Gregory's ServerIf you agree murder is bad, but you don't view insurance corporations denying critical medicine to people knowing full well they will die as a result, as a form of murder, then you don't in fact believe murder is bad. You believe rich people should be able to kill poor people and you should learn to be honest with yourself.
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159 comments
 @SearingTruth @QasimRashid Single Payer would solve almost none of the problems in the US health care system. Health insurance companies in the US operate on profit margins around 4%. That 4% is not the answer to the problems in the US health care system. While symbolicly fun to reason about, people making these claims just don't know what they're talking about. Most European countries don't thave single payer systems and none of them have these problems. The issue is corrupt politicians.  @Schouten_B Onus is on you to draw the line between corrupt politicians and a doctor defrauding insurance companies by overbilling. You blame one thing with not a single feeling that you should make that make sense at all. They don't have corrupt politicians in other countries? They don't have single payer? Are you for real? @jenzi @Schouten_B do you know how billing works? Married to a doctor and figuring out how to get a patient covered by their insurance though the arcane billing codes is far more the norm than defrauding. Sure there are corrupt docs but Iβd say mandated billing procedures by hospitals is more where you want to look. @fistfulofdave oh relax, no one named you - yes I know how billing works, I've worked on both sides of the entire scam (including your sacred doctors) and know a lot of people who do fraud investigations too... there are a billion issues, I cited just one. I just wanted to know how a corrupt politician was to blame for bad doctors (who act defensive on social media). @fistfulofdave @jenzi I don't think doctors are the big ones here. There's a lot of care providers involved in processes where there is a lot more fraud if you look at the data (more in long-term care and nursing as well aiui). But yeah, almost everywhere in the western world doctors are complaining about the complexity of billing procedures. I know Dutch doctors feel that way at least :-). @Schouten_B @SearingTruth @QasimRashid You have no idea what you are talking about. Do you want someone to profit off denying you health care? @66gardeners @SearingTruth @QasimRashid The profits of US health insurance companies are a little on the high side. But also not crazy. Essential Health Benefits of course should always be covered (and that is mandated by the ACA). More complex and extensive treatment options, that's another story, and that's where insurance companies come in. A famous one that isn't covered in NL for example is lymph duct reconstruction after a lymphadenectomy. Lots of discussion about that. It's hard. @QasimRashid they have deer season, turkey season, etc. They should seriously have billionaire season  @QasimRashid  @QasimRashid to be honest, I already consider murder a lesser crime than slavery. So I am close to saying it's not wrong. @QasimRashid one death is a tragedy, a thousand deaths is a statistic. the answer of course is that more CEOs have to die @QasimRashid I don't believe in corporate murder for profit and I don't believe in individual murder. I struggle with it though, I really do. @QasimRashid one of the trolly problem variants: the active killing is bad, the active killing with extra rube-goldberg steps is... less.... bad???  @QasimRashid Terrorist commit mass murder for fundamental radical ill guided beliefs. These healthcare CEOs do the same for shareholder value. @QasimRashid @QasimRashid This is obviously complete bullshit. Insurance companies everywhere, as well as organizations like NICE are always denying lifesaving care to people. Their whole -job- is to decide what life saving care is cost effective. As we have to distribute a limited supply of care over the population. Could you argue that in the US there are too many people grifting profits from this? Sure. But denying some care and granting others - that's their job.  @Schouten_B @QasimRashid In my country we have avalable treatments. If you need them you get them. The only time you would not is if those treatments would make YOU suffer more or simply have no effect. Even those terminally ill will be treated to give them comfort and extend their time if possible. Not defending the OP, just saying I still feel the US is deeply flawed in healthcare and put profit above humanity. @kDelta @QasimRashid I don't know which country you live in, but in every EU country, the UK, Australia and NZ I can point you to the government entity which decides which life saving care gets paid for and which doesn't. Every country has this, and every country has to, as there are plenty of life extending treatments that run in the millions and no health care system can afford to pay for them. (Even if some individuals can) @kDelta @QasimRashid Aah, sorry, I misunderstood the phrasing. Right, in Germany it's the G-BA that decides which treatments are available under the