I am close to retirement but far away from Medicare age. The health care situation alone makes me want to leave this country. It’s such a mess. And I don’t see any movement to improve things. It’s just getting worse every year.
The lack of health coverage has been what has stopped me from starting my own business. I do not want to risk any of my family getting sick and not being able to cover it, but I also don't want to blow through all my savings paying for health insurance waiting until I get a VC to give me money.
I’ve basically opted out. I can’t see that the healthcare system has any incentives to keep me healthy. In fact all the incentives are to keep me medicated indefinitely. No thanks. I have a plan for catastrophic coverage but I stay as far away from hospitals and doctors as I can otherwise.
What's your maximum out-of-pocket for the catastrophic plan?
Btw-- make sure to double the MOOP since catastrophes can easily straddle the end of one 12-month period and the beginning of the next 12-month period.
But you'll get to learn about part D medication plans and Medigap part F*, G, N, and the other 7 gotcha plans that are run mostly by for-profit megacorps that get to change their prices every year. Oh and Medicare Advantage (part C, not to be confused with Medigap parts) is a total scam with lifetime limits that has already fooled 54% of recipients. Traditional Medicare is way too complicated and should be thrown away and replaced with a universal single-payer system without any for-profit corporate bullshit. Also not covered: dental, vision, hearing aids, long-term care, skilled nursing... you and your family need to be be completely broke to receive Medicaid for long-term care.
* So sorry, you can't have this one anymore because part B deductibles are no longer covered due to the neoliberal MACRA 2015 that doesn't care about costs borne by the poorest Medicare recipients.
It’s not better elsewhere. Healthcare is fundamentally expensive. You can choose between cost, availability of specialists or new treatments, and speed of being seen. The bureaucracy and vague denials under some government healthcare programs make United, Aetna, etc look good.
It's at least better in not making the system a confusing mess of coverage tiers, copays, deductibles, in-network staff in out-network facilities, and all the other jargon used to complicate it to the point where many people don't know if they are covered or not.
Nowhere is absolutely perfect but it's much easier to navigate, and many developed countries have very good care for emergencies and/or life-threatening ailments. It might suck to investigate something chronic but non-life threatening, it won't stress you if you think you are having a stroke and need to call an ambulance.
That’s what frustrates me a lot. The system is not only super expensive but also incredibly complex an unpredictable with tons of very costly traps. Basically it combines the worst aspects of the different approaches.
Pardon the internet lingo, but this is cope. Americans pay way more for their healthcare than citizens of countries with universal healthcare, like France, and their life expectancy is still lower. So clearly, it is better elsewhere. Don't fall into helplessness, the situation can be improved, it will "just" require actual political will to do so, that you unfortunately can't find anywhere among the Right or "moderate" democrats.
For-profit pay-viders (payer-provider mergers) should be illegal. In theory they can drive greater efficiencies that pass down to consumers, but in practice pay-vider integration makes available a lot more levers to screw consumers. All of those levers are easier to pull than increasing efficiency of care delivery.
If you want to act as both insurer and provider, then you should have to be a non-profit and have thorough performance monitoring in place to ensure you're passing what's possible back to consumers.
Each year they pay me $1,000 (in the form of HSA deposits, which I can invest) to do basic things like get a checkup, get a flu shot, and get a blood test. I sync my wear-able data and they pay me $1-2 each time I exercise or get enough sleep.
I had them via a previous employer and had serious surgery; they asked me to go through the “get a second opinion” process which was getting all the records to their system and then a virtual/video call, but after that, they paid for everything.
I don't. I have their "platinum" insurance, and they still seem to fight any claim we file.
For example, my wife got knee surgery recently, and the doctor recommended we rent a CPM machine to help her knee avoid atrophying. Renting the machine is $200 a week. Insurance said it was "optional" and refused to cover any of it. We ended up buying a used one on eBay for about $900, which is a lot but not insurmountable for us.
It kind of annoys me though, because not all their clients are yuppie software people who have disposable income. A lot of people can't afford to rent a machine for $200 a week or buy one for $900 on eBay, but they do make it much easier for the leg to heal better. Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance? It seems more than a little unfair that my wife's leg is more likely to heal better purely because she's married to a software engineer.
I really have no fucking idea what the difference between the cheap and expensive UHC plans. It sure seems like I'm paying many thousands of dollars more for medical stuff than I was for equivalent services with Anthem. Oh, well, at least my premiums are higher too, so that's fun.
