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comment by goobster
goobster  ·  2577 days ago  ·  link  ·    ·  parent  ·  post: Human Mealworm says people should choose between "iphones" and healthcare

Yeah... I know way more of the sausage factory of medical billing than I like to let on... I wrote a database application for a medical office that handled all the ICD9 codes (yes, ICD9... it was that long ago) and CPT codes. Took almost a year to write, and still didn't catch all the edge cases and weirdnesses of that messed up system.

    And that's why you think "that people aren't even talking about anything that matters". If you want healthcare like the rest of the world, the risk pool has to be "everyone" and the profit has to be "zero." As it is right now, the risk pool is "people who can afford it" and the profit is "maximum."

This is really the crux of it.

There is no plan that works in a purely capitalist way. Because you have to force people who don't need things into buying them. The healthy have to underwrite the sick. Period. That's it. Without that pool of swirling money that everyone gets to dip in to when they need it, you have people going bankrupt and still dying of their cancer because they can't afford treatment.

Incidentally, I've filed maybe 20 insurance claims throughout my life. Sprained ankle, broken finger, cavity fillings, root canals, eye exams, glasses, liver "weird readings" diagnoses (multiple times), etc. (All "covered" expenses under whatever plan I was on at the time.)

And the FIRST time I EVER had insurance accept ANY of my claims was about 2 years ago. Working for a tech company, something happened to my brain and I couldn't stand up. In-home doctor visit within 2 hours of my call, and I was diagnosed (something minor, I think it was viral, can't recall), and insurance paid for ALL of it. Every single other claim I have ever filed in my entire life has been denied due to some loophole. So I fully expect if I ever come down with anything truly nasty, it's a shotgun and a shallow hole in the back yard for me.





user-inactivated  ·  2577 days ago  ·  link  ·  

Having had two parents with nasty somethings, denied often doesn't mean "denied" so much as "we know we should be paying for this, but we're going to make you pick a fight with our callcenter drones under the assumption that if you can pay for it yourself you're rather do that than fight with our callcenter drones."

And they're right. When the cost is less than an afternoon of hold music, vague threats about lawyers and shouting I just pay my father's bills out of pocket. They always cave when it's worth the trouble to fight over, but they save a lot of money when it isn't. Hooray for capitalism.