What’s super interesting is suddenly everyone is pointing fingers at insurance. Which I totally get. Private insurance is pure evil. But people are acting as if insurance is the sole reason for our incredibly expensive healthcare in the US.
And it is super obvious that healthcare providers (hospitals/doctors etc) are enjoying this. The amount of posts I am seeing from hospitals and doctors talking about how evil UHC was is really rubbing me the wrong way.
Because its like hold up.. just a couple years ago it was the providers who were put on blast. Remember all the NYT/WashPost/Atlantic articles exposing how much fraud went on at hospitals and private practices? Remember the journalist that tracked the outrageous price of pregnancy tests ordered at hospitals across the US. Or the one hospital that had a “profit” dept that literally had ppl sign over their financial rights BEFORE they got life saving surgery.
Providers are just as guilty. Alot of times its been my insurance company that has been on my side and has denied claims for outrageous bills ive gotten from the hospital and forced the hospital to send receipts. I have never ever ever had a good experience calling a providers billing office. Ever.
With insurance its about 50/50. Idk I just feel weird seeing all these tweets from doctors and hospitals riding this insurance hate wave when they are literally part of this healthcare industrial complex that is destroying our wallets.
Hi there,
I’m a 25F who graduated with a BS in Biology with a double minor in Chemistry and Physics. I have been working a lab tech job since I graduated at my local hospital, however, I desire more. The issue at hand is I’m not sure which path to take. I have applied to PT school, have thought about respiratory therapy, sonography, and I’ve even thought about nursing. I will admit that nursing does intimidate me because of the things I’ve heard about hazing, cliques, etc. in my hospital, but I am open to any and all paths/additional education related to healthcare. The only exception I have is that I can’t attend medical school at the moment because of health restrictions.
So I was wondering, for those in healthcare who make good money and are happy with your jobs, what do you do for a living? Which path did you choose to take in healthcare? Was it worth it to you? What were the positives and negatives?
Thank you so much in advance!
I'm trying to understand the criticisms surrounding the UnitedHealthcare (UHC) CEO and other health insurance companies. The Affordable Care Act (ACA) imposes rules like the 80/20 rule (for smaller insurers) and the 85/15 rule (for larger insurers like UHC). This means they are legally required to spend 85% of premiums on client medical expenses, leaving only 15% for administrative costs and profit (source)[https://www.healthcare.gov/glossary/medical-loss-ratio-mlr/].
Given this:
Insurance companies mainly compete by managing costs—either by reducing benefits or increasing claim denials.
Consumers can choose from a spectrum of insurers with different levels of benefits and claim approval rates.
If one insurer starts paying out more claims, premiums would rise, allowing more affordable competitors to enter the market, and the cycle would repeat since clients who can't pay the higher premiums would move to the cheaper higher denial insurance offering the same benefits (on paper). How can a "good" CEO do anything differently for a health insurance company, since they can at most only pay out 15% above the competition if all their staff were volunteering for free?
Is the problem even fixable at the CEO level? Or, for example, does the industry need an overhaul like a government regulator deciding what is and is not paid out as part of each policy to ensure predictable outcomes when people buy health insurance?
They already normally follow Medicare rates for Medicare Advantage plans as does Tricare and the IHS yet providers usually accept both of those. So why don't regular insurance companies pay those rates instead of negotiating rates that are over 2x as much?
Edited for grammar and clarity Yes I'm aware of Maryland's all payer system