Hopefully obviously I don't advise shooting a CEO for several reasons (both ethical and legal), but I have to say that I was unable to cry many tears when I heard it happened.
>Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?
I thought the operative term was "medically necessary"? "would help with healing" can theoretically cover everything from protein shakes for knee injuries, to iPads to help with stroke recovery. A CPM machine is on the far end of this, closer to "medically necessary" than the other examples, but you have to draw the line somewhere, so some reasonable-but-theoretically-optional equipment gets excluded.
Sure. I guess I would draw the line in a different place.
There are plenty of things that aren't strictly "necessary" but are still provided by insurance. My wife's painkiller medication isn't strictly necessary, she wouldn't die without it and the leg would probably heal the same way, but they covered that because obviously they should cover that. I feel like a piece of medical equipment like a CPM machine is more necessary than painkillers.
Well first question to my mind is does a CPM actually help? There's a lot of waste in American Healthcare on expensive but fairly useless treatments.
My guess was that a CPM might fall into this category (I did PhD research in bio mechanics in MatSci). So I googled it and it returned a quote:
> Do doctors still use CPM machines?
> The machines are no longer widely used because of the multiple studies that found CPM following knee replacement surgery has minimal benefits. However, some surgeons still recommend CPM following knee surgery when the limited pros outweigh the cons in a particular case. (1)
From an insurers perspective it makes sense not to cover a marginally useful piece of equipment. The better use of resources would probably be covering PT where there's movement and weight on the joint.
Fair enough. It was still prescribed by the doctor and I would rather have not paid for it.
Even if its benefits are marginal, they’re probably still more tangible than acupuncture and chiropractic, both of which are apparently covered by my insurance, and the CPM machine probably doesn’t cause a stroke like chiropractic does.
> Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?
You are confusing "health insurance" with a "system that guarantees healthcare as a human-right". Those are different things.
The purpose of health insurance is:
- To constrain healthcare coverage to the minimum allowed by law or the plan contract, therefore maximizing profit margins.
- To provide a shared risk coverage pool to pay for treatment for catastrophic health events that are unforeseen.
- To provide a product to be used as leverage by employers over employees as part of the "benefits" of a compensation package.
Healthcare as a human-right doesn't exist in the United States unless a health situation has gotten so bad that you end up in the emergency room, which is then legally required to provide you emergency healthcare.
No, but working at a company that was founded by a bunch of former gov employees, the coverage is mostly ok and some having to manage the refusal bs. What was new to me - a gap that went employed -> consulting -> employed - (same company family) - how damn expensive top tier coverage for a family of three really is - $3700/mo. Insane.
I am also not advocating anything but ... wasn't the famous Spock line "needs of the many outweigh the needs of the one". The question is of empirically proving it and that's the challenge. The jury may not be co-opted but the judiciary is. I wonder how do we go about proving this.
Utilitarianism is a dangerous mistress when it comes to justifying moral and ethical transgressions. Sounds great until TPTB decide that the half dozen lives that can be saved with your organs matter more than your one life.
Here's a point about all the insurance companies: UHC administers the medical plan on behalf of your employer. For all practical purposes, they are a whipping boy for the real 'man behind the curtain' (your employer).
Your company (for self-funded plans) actually decides what’s covered and what isn’t, sets copays and deductibles, and ultimately saves or spends money on healthcare costs. UHC’s role is to apply those rules, maintain the provider network, and handle the billing and customer service.
If your company offers insurance, there is someone who can tell the "insurance company" to cover the service they are not covering. Usually the HR Benefits Administrator, or 'plan sponsor'. And they do it all the time! If you have a sad story and the budget is ok for the quarter, they will help! If you are a company officer, you can also have whatever your company can afford.
This only applies to large employers. Smaller ones are just presentef a limited list of plans to pick from, and the plans change every year. Most of the time, as a startup, you can’t buy a Mag7 equivalent health plan for any amount of money off the marketplace
Mag7 surely is self insured. They have an amazing risk pool of young people. Probably biggest cost is babies. So in this way employer sponsored health insurance screws the rest of the market, as it "hordes" the best risks. The insurance companies then wail about the cost of the risker pool of those of us stuck in the smaller plans...
There should only be one risk pool which is the whole country. Unfortunately the republicans want to go the other way and push sick people into high risk pools which will be unaffordable for a lot of people
It depends. If your employer is part of a self-funded group of other employers, then there is a group of trustees from all the employers that can approve.
