• xantoxis@lemmy.world
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    2 months ago

    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.

  • The Snark Urge@lemmy.world
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    2 months ago

    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.

    • aesthelete@lemmy.world
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      2 months ago

      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.

  • moktor@lemmy.world
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    2 months ago

    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.

    • Landless2029@lemmy.world
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      2 months ago

      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

  • capital@lemmy.world
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    2 months ago

    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)

    • Hackworth@lemmy.world
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      2 months ago

      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.

      • capital@lemmy.world
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        2 months ago

        Yikes. I’m guessing that provider has had issues being paid by this insurer in the past?

        • Hackworth@lemmy.world
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          2 months ago

          I’m told being required to pre-pay is becoming more common in general, apparently as a reaction to insurance companies’ new requirements that force a doctor to write follow up “approvals” for Rx’s they’ve written. But this insurer was also recently sued by the federal gov for stealing from the insured.

  • andros_rex@lemmy.world
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    2 months ago

    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.

      • andros_rex@lemmy.world
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        2 months ago

        The funny thing is, I probably wouldn’t have had gender surgery if it wasn’t a legal requirement. I barely had anything and could pass topless anyway. I just needed to be able to get a job, which was proving difficult with the non matching ID. It is 100% legal where I live to fire someone for being trans, and it had happened at multiple times by that point.

  • Zess@lemmy.world
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    2 months ago

    Same as student loan “servicers” collecting billions in interest to just keep track of peoples’ debts.

  • TrickDacy@lemmy.world
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    2 months ago

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

  • Doomsider@lemmy.world
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    2 months ago

    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.

  • orangeboats@lemmy.world
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    2 months ago

    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.

    • merc@sh.itjust.works
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      2 months ago

      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.

    • madcaesar@lemmy.world
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      2 months ago

      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.