Do you think medical insurance is a money-making scheme?

US medical insurance, the ultimate magic show! It's like they play hide and seek with coverage, offer deductibles taller than NBA players, and speak in insurance jargon that's harder to crack than secret codes.

But here's the real kicker: Prior authorization denials are their favorite disappearing act! "Poof! Denied!" Then, "Abracadabra! Approved!" Just when you thought you needed a PhD in insuranceology, they surprise you. It's a wild ride, folks!

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dancingtongue · 80-89, M

For-profit insurance companies with stockholders to appease certainly contribute to the problems. But there is a fundamental flaw in how doctors and hospitals are paid as well, whether they are for-profit or non-profit: the traditional fee-for-service piece rate approach, which leads to unnecessary services being added on and $15 band-aids from mark-ups. Part of Obamacare, if it wee allowed to fully roll out, was to gradually shift to payment based on type of medical procedures required with quantified serv ice and quality standards factored in.

Layer on top of this the lack of universal coverage but mandated treatment of everyone regardless of their ability to pay. This is a triple whammy in that (1) hospitals in particular, but medical personnel as well, factor in the need to cover the expenses for these people who show up in the ER, (2) the ER is one of the most expensive venues to provide care, and (3) many of these ER visits, or treatments at all, could have been avoided with cheap preventive health care services . But the uninsured put off such visits until they are so sick they need the ER.

ninalanyon · 61-69, T

@dancingtongue Perhaps we should pay doctors in the way that a story I read once said that doctors were paid in ancient China. There you paid your doctor while you were healthy. If you fell ill you stopped paying until the doctor cured you.

dancingtongue · 80-89, M

@ninalanyon Exactly what Dr. Sidney Garfield used as his inspiration for founding what is now known as the non-profit Kaiser Permanente medical care program, where the medical groups are paid a monthly per member flat rate and individual doctors are salaried. The model for the HMO concept, which unfortunately got twisted by for profit insurers into "mother may I" operations forgetting the original concept.