If it's a 'fully insured' group plan then the insurance company is technically in charge, but your company can do an Employer-paid exception (aka carve-out reimbursement) to cover something thats getting rejected. They also have the option to purchase add-on policies to add coverage for upper class stuff like fertility treatments, weight loss drugs, or gender-affirming care.
Insurance companies are a whipping boy, but for doctors not your employer.
Doctors charge massively high prices, which is why insurance bills are high. Doctors have the most powerful trade union on the planet and strictly limit residencies, thus limiting new doctor supply and keeping prices super high.
It's not acceptable to comment like this on HN, no matter who it is or what it's in reply to. The guidelines ask us to "assume good faith", "edit out swipes" and "be kind". That applies equally to all of us and in replies to anyone else on HN. If someone posts a comment that's egregious, just flag it, don't abuse the commenter, as it just makes the place worse for everyone.
Comments do not exist in a vacuum. 4chan is a failed experiment
Assuming good faith is a good guideline when there is no evidence of bad faith. If someone usually post racism and corporate bootlicking and is using their collected to Internet points to abuse the good faith of others, the system breaks down.
It’s terrible that this is an area that is caught up in political ideology. Somehow, healthcare MUST be decoupled from capitalistic incentives. I don’t pretend to have the answer but continuing on this path will lead to worsening patient outcomes. We cannot have corporations expecting to make a dollar off human life.
Afaict the original sin of the US healthcare system is having the healthcare providers chosen by employers. That means that the patient is not the customer, the patient's employer is. That in itself has dire consequences.
Privatized health care need not be so bad. Germany has privatized health care, but it's pretty much fine, at least for patients. It's regulated to the moon and back, but afaict so is the US system, just with very different goals. The ACA feels a bit like the beginnings of a German-style system.
> We cannot have corporations expecting to make a dollar off human life.
That's literally a political ideology.
The answer to problems like this isn't to pretend politics is some kind of abstract system imposed by higher-order beings, its to use political power to fix it.
> Somehow, healthcare MUST be decoupled from capitalistic incentives. I don’t pretend to have the answer but continuing on this path will lead to worsening patient outcomes. We cannot have corporations expecting to make a dollar off human life.
Give yourself more credit! You just stated the answer above.
> healthcare MUST be decoupled from capitalistic incentives
Capitalism pays for our healthcare.
The problem is that Healthcare has an infinite hunger for resources - there is always more that could be spent - and it is always morally correct to spend more (people's lives have high priority).
There needs to be some manner of allocating limited resources between different people with different needs.
Every country seems to find different ways to deal with the fundamental friction of healthcare (unlimited demand and limited resources).
Unfortunately voters don't like the reality of limitations.
Canadian health care sucks but in a different way; so that’s not the solution either. You can look up the wait times for different procedures on the provincial websites.
Things you can get in 72 hours anywhere near a decently sized American city such as an MRI scan can take months in Canada.
Every developed country would say their medical system sucks in some way. We (Americans) happen to both pay more for a system that sucks more than those. The results are in our poor life expectancies, and we basically pay twice (privately and once again via taxes) for it.
Yeah, that same MRI scan can, and often takes an infinite amount of time here. I never said Canada's system was perfect, but it might as well be compared to what we have going on here.
> The bare necessities to live must be decoupled from capitalistic incentives
We don’t have evidence we live in sufficient abundance to guarantee this sustainably even in rich countries. Particularly when bare necessities are decried as cruelty and so cost creep comes to pass.
What we can do: free basic nutrition for all, free prenatal and neonatal care, free preventative medicine and annual check-ups, free access to generics where medically necessary, and a fixed amount of water and electricity to each household. Not enough to be remotely comfortable or long lived. But enough to survive.
Even if you're selfish (and a lot of people are community spirited), the same people who as shareholders vote for the company to grow rather than to pay out more dividends.
I think the incentive itself is good, but there's too much corrupt abstraction in between.
Ultimately I want good providers to be paid well and poor providers to struggle. That is a good system. We don't have that. We MUST recouple healthcare and capitalistic incentives.
United Healthcare isn’t the reason healthcare is unaffordable any more than Geico causes car repairs to be expensive. American demand for healthcare is insatiable, and doctors are a scarce and greedy bunch. That there is a middle man trying to get his 5% isn’t the problem.
