What are the penalties for bad faith 'compliance' on something that kills people?
Does the company risk being shut down?
Do the company officers personally face criminal charges?
Does the company risk being shut down?
Do the company officers personally face criminal charges?
What is interesting today is that Republicans campaigned for years on getting rid of Obamacare. When they finally got control of Congress and the Presidency they did not kill it. Eventually there will be another overhaul because these companies just can’t help but be shitty.
If you are a government leader and you offer healthcare to everyone, you are now clearly responsible for any failures. But with an MCO in the middle, fingers can be pointed all over the place.
Different formularies and prior authorization rules can be set for different populations. For example, reimbursement can be lower for Medicaid patients (poorer/younger people), so they end up with less access to doctors, and higher for Medicare (older, likelier to vote), so more doctors are available there. Senators can get their own plan, and the military another, and the tech company employees yet another, and fast food employees, and so on and so forth.
This system benefits all the leaders, so it is not going anywhere. In fact, I would bet UK and Canada move towards this.
I keep reading about NHS in the UK having issues holding it together.
I'm in the UK and yep, the system is on the verge of collapse, but it feels like it's entirely by design so it can be finally privatised and killed off once and for all - it feels inevitable at this point.
Basically right now it works for:
- maternity
- anything child related
- emergency services(to an extent, unless you are literally dying you will still wait hours for an ambulance).
Everything else is so massively underfunded it's a miracle it exists at all.
A friend was referred to see a psychiatrist on the NHS recently - you know what the wait time is to see a psychiatrist on the NHS in our region? 210 weeks. About 4 years.
Few which provide the level of care the upper middle class and above have come to expect in America. If you make more than $100 yo 167k (85th and 95th percentiles [1]), a good fraction of HN readers, you should be able to virtually walk into any medical establishment and get not only seen within a few days, but also tested and imaged by the latest technology, and consulted on by some of the best doctors in the world. You will do this without worrying about costs, because your employer has chosen an insurer who pitched on experience in addition to cost, because you have the market power to change jobs (or be heard by management) if your healthcare sucks.
Universal healthcare means everyone on a PPO falls to the middle class’s HMO-esque standards. For us privileged few, that’s a tough pill to swallow. That is the fundamental injustice and tradeoff that locks us into the status quo, not some paranoia about socialism.
[1] https://en.m.wikipedia.org/wiki/Affluence_in_the_United_Stat...
It was fear of socialism that caused the outrage at Clinton’s healthcare proposals. The fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1994. Look up the number of times things being labeled communism and socialism has been used to try to halt legislation.
Out of curiosity, where are you? (I should have geographically qualified my statement.) In New York, the Bay Area and even western Wyoming (in a wealthy enclave), I have never waited more than a week for an appointment.
> fear and outrage was so great that for the first time in decades Republicans took control of the House of Representatives in 1992
Fair enough, will further qualify by last decades.
The bracket I’m speaking of knows European healthcare. They understand it is generally high quality and much cheaper. But being able to demand an MRI or the surgeon of your choice when something goes wrong is a real perk, and the one politicians are talking about when they reference public medicine.
Not the parent, but in Seattle-Tacoma area, I have waited 10 weeks for an ENT, and 12 weeks for PT availability following a car accident (in which case I ended up doing my own PT and bought bands and tools to do so until then).
Anecdotally those wait times seem crazy. The PT one especially. I have 5 different pt choices in walking distance to me that can typically get you in next day or worst case a week lead time if you want a time block that is contended (right before/after normal business hours).
Have you checked if this varies with insurance provider?
This opinion is the opposite of what I’ve heard from people from peer countries who’ve experienced both, not to mention even countries we tend to look down on (there’s an entire industry around even pretty affluent Americans going to Mexico to save money for equivalent treatment). I’d believe it for the 98+th percentile crowd, but I’ve also known people considering going back to Europe because the lower salary is better than all of the out of pocket costs, stress, and risk.
What is perennially interesting is that Republicans (Baby Boomers specifically, in this case) claim to hate "socialized medicine" but every time cuts to Medicare are floated under the guise of "fiscal responsibility" or whatever they're DOA. It's a trite observation at this point they are truly the fuck-you-got-mine generation.
Sadly, one of the only things that _has_ trickled down from their generation is the belief that "socialized medicine" is evil. A maddeningly large percentage of Gen-Xers, Millennials and beyond have fallen for this line of reasoning. The ironic part, in my direct experience, is that a lot of those folks are the ones getting health insurance from the federal/local governments through the military, emergency response positions, sanitation, etc. So, again, got-mine-fuck-yours.
As a counterpoint, I know a number of people in Europe who have been able to take entrepreneurial risks that either aren't realistic or responsible for people in the U.S. who are tied to their jobs for the sake of healthcare, medical/maternity/paternity/etc. leave, etc. One of them recently had a major health crisis that would have devastated an upstart entrepreneur in the U.S. and was actually able to focus on recovering instead of hustling side gigs or taking out predatory loans to ensure he didn't lose his house or his ability to send his kids to daycare. It's been very enlightening to watch play out in real-time.
Existing socialized medicine, that helps them, is OK. New socialized medicine, which might help other people, is not OK. The politics involved here are not complex.