing them less over the long haul if you keep up to date with your Dr. appointments.
It's not a great system; but it does work very well for some customers, and failing to recognize that tends to preclude having a productive discussion.
- the united states is #1 in medical bankruptcy, including people with insurance.
  insurance is a scam youve been taught to not see as a scam. its a terrible middleman which extracts profits from sick and hurt humans by denying them care. if they paid all the claims, they would have no profit. and why should they? how can anyone defend such a gross money grab.
  giving the scam credibility keeps those costs high . pretending it has value keeps us from moving to a cheaper, more universal system.

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.

Fuck, I hope that's not on mine. I had bottom surgery and they have paid upfront for everything except the OR day. $120k just sitting for a year as I ping the insurance and hospital every month.
- My current plan has an exclusion, which fucking sucks. I want to get bottom surgery and move across the country so that I don’t have to deal with this shit anymore.

Is this a US thing that I’m to Europe to understand?

Yeah in the United States of Billionaires healthcare is a product to extract profit from in every way possible.
Pharma companies get public funding for research and then turn around and charge insane prices for the final product infuriatingly referring to research costs to justify their pricing.
Hospitals are bought and run by investment companies.
"Insurance" ~~scammers~~ corporations have their own fiefdoms that they control so there's very little competition and their sole reason for existing is to take your money and deny coverage for absolutely anything they can possibly deny you for so they keep the most money possible.
We have The Best System In The World™ (for the ultra wealthy)
Apparently, yeah.
You probably haven't even shot up a school or anything have you.
- Get that person a hamburger and a mountain dew stat!

TBH Hospital Boards aren't all that innocent, either.

- One hand washes the other
Nor the doctors themselves (well most are innocent, but there are a few who lobby with the AMA to help keep prices high so they keep getting paid)
So the boards should be reformed and have equal parts worker/union, patient, and shareholder representation.
- Nah fuck that lets just do singlepayer.

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.

First. I hope your family is OK.
Second its total bullshit the medical insurance companies can just declare something isn't needed (usually by a doctor on thier payroll). Then use that as a justification to decline coverage.
This is supposedly a standard tactic for them too. Decline all big claims and see who fights it.
That's insanely immoral especially because anyone with a huge medical bill clearly has some shit going on and the last thing they need is the massive stress of a massive medical bill.
We have movies and TV shows that poke at how bad our medical coverage is and we Americans just accept that the plot is acceptable.
The ones that come to mind are:
The Rainmaker kid dies of lung cancer because insurance declined treatment due to it being "experimental".
Breaking Bad yeah. Cooking meth to pay for cancer treatment
- They should be held legally to prove why the procedure is not necessary only then they can refuse the claim. Otherwise they have to provide the claim. This should be the law.

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.

Health insurance companies sure seem like socialized healthcare but with some rich guys that steal money out of the pot

If you squint your eyes just enough, insurance is like gambling... You are betting that something is going to happen to you, the insurance company is betting against that. The insurance company can improve their chances by adding conditions to that something.

That's the part that makes the US system insane.
In countries with a public health care system, the goal of the patients and the doctors is the same. Everybody's goal is to prevent diseases and sickness, and to treat it when it isn't prevented. The administrators just estimate how much funding is needed to achieve that goal.
In the US system, the patients are trying to prevent and treat their sicknesses and diseases. The administrators are trying to find ways to avoid paying for any treatments, and the doctors make more money if they can find a way to bill more things.
And, what's especially insane is that healthcare really isn't a normal market like other things. If you're buying a truck, you can shop around, haggle with salespeople, etc. If you're hit by a truck, you're not going to be comparison-shopping emergency rooms.
It's way worse than gambling. When you win a jackpot there are laws that require you to get paid out.
Insurance companies can just say no and fight you in court until you die because it's cheaper for them to pay some lawyers than for your treatment.

Same as student loan "servicers" collecting billions in interest to just keep track of peoples' debts.