> any more than Geico causes car repairs to be expensive
Given how much cheaper things like body shop repairs are if you do not have insurance, is it really clear that Geico does not cause car repairs to be expensive?
And for that matter, get emergency health care without insurance and then fight the cost to get a massive reduction, and you'll wonder whether it actually is UHC and their ilk that help make healthcare unaffordable ...
> United Healthcare isn’t the reason healthcare is unaffordable any more than Geico causes car repairs to be expensive. American demand for healthcare is insatiable, and doctors are a scarce and greedy bunch. That there is a middle man trying to get his 5% isn’t the problem.
Spoken as a software developer who's salaries are approaching or even surpassing doctor salaries while working on optimising "engagement" (or how to make their app the most addictive).
there is a multi-pronged solution necessary that is both intertwined with insurers and also completely separate, so in that part I agree with you
the costs of services are arbitrary and need to be addressed before we can realistically deal with how any insurance pool works, in the US both parties have chiseled at this over the last decade - from getting prices more transparent, to attempting to have a large scale state negotiator - and this makes the conversation more palatable in gaining consensus
not close, but it's not as partisan as people think, despite the parallel existence of entrenched interests
what doesn't have consensus is a forced insurance pool that doesn't address the costs and has no ability to negotiate those costs (yes, this is partially due to the bill being gutted and a handicapped version being the only thing that passed) a deeper review and regulation of costs is the only thing that can help reach consensus
Wrong. 'Medical insurance companies' do absolutely nothing in terms of health care, drain massive amounts of money in what amounts to a Brazil-style (movie) system, corporate death panels, and a drain on all of our resources.
And its not even a product we want. We dont buy it. The companies we work for do, and never have to dogfood any of it. But for the rest of us, its a take it or leave it proposition.
> doctors are a scarce and greedy bunch.
Speaking of that, an MD is the ONLY profession who is solely controlled how many can apply is controlled by Congress.
Get rid of that, and that would fix a facet.
But getting rid of insurance companies would also work a great deal. Or at least, decoupling work/med insurance would be a start.
Even going full competitive capitalism OR full socialism would be better than the garbage we have now.
My girlfriend is nurse practitioner and she says United is the worst to deal with. They deny everything and it sucks up enormous amounts of time to appeal.
I really hope my employer changes to pretty much any of the other ones eventually. I really hate having to argue on the phone with with a poor representative over everything.
Anthem BCBS and Aetna never gave as much trouble. I know they both have their scandals and it's not like I love any American health insurance company, but I definitely rank UHC lower.
The law of supply and demand controls the high prices we see in healthcare. Doctors have the most powerful trade union on earth and have lobbies for strict limits on the number of new doctors per year by limiting residencies.
Shrink the federal government and its overbearing regulations in healthcare and allow many more people to go through residency to become doctors.
I found it’s terrible too. Especially with dental insurance they negotiate terrible rates so you end up paying a lot more than if you went with the local Blue Cross Blue Shield or Delta dental.
I am close to retirement but far away from Medicare age. The health care situation alone makes me want to leave this country. It’s such a mess. And I don’t see any movement to improve things. It’s just getting worse every year.
The lack of health coverage has been what has stopped me from starting my own business. I do not want to risk any of my family getting sick and not being able to cover it, but I also don't want to blow through all my savings paying for health insurance waiting until I get a VC to give me money.
It actually gives you more control.
Assuming you have business income to pay for insurance.
I’ve basically opted out. I can’t see that the healthcare system has any incentives to keep me healthy. In fact all the incentives are to keep me medicated indefinitely. No thanks. I have a plan for catastrophic coverage but I stay as far away from hospitals and doctors as I can otherwise.
> No thanks. I have a plan for catastrophic coverage but I stay as far away from hospitals and doctors as I can otherwise.
This is pretty much the Republican plan for healthcare.
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This is what the current Republican administration recently posted to the website of the Centers for Medicare & Medicaid Services:
"Expanding Access to Health Insurance: Consumers to Gain Access to “Catastrophic” Health Insurance Plans in 2026 Plan Year"
https://www.cms.gov/newsroom/fact-sheets/expanding-access-he...
What's your maximum out-of-pocket for the catastrophic plan?
Btw-- make sure to double the MOOP since catastrophes can easily straddle the end of one 12-month period and the beginning of the next 12-month period.