GKV. But of course you can get PKV and get much more treatments covered, so there's certainly still inequality. GKV covers a much broader portion of the population and is more accessible than Medicaid in the US of course. @kDelta @QasimRashid Note that the ACA also has Essential Health Benefits which describe what insurers must cover. But the legal maximum for out of pocket expense is quite high (~$10K for an individual or like $15-20K for a family). Which is obviously much more than the highest deductible you can get at GKV or any PKV that I'm aware of. @Schouten_B @QasimRashid The funny thing is as we discuss this you have reminded me that my employer gives me private healthcare as part of my job too! Yet I never even think about it! π€ @kDelta @QasimRashid Funnily enough my company gives my German and US colleagues private health care. But here in NL they don't have a plan and I just need to pay for my own private health care. So while my US colleagues get great coverage that doesn't come out of their salary, I pay 200 euros a month for mine with a 800 euro deductible :p. But yeah, it says something about my bubble that everyone in Germany I know is under PKV. @Schouten_B @kDelta @QasimRashid For comparison. I'm in the US. I have an insurance plan through my employer. It's a family plan covering myself, my wife, and my son. Total bi-weekly premium is $914.26. I pay $409.58 every paycheck, the company pays the remainder. Over $10k in just premiums this year out of my pocket. Over $20k in total. I pay that regardless if I use the insurance at all There is also a $3,200 deductible per individual. With a $6,400 family deductible. @finner @kDelta @QasimRashid Those are actually pretty good deductible by US standards. But yeah, the US health care system is -crazy- expensive. Some of that is the fault of the people (no, you don't need an MRI scan every time you have a headache or a knee is sore, or an antibiotic every time you sneeze), but a significant portion is also health care providers, pharmaceutical companies and others all grifting money from the system. Not changing with the GOP in charge though. @Schouten_B @kDelta @QasimRashid Crazy expensive is right. I know this country has more than it's fair share of entitled assholes, but unless you have some data to throw out I think I'm going to call bullshit on blaming people for the issues of the expensive costs of healthcare in this country. People that can't afford to cover a few hundred dollar emergency expense aren't paying $500+ for an MRI because they have a headache. Most people I know, myself included, avoid care due to costs. @finner @kDelta @QasimRashid But the US is doing several times the amount of medical imaging per capita of any other developed nation (only Japan and Germany get close I believe), most of which is terribly wasteful. You're right that that isn't just the people, it's probably also people who own MRI machines and CT scans wanting to make money, but based on what I know from doctors in the US the people are also a part of the problem, but I can look for some data. @finner @kDelta @QasimRashid (And when I say crazy-expensive, I don't mean crazy-expensive for the individuals necessary. But as a society it is paying incredible amounts per capita. Both Medicare and non-medicare per capita cost are a lot higher than that of any health care system in the Western world.)  @Schouten_B @finner @kDelta @QasimRashid The problem with healthcare is there is usually a marginal benefit. Consider shoulder injury. Say 50% heal, 50% complete tear. We can wait 8w of PT and they sort out for the few who do PT. Or we do MRI and operate on half. @Schouten_B @finner @kDelta @QasimRashid If MRI were cheap we would just do MRI on all. But it is not cheap now. Probably one day. In single payer costs are limited by the MRI queue. In US by all kinds of kludgy things. @jgordon @finner @kDelta @QasimRashid Yeah, some single payer systems (like the UK) are notorious for their lengthy queues, not great either. @Schouten_B @jgordon @finner @QasimRashid Again, you are mixing up two different heath systems, NHS England has half out sourced and sold off itself, and queues down there are longer and services worse than NHS Scotland where the people have insisted in maintaining public ownership. Regardless nobody England or Scotland would ever want to give up this system for the US system. @kDelta @jgordon @finner @QasimRashid Do you have sources for that in the UK the queues are correlated with things being outsources or sold off? Overall for-profit medical imaging resources have shorter queues than public medical imaging resources. But the UK could be different here somehow (and one could imagine different reasons for that)? @Schouten_B @kDelta @QasimRashid If it's crazy expensive in general, how is it not crazy expensive for the individual? Who is paying the bill if it's not the individuals either through premiums, co-pays, deductibles, tax dollars for the portion that isn't privatized? Per capita means per individual right? Yeah, I understand that some individuals are subsidized, but they are subsidized through the higher costs to other individuals. Ultimately we, the consumer in