this post was submitted on 03 Sep 2025
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As I get older and need the healthcare system more, I have had this realization that except for cosmetic surgery no one uses healthcare that they don’t need. Like, no one is out there trying to scam their insurance company out of a free colonoscopy. They get that procedure because they don’t want to die. Rejecting claims should be illegal. The goal of the healthcare system should be to treat people. Insurance is the wrong paradigm to manage healthcare because implicitly it’s built around rationing resources.
We don’t do this with food, and yet healthcare is a basic need. What do we do as a society to meet our food needs? We scale up. We plant megatons of crops. We build new technologies to be able to produce more. Why with healthcare do we not do the same? Med schools should accept more than 2% of applicants. The number of doctors in the US is kept artificially low. Also, let people interested in medicine attend abbreviated university programs. Skip the 4 year bachelors and get your med school degree directly in 5-6 years like they do in the UK. Redirect all the overhead and money spent on insurance to building hospitals and hiring doctors.
Rejecting claims does have some legitimate purposes.
Invalid ID numbers, people aren’t actually a customer of the insurance company, unreadable data, and actual medical fraud to name a few.
Denials should trigger a government review that the insurance company must justify to a neutral 3rd party that has a medical degree
The goal of a good healthcare system is to treat people. The goal of ours is to treat the rich to another yacht. Healthcare providers bill far above cost for profit, knowing that either the insurance or the patient will have no choice but to eat the cost. Insurance providers use high healthcare costs to justify high policy prices and then do unethical shit to avoid paying out.
The hospitals make money. The insurance company makes money. The shareholders and corporate owners make money. The people needing healthcare get screwed.
The system is, unfortunately, working as intended for those who benefit from it being the way it is.
The problem is a lack of residencies, and there’s been lobbying to keep the number of residencies low, to keep doctor wages high.
Also true and indefensible.
Cystic acne treatment is frequently covered by insurance and the same treatment is desirable to those that suffer from normal acne. Emotional support animals required doctors notes and were desirable for free admittance on planes. Ozempic as a weight loss drug. Topical steroid treatments for treating inflammation. Glasses to see better than 20/20.
There are all kinds of medical treatments (relatively) healthy people would want if they were affordable and knew they existed.
Perhaps so, but it should be up to a medical professional (doctor) whether or not those treatments are appropriate for the patient. Not for-profit companies run by sociopathic executives. (Although in this case we are talking about state-run Medicare using private companies’ AI to make the determination.)