But you'll get to learn about part D medication plans and Medigap part F*, G, N, and the other 7 gotcha plans that are run mostly by for-profit megacorps that get to change their prices every year. Oh and Medicare Advantage (part C, not to be confused with Medigap parts) is a total scam with lifetime limits that has already fooled 54% of recipients. Traditional Medicare is way too complicated and should be thrown away and replaced with a universal single-payer system without any for-profit corporate bullshit. Also not covered: dental, vision, hearing aids, long-term care, skilled nursing... you and your family need to be be completely broke to receive Medicaid for long-term care.
* So sorry, you can't have this one anymore because part B deductibles are no longer covered due to the neoliberal MACRA 2015 that doesn't care about costs borne by the poorest Medicare recipients.
[dead]
It’s not better elsewhere. Healthcare is fundamentally expensive. You can choose between cost, availability of specialists or new treatments, and speed of being seen. The bureaucracy and vague denials under some government healthcare programs make United, Aetna, etc look good.
That isn't really true. The US just happens to train really few physicians and therefore has really few physicians per capita.
In Sweden it's about 2x higher. Of course, they're still experts, so it's somewhat expensive, but not like in the US.
It's at least better in not making the system a confusing mess of coverage tiers, copays, deductibles, in-network staff in out-network facilities, and all the other jargon used to complicate it to the point where many people don't know if they are covered or not.
Nowhere is absolutely perfect but it's much easier to navigate, and many developed countries have very good care for emergencies and/or life-threatening ailments. It might suck to investigate something chronic but non-life threatening, it won't stress you if you think you are having a stroke and need to call an ambulance.
That’s what frustrates me a lot. The system is not only super expensive but also incredibly complex an unpredictable with tons of very costly traps. Basically it combines the worst aspects of the different approaches.
Pardon the internet lingo, but this is cope. Americans pay way more for their healthcare than citizens of countries with universal healthcare, like France, and their life expectancy is still lower. So clearly, it is better elsewhere. Don't fall into helplessness, the situation can be improved, it will "just" require actual political will to do so, that you unfortunately can't find anywhere among the Right or "moderate" democrats.
For-profit pay-viders (payer-provider mergers) should be illegal. In theory they can drive greater efficiencies that pass down to consumers, but in practice pay-vider integration makes available a lot more levers to screw consumers. All of those levers are easier to pull than increasing efficiency of care delivery.
If you want to act as both insurer and provider, then you should have to be a non-profit and have thorough performance monitoring in place to ensure you're passing what's possible back to consumers.
Does anyone have something positive to share about UnitedHealth?
Yeah I really like their rewards program: https://e-i.uhc.com/uhcrewards
Each year they pay me $1,000 (in the form of HSA deposits, which I can invest) to do basic things like get a checkup, get a flu shot, and get a blood test. I sync my wear-able data and they pay me $1-2 each time I exercise or get enough sleep.
It's great!
>I sync my wear-able data and they pay me $1-2 each time I exercise or get enough sleep
I wonder if the data is sold off and if so whether it's properly anonymized...
I had them via a previous employer and had serious surgery; they asked me to go through the “get a second opinion” process which was getting all the records to their system and then a virtual/video call, but after that, they paid for everything.
I don't. I have their "platinum" insurance, and they still seem to fight any claim we file.
For example, my wife got knee surgery recently, and the doctor recommended we rent a CPM machine to help her knee avoid atrophying. Renting the machine is $200 a week. Insurance said it was "optional" and refused to cover any of it. We ended up buying a used one on eBay for about $900, which is a lot but not insurmountable for us.
It kind of annoys me though, because not all their clients are yuppie software people who have disposable income. A lot of people can't afford to rent a machine for $200 a week or buy one for $900 on eBay, but they do make it much easier for the leg to heal better. Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance? It seems more than a little unfair that my wife's leg is more likely to heal better purely because she's married to a software engineer.
I really have no fucking idea what the difference between the cheap and expensive UHC plans. It sure seems like I'm paying many thousands of dollars more for medical stuff than I was for equivalent services with Anthem. Oh, well, at least my premiums are higher too, so that's fun.
Hopefully obviously I don't advise shooting a CEO for several reasons (both ethical and legal), but I have to say that I was unable to cry many tears when I heard it happened.
>Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?
I thought the operative term was "medically necessary"? "would help with healing" can theoretically cover everything from protein shakes for knee injuries, to iPads to help with stroke recovery. A CPM machine is on the far end of this, closer to "medically necessary" than the other examples, but you have to draw the line somewhere, so some reasonable-but-theoretically-optional equipment gets excluded.