need of medical care, pays all. @finner @kDelta @QasimRashid The difference that I think is meaningful here is that if it's society as a whole, those are high cost spread equally (or in an income dependent way) over people. The US -also- has crazy expensive healthcare on an individual level, what I mean by that is that the high cost of the system also falls significantly to the individuals requiring treatment. Which makes the high cost (which is always problematic for any society), even more problematic. @finner @kDelta @QasimRashid As you rightfully said, ultimately we the people as consumers pay all of the cost. But some of us need more care than others, and the thing about health care systems is to think about how much of that cost you put on the individuals requiring care, and how much you share among the healthy population. If you're overall cost per capita is just way too high, for whatever the reason, both of those portions go up. @Schouten_B @kDelta @QasimRashid So you acknowledge that the cost is out of control. And that the cost is a problem for society and the individual. Yet you seem to continually say that none of the reason for the out of control costs is due to the fact that it's mostly all privatized and for profit. I guess it's just expensive for "reasons" and we'll never know. @finner @kDelta @QasimRashid I'm saying the evidence for that is poor. Because most European health care systems are privatized and for-profit, and don't have these problems. And most of them outperform for example the single-payer Canadian system by quite a bit. So there seem to be other factors that play an important role here. :) @Schouten_B @kDelta @QasimRashid So the other countries probably have better regulations that prevent the for-profit enterprises involved in health care from making all decisions based solely on what's most profitable. I read that as for-profit being the -root- cause problem. You can fix that through regulation of the for profit enterprises or by getting rid of them entirely and going publicly funded. Either way you're addressing the root cause of them being solely driven by profit. @Schouten_B @kDelta @QasimRashid I'd be happy to hear what other root cause problem there may be or better/alternative fixes to the issue if you have any. @finner @kDelta @QasimRashid Well eliminating for-profit entirely might (some would argue) reduce the drive for efficiency in the system. But that is a separate discussion. I think in general you are right, the US could have much better regulations. But it goes well beyond the system itself. I'll give some examples on your other toots :). @Schouten_B @kDelta @QasimRashid Correct, I would venture to say that in the vast majority of cases, it's not the individual requesting an MRI or any other other procedure. The doctors should be requesting required tests to determine the appropriate treatment plan. But you have an entire for profit industry in bed with each other that has far more incentive to generate profit than it does to do the right thing regarding any individuals health. @finner @kDelta @QasimRashid Still that problem is much worse in the US.. for reasons. Most European countries have for-profit health systems (even most that have single-payer systems), but none suffer from the same level of poor decision making. This isn't about the profit aspect, it's about regulations and integrity. The framework in which profits are to be made. @Schouten_B @kDelta @QasimRashid So poor decisions are made because "reasons" but it's not because decisions are being made in the name of profit but that we haven't properly regulated the decision making and profit generating resulting in all decisions being made solely in the name of unregulated profit. You really seem to want to cheerlead and make excuses for the capitalists and for-profit enterprises. @Schouten_B @finner @QasimRashid You blame the people for that? Is it not the hospitals who see a headache with cash in their eyes? π€ I can get 16 paracetamol from a shop for 30 cents, how much does a US hospital charge for two? @Schouten_B @QasimRashid Thatβs alright, I kept it brief toot style π I was going to add that as a weird oddity the UK does not have a healthcare system that spreads across the whole country, NHS Scotland and NHS England are actually entirely separate and the medications and treatments you can get can vary a bit. With that said if I broke my leg in London and got treated down there itβd still be zero paperwork for me. So most in the UK donβt even realise they are separate systems π @kDelta @QasimRashid Yeah, and treatment coverage are decided by NICE which actually -is- a single body for the entire UK I think. @Schouten_B @QasimRashid is it possible to justify a limited supply of care in a country as predatory with its client states, and thus rich, as the US? They're sucking my country dry, yet we have a pretty decent public health system, how can they not? @ciatmusings @QasimRashid The US spends more on health care per capita than any other country in the world. The insurance or spending isn't the problem. The grifters everywhere else in the system are. The pharmaceutical patent system, excessive diagnistic