All health care costs then also are greatly inflated just so these a-holes can make money without affecting what the doctor gets.

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.

Insurance transition from protection against highly unlikely emergencies to our default payment system is the biggest scam in world history.

Yeah, it's a big misunderstanding to think that insurance is not a product. It is product. The problem is that these companies all have the most shit versions of this product. It's like living somewhere where every sandwich shop had a slice of bolongne on white bread, and they just changed which brand of mayonnaise they used.
This is a serious part of the problem. Home insurance, car insurance, can be bad, but at least you don't usually have to deal with them. You can go years without needing anything from your home insurance.
You WILL need healthcare, minimum once a year. Most people need it every month or every few months. Your car insurance doesn't pay for your oil changes or new tires because those are guaranteed maintenance costs, not unexpected emergencies.

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.

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.

Good god when I hear stories like this one I think if I were in their place I'd try my best to get hired abroad so I can have proper coverage. I know it's not possible for everybody but it is what comes to mind

Yep. They produce nothing.

Just wait until you learn about landlords.

they produce a negative-service
- Then don't buy it.

I 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.

The issue is that they are run as for-profit businesses but the product that they provide is a public good. They make money by providing as little product as possible. This type of structure is fine if your company makes luxury goods, but in the case of health insurance it results in unnecessary pain and death.
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.
My dad can't get a medication that actually resolves one of his health problems because it's not on whatever list of medications his insurance company has for that issue. Even though his doctor prescribed it and it worked up until he got a new insurance. Now he has to use some other medication that barely helps. Insurance companies are bullshit. Doctors should be reviewing what other doctors are doing. Not some office peon who probably gets a bonus for rejecting claims.
- Yeah, the system is jacked up. We need a better one like our lives depend on it.

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.

- Germany: If your physician thinks, you need your brain scanned, they will give you a referral, you make an appointment for your brain scan, your brain gets scanned, and your physician now knows if your brain has a problem. Your insurance pays for this.
  Source: got my brain scanned, brain is fine and at the proper location.
Not sure if you are in the USA or Germany based on your URL but The general idea is that a private company should not have to hold the cards for our fate, and our health treatment. That's what you are clearly missing. If you get chronically ill in some of the better parts of Europe, you won't have any medical or financial consequences of that. Ambulance is don't cost much of anything directly, hospital stays don't cost you much. In the USA you cannot say the same. Going to the hospital for some major illness like cancer or emergency surgery could cost you anywhere from $15,000 to $200,000. Look up the cost of having a baby at a hospital especially when there are complications. It's unbelievable.
The idea is that you should pay into a system that works for everyone, namely the government and taxes, and they help you out in return once you have a hardship at a low or no cost because you have been paying into it. This is not how insurance works. In most cases, you pay stupid amounts of money into insurance, and once the new year rolls around, you have lost your entire deductible and you're out of pocket is completely reset. You have severe limitations on your FSA or health savings accounts so you can't save enough money. Literally not allowed for you to save and stockpile lots of money for covering healthcare. You have to pay into this stupid for-profit company that doesn't give a damn about you and will never lift a finger to help you. Sometimes people are lucky and benefit from the insurance. Those situations are extremely rare, and situations in which people are financially ruined by insurance and healthcare are far more common.
I'm glad that the system in place has worked for you currently. But that does not mean it works for everyone, and that's something you need to understand. Just because something works for you doesn't mean it's a great system.
- Yeah, I'm in Germany. It is widely known that the US medical system absolutely sucks ass. Doesn't mean that the concept of health insurance sucks. In most of the developed world it works well. It's only the US implementation that is majorly flawed.
The problem is greatly unequal access to healthcare. I'm glad your insurance is doing well for you, but there are many out there who are struggling to pay for expensive family insurance with high deductibles that still leave them in medical debt.
I'm also currently in a situation where I'd like to find a new job, but I have some expensive medication ($750 a month for one of them) and I am worried about losing my insurance/not being able to afford the premium while I wait for benefits to kick in at a new job. I also have absolutely no way of knowing if another employer's plan will cover my medication or if my current group of providers will be in network. All this added stress, and yet I'm lucky to work in a field where almost every employer offers health insurance.
Ideally, there would be universal safety nets to provide the services you're benefiting from to all Americans. It's not even like we're saving money by relying on private insurance, as the US spends way more per capita on Healthcare for average results, at best.
So I'm glad that your insurance is taking care of you, truly I am. But spare a thought for the thousands of Americans out there who are struggling to survive under the same system.
- I think the issue is that you look like you are talking about health insurance in the US. There is basically a zero percent change the person you are responding to is talking about insurance from any plan in the US.
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They literally don't even have a product.