Sure. I guess I would draw the line in a different place.
There are plenty of things that aren't strictly "necessary" but are still provided by insurance. My wife's painkiller medication isn't strictly necessary, she wouldn't die without it and the leg would probably heal the same way, but they covered that because obviously they should cover that. I feel like a piece of medical equipment like a CPM machine is more necessary than painkillers.
Well first question to my mind is does a CPM actually help? There's a lot of waste in American Healthcare on expensive but fairly useless treatments.
My guess was that a CPM might fall into this category (I did PhD research in bio mechanics in MatSci). So I googled it and it returned a quote:
> Do doctors still use CPM machines? > The machines are no longer widely used because of the multiple studies that found CPM following knee replacement surgery has minimal benefits. However, some surgeons still recommend CPM following knee surgery when the limited pros outweigh the cons in a particular case. (1)
From an insurers perspective it makes sense not to cover a marginally useful piece of equipment. The better use of resources would probably be covering PT where there's movement and weight on the joint.
1: https://www.verywellhealth.com/do-i-need-a-cpm-following-kne...
Fair enough. It was still prescribed by the doctor and I would rather have not paid for it.
Even if its benefits are marginal, they’re probably still more tangible than acupuncture and chiropractic, both of which are apparently covered by my insurance, and the CPM machine probably doesn’t cause a stroke like chiropractic does.
> Isn't "stuff that most people can't afford but would help with healing" the stated purpose for health insurance?
You are confusing "health insurance" with a "system that guarantees healthcare as a human-right". Those are different things.
The purpose of health insurance is:
- To constrain healthcare coverage to the minimum allowed by law or the plan contract, therefore maximizing profit margins.
- To provide a shared risk coverage pool to pay for treatment for catastrophic health events that are unforeseen.
- To provide a product to be used as leverage by employers over employees as part of the "benefits" of a compensation package.
Healthcare as a human-right doesn't exist in the United States unless a health situation has gotten so bad that you end up in the emergency room, which is then legally required to provide you emergency healthcare.
No, but working at a company that was founded by a bunch of former gov employees, the coverage is mostly ok and some having to manage the refusal bs. What was new to me - a gap that went employed -> consulting -> employed - (same company family) - how damn expensive top tier coverage for a family of three really is - $3700/mo. Insane.
if you don't have anything nice to say... :3
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> Shooting their CEO caused more people to get claims approved
One, it was a middle manager with a CEO title.
Two, genuine question, can you point out how UnitedHealth’s profits relative to peers changed after the shooting versus before?
I am also not advocating anything but ... wasn't the famous Spock line "needs of the many outweigh the needs of the one". The question is of empirically proving it and that's the challenge. The jury may not be co-opted but the judiciary is. I wonder how do we go about proving this.
Utilitarianism is a dangerous mistress when it comes to justifying moral and ethical transgressions. Sounds great until TPTB decide that the half dozen lives that can be saved with your organs matter more than your one life.
If we followed the rules strictly, and not different rules for the rich, why's that a problem?
Here's a point about all the insurance companies: UHC administers the medical plan on behalf of your employer. For all practical purposes, they are a whipping boy for the real 'man behind the curtain' (your employer).
Your company (for self-funded plans) actually decides what’s covered and what isn’t, sets copays and deductibles, and ultimately saves or spends money on healthcare costs. UHC’s role is to apply those rules, maintain the provider network, and handle the billing and customer service.
If your company offers insurance, there is someone who can tell the "insurance company" to cover the service they are not covering. Usually the HR Benefits Administrator, or 'plan sponsor'. And they do it all the time! If you have a sad story and the budget is ok for the quarter, they will help! If you are a company officer, you can also have whatever your company can afford.
This only applies to large employers. Smaller ones are just presentef a limited list of plans to pick from, and the plans change every year. Most of the time, as a startup, you can’t buy a Mag7 equivalent health plan for any amount of money off the marketplace
Mag7 surely is self insured. They have an amazing risk pool of young people. Probably biggest cost is babies. So in this way employer sponsored health insurance screws the rest of the market, as it "hordes" the best risks. The insurance companies then wail about the cost of the risker pool of those of us stuck in the smaller plans...
There should only be one risk pool which is the whole country. Unfortunately the republicans want to go the other way and push sick people into high risk pools which will be unaffordable for a lot of people
Yeah, I work for a smaller company. I'm not sure which options they omitted but I don't think have the same bargaining power as a BigCo.