tests, the debt collectors. And let's not forget the terribly unhealthy lifestyle weighing in the system. @Schouten_B @QasimRashid "Their whole -job- is to decide what life saving care is cost effective." Cost effective for whom? UHC et al are now, and have been, denying care across the board to increase their profits and their profits have increased. @gpilz @QasimRashid UHCs margins are around 6%. That's a little too high, but it's also not crazy (I feel 2-3% is a much more reasonable target, depending a little bit on inflation), it's not going to significantly reduce the available care. Should it be lower? Yes. But the US health care system issues primarily don't lie with the insurance companies. The rot is primarily in other parts of the system. @Schouten_B @QasimRashid I don't agree that margins are the correct way to measure health insurance companies. Many things can impact margins including staffing, compensation, etc. How many people were denied treatments, procedures, medicine, etc. that falls within the range of "common practice" in other industrialized countries? @gpilz @QasimRashid The Essential Health Benefits -have- to be covered under the ACA. For other treatments it becomes more complicated, and it differs per country. The Netherlands essential benefits (the ones all insurers have to reimburse) for example do not reimburse lymph duct reconstruction after lymphadenectomy. The Germany essential benefits to include it. Who's wrong and who's right? Hard to say. QOL improvements are real. @Schouten_B @QasimRashid @66gardeners @QasimRashid It is the job of an insurance administrator, and of course to some extent the IOM/SecHHS (or in the UK the NICE, Germany the G-BA, etc) to decide which treatments are worth the money. A doctor decides only if a treatment is appropriate for a patient's situation, not whether the treatment is cost-effective for society as a whole. Plenty of millions of dollar cancer therapies that no industrialized nation pays for but a doctor could reasonable say are life-extending. @QasimRashid there are people who medically need it for various reasons like ADHD , diabetes, & & places including Africa where there are places that need more #medication in fact #healthcare should be a #rights I fear that means that as a nation, the USA believes that being able to kill people who are both poor and ill or 'defective' in some way is right and proper. This is precisely what the Nazis did to the handicapped and infirm - so isn't it heartwarming that the good ole USA feels able to do the same but passively, by denying them the medical treatment they need to stay alive, rather than actively by using gas chambers.   @QasimRashid Murder is bad, but you feel less sympathy if murdered is the murderer, even if only by proxy.  @QasimRashid @QasimRashid How many times have corporations decided that only when the cost to recall an unsafe or deadly product is greater than the cost to pay off the families affected by the unsafe product should the corporation agree to pay a legal settlement. They place a death value, a statistical probability on human life. This is wrong on so many levels. Where profit is involved, these corporations are willing to throw out the baby with the bath water.  @QasimRashid What if you believe both are bad? Seeing so many people in the fedi suddenly pivot to supporting and even celebrating the American gun violence they used to condemn is disappointing and sickening.  @QasimRashid it's not murder if you say "no homicide" :blobcatgooglyheadache:
@QasimRashid The "problem" with that logic is that it forces people to realize that spreading Covid through inaction (i.e. not wearing a mask in closed spaces) is also a form of murder. The people chose brunch.  @QasimRashid At first I was like, "Killing is bad - I mean even Donald Trump, for all his horrible action doesn't deserve to be assassinated, that's wrong" but like. if we're OK with executing Bin Laden because he ordered the death a few thousand Americans but we aren't OK with executing a CEO who orders the bankrupting, torturous death of thousands of Americans instead of profits, it's not actually the deaths that we care about.  @QasimRashid Gives a whole new meaning to the term #policymurder Or maybe itβs not that new  thank you!!!!!!! i have been so broken-hearted & frustrated at trying to explain this to people i thought should have understood this already by instinct... you have phrased it perfectly  @QasimRashid when someone innocent gets murdered people are outraged. When somebody guilty gets killed many will say just desserts. How this applies to the CEO of a health insurer is beyond me   @QasimRashid "The pen is mightier than the sword" also applies to the ability to devastate communities  @QasimRashid Government exists to fund infrastructure that is necessary but not profitable. If insurance isn't profitable, maybe it's time to turn it over to the government? @QasimRashid |
@QasimRashid
"We must end the predatory Health Destruction Industry in one fell swoop, lest one more innocent life than already condemned be sacrificed to profit.
Single payer healthcare for all Americans is the only just practice, and solution."
SearingTruth