Then don't buy it.

(I'm tired of the oversimplification that gets voted to the top of any social media)

The in-network healthcare providers don't trust my employer's insurer. So much so, they require full payment up front. At this point, I don't know what in-network even means. I no longer buy it.
- Yikes. I'm guessing that provider has had issues being paid by this insurer in the past?

Denial is a product

That’s dark, man.

Yeah no kidding. A company gets to profit off keeping us from getting treatment and it's just accepted and normal.

Pretty much the same as bankers

And half the finance industry.

Insurance is a product. Just because you don't like the product doesn't make it fake.

Words have meaning.

Words do have meaning. But putting paperwork and process around something that would happen anyway and claiming that paperwork and process IS the thing that would happen anyway is bullshit.
It's a "product" like "AI" is "artificial intelligence".
- Whatever you say, it's your head cannon we live in.

This is why I'd rather die then go to the doctor.

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.

Yeah the actual health care providers get the screwjob on a regular basis. Meanwhile there's some insurance fatcat going door to door doing sales to employers.
I shit you not I once watched an insurance middleman asshole come into the office and be like "the problem with health care costs is definitely not the insurance companies". Like yeah, it's totally not the fact that you have a job going around to the offices in the area accomplishing nothing, Mr. Combover, it's totally the health care workers that actually provide service that are the problem.
- I've worked in, for and with the health insurance industry, in the past, and adjacent industries (mental, physical, occupational, speech therapies, gp* skilled nursing facilities, etc). It's definitely the middle -men.
- I'm really sorry to hear that. I did a very quick search, so I'm not sure how current that information is, with regard to executives. Do you live near enough the VA facility to schedule an in-person visit? If not, can you contact them and ask for assistance in meeting your needs? Do you receive any sort of disability or Medicare, that can help cover costs? If you may or not qualify for disability, please request go online and request your DD-214, and start proceedings to get your records to and apply. If I'm understanding correctly (and I may not be, my information is sparse and outdated), the government has to prove that any disabilities did not arise from your service duties.
  I'm currently trying to help a community veteran with this process, so if you'll DM me so I don't forget, I'll pass along information as I learn, but we just requested the DD-214 this week, so it may be a long, convoluted process. My very best of luck to you, I am sorry this is how we thank our service members and vets for their service. I appreciate you, and I'm pulling for you.

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.

America is largely de-industrialized, it doesn't "make" much, so instead it's dominated by Usury, ie financial Capital.

What kind of libertarian bullshit is this?

Think about it for more than 2 seconds.

What are insurance companies here for?

Profit....
- No, they socialize the risk of becoming ill.
  Are privatised health insurances in the USA shit right now?
  Sure.
  But as a European with nationalised healthcare let me tell you: we also have (heavily regulated) health insurances.
  The alternatives is: every health problem is a potential cause of financial ruin.
What does libertarianism have to do with anything? The US health insurance industry is objectively evil. It exists solely to extract profits, while providing no service. It's just a middleman between you and health care providers. It's a poster child for regulatory capture and blatant corruption.
Profit...

Well said!

...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.

Why can't we have universal healthcare or a public option?