It depends. If your employer is part of a self-funded group of other employers, then there is a group of trustees from all the employers that can approve.
If it's a 'fully insured' group plan then the insurance company is technically in charge, but your company can do an Employer-paid exception (aka carve-out reimbursement) to cover something thats getting rejected. They also have the option to purchase add-on policies to add coverage for upper class stuff like fertility treatments, weight loss drugs, or gender-affirming care.
Insurance companies are a whipping boy, but for doctors not your employer.
Doctors charge massively high prices, which is why insurance bills are high. Doctors have the most powerful trade union on the planet and strictly limit residencies, thus limiting new doctor supply and keeping prices super high.
We have a UHC choice plan at work and it’s been completely invisible, both for me and coworkers I know.
Health insurers are like Congressmen. Most people hate the institution, but are satisfied with their own insurer. https://www.kff.org/affordable-care-act/kff-survey-of-consum...
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> I think you're a bad person.
It's not acceptable to comment like this on HN, no matter who it is or what it's in reply to. The guidelines ask us to "assume good faith", "edit out swipes" and "be kind". That applies equally to all of us and in replies to anyone else on HN. If someone posts a comment that's egregious, just flag it, don't abuse the commenter, as it just makes the place worse for everyone.
https://news.ycombinator.com/newsguidelines.html
Comments do not exist in a vacuum. 4chan is a failed experiment
Assuming good faith is a good guideline when there is no evidence of bad faith. If someone usually post racism and corporate bootlicking and is using their collected to Internet points to abuse the good faith of others, the system breaks down.
[flagged]
Please don't reply to a bad comment with a worse one, it just drags the whole place down.
https://news.ycombinator.com/newsguidelines.html
It’s terrible that this is an area that is caught up in political ideology. Somehow, healthcare MUST be decoupled from capitalistic incentives. I don’t pretend to have the answer but continuing on this path will lead to worsening patient outcomes. We cannot have corporations expecting to make a dollar off human life.
Afaict the original sin of the US healthcare system is having the healthcare providers chosen by employers. That means that the patient is not the customer, the patient's employer is. That in itself has dire consequences.
Privatized health care need not be so bad. Germany has privatized health care, but it's pretty much fine, at least for patients. It's regulated to the moon and back, but afaict so is the US system, just with very different goals. The ACA feels a bit like the beginnings of a German-style system.
> We cannot have corporations expecting to make a dollar off human life.
That's literally a political ideology.
The answer to problems like this isn't to pretend politics is some kind of abstract system imposed by higher-order beings, its to use political power to fix it.
> Somehow, healthcare MUST be decoupled from capitalistic incentives. I don’t pretend to have the answer but continuing on this path will lead to worsening patient outcomes. We cannot have corporations expecting to make a dollar off human life.
Give yourself more credit! You just stated the answer above.
> healthcare MUST be decoupled from capitalistic incentives
Capitalism pays for our healthcare.
The problem is that Healthcare has an infinite hunger for resources - there is always more that could be spent - and it is always morally correct to spend more (people's lives have high priority).
There needs to be some manner of allocating limited resources between different people with different needs.
Every country seems to find different ways to deal with the fundamental friction of healthcare (unlimited demand and limited resources).
Unfortunately voters don't like the reality of limitations.
But the answer is easy. Just look toward the North.
Canadian health care sucks but in a different way; so that’s not the solution either. You can look up the wait times for different procedures on the provincial websites.
Things you can get in 72 hours anywhere near a decently sized American city such as an MRI scan can take months in Canada.
Every developed country would say their medical system sucks in some way. We (Americans) happen to both pay more for a system that sucks more than those. The results are in our poor life expectancies, and we basically pay twice (privately and once again via taxes) for it.
Yeah, that same MRI scan can, and often takes an infinite amount of time here. I never said Canada's system was perfect, but it might as well be compared to what we have going on here.
Food, housing, and a living wage too. The bare necessities to live must be decoupled from capitalistic incentives.
> The bare necessities to live must be decoupled from capitalistic incentives
We don’t have evidence we live in sufficient abundance to guarantee this sustainably even in rich countries. Particularly when bare necessities are decried as cruelty and so cost creep comes to pass.
What we can do: free basic nutrition for all, free prenatal and neonatal care, free preventative medicine and annual check-ups, free access to generics where medically necessary, and a fixed amount of water and electricity to each household. Not enough to be remotely comfortable or long lived. But enough to survive.
So easy to say free when you're expecting others to pay.
Who votes for higher taxes on themselves?
> Who votes for higher taxes on themselves?
People who don't want to have to live amidst poverty. Or vote alongside folks who are struggling. In summary, good people.
> Who votes for higher taxes on themselves?
Even if you're selfish (and a lot of people are community spirited), the same people who as shareholders vote for the company to grow rather than to pay out more dividends.
I think the incentive itself is good, but there's too much corrupt abstraction in between.
Ultimately I want good providers to be paid well and poor providers to struggle. That is a good system. We don't have that. We MUST recouple healthcare and capitalistic incentives.
United Healthcare isn’t the reason healthcare is unaffordable any more than Geico causes car repairs to be expensive. American demand for healthcare is insatiable, and doctors are a scarce and greedy bunch. That there is a middle man trying to get his 5% isn’t the problem.
> any more than Geico causes car repairs to be expensive
Given how much cheaper things like body shop repairs are if you do not have insurance, is it really clear that Geico does not cause car repairs to be expensive?
And for that matter, get emergency health care without insurance and then fight the cost to get a massive reduction, and you'll wonder whether it actually is UHC and their ilk that help make healthcare unaffordable ...
> United Healthcare isn’t the reason healthcare is unaffordable any more than Geico causes car repairs to be expensive. American demand for healthcare is insatiable, and doctors are a scarce and greedy bunch. That there is a middle man trying to get his 5% isn’t the problem.
Spoken as a software developer who's salaries are approaching or even surpassing doctor salaries while working on optimising "engagement" (or how to make their app the most addictive).
I’m a personal injury lawyer who looks at medical bills all day.
I recommend you to look at Dr. Glaukomfleckens videos about pre authorization.
What is the problem breakdown by % in your eatimate?
there is a multi-pronged solution necessary that is both intertwined with insurers and also completely separate, so in that part I agree with you
the costs of services are arbitrary and need to be addressed before we can realistically deal with how any insurance pool works, in the US both parties have chiseled at this over the last decade - from getting prices more transparent, to attempting to have a large scale state negotiator - and this makes the conversation more palatable in gaining consensus
not close, but it's not as partisan as people think, despite the parallel existence of entrenched interests
what doesn't have consensus is a forced insurance pool that doesn't address the costs and has no ability to negotiate those costs (yes, this is partially due to the bill being gutted and a handicapped version being the only thing that passed) a deeper review and regulation of costs is the only thing that can help reach consensus
Wrong. 'Medical insurance companies' do absolutely nothing in terms of health care, drain massive amounts of money in what amounts to a Brazil-style (movie) system, corporate death panels, and a drain on all of our resources.
And its not even a product we want. We dont buy it. The companies we work for do, and never have to dogfood any of it. But for the rest of us, its a take it or leave it proposition.
> doctors are a scarce and greedy bunch.
Speaking of that, an MD is the ONLY profession who is solely controlled how many can apply is controlled by Congress.
Get rid of that, and that would fix a facet.
But getting rid of insurance companies would also work a great deal. Or at least, decoupling work/med insurance would be a start.
Even going full competitive capitalism OR full socialism would be better than the garbage we have now.
United is a disaster of a company. Physicians hate them. Patients hate them. I feel bad for anyone forced to deal with their BS.
Their reputation is so bad I wouldn’t be surprised if they rename the company at some point in hoping people forget that they’re United Healthcare.
My girlfriend is nurse practitioner and she says United is the worst to deal with. They deny everything and it sucks up enormous amounts of time to appeal.
I really hope my employer changes to pretty much any of the other ones eventually. I really hate having to argue on the phone with with a poor representative over everything.
Anthem BCBS and Aetna never gave as much trouble. I know they both have their scandals and it's not like I love any American health insurance company, but I definitely rank UHC lower.
The law of supply and demand controls the high prices we see in healthcare. Doctors have the most powerful trade union on earth and have lobbies for strict limits on the number of new doctors per year by limiting residencies.
Shrink the federal government and its overbearing regulations in healthcare and allow many more people to go through residency to become doctors.
I found it’s terrible too. Especially with dental insurance they negotiate terrible rates so you end up paying a lot more than if you went with the local Blue Cross Blue Shield or Delta dental.
My experience with United Health Care has been terrible.