there's a bunch of problems with the setup but a major one is that employer health plans are tax deductible. employees don't really get market choice, and employers really only care about reducing their own expense in regards to healthcare. ending this would be very expensive and disruptive for both employer and employee in the short term, and people have a strong preference for the devil they know vs. the devil they don't (either a public option or fully market-based healthcare)

it's worth noting that the healthcare system has a couple of antagonistic components and right now probably insurers are the only group actually fully happy with the situation. medical providers, pharmacists, and patients are all getting shafted.

There's a lot of problems you can point at:

- Through extensive lobbying, the US passed the HMO act of 1973 which requires that all employers offer an HMO plan to employees. HMOs were created to keep costs down, but United really took this to the extreme, making it as hard to use your health insurance as possible, and creating vertical monopolies like OptumRX. United takes so long to pay providers for the work they do that they now offer payday loans to doctors offices, which is crazy.

- The US uses a fee-per-service model that priorities procedures over preventative treatment or patient education. Some other countries have moved towards reimbursement based on health outcomes.

- The Affordable Care Act banned physician owned hospitals, which were growing in popularity and had better outcomes for less fees to patients.

- Private Equity is swallowing up hospital systems, emergency departments, etc. The most common seller is another PE firm, so they try to make a quick return through heavy cuts and then flip it 5 years later.

I'm not sure if there's any hope of US healthcare improving for a long while. The ACA was the only recent improvement. It was a small change, but the electorate decided that it was bad, pushed its supporters out of office, and elected a series of people who promised to "repeal and replace" it, but weren't really serious about any improvement. And then when the "repeal and replace" crowd failed, they were not held accountable, but reelected anyways.

There also isn't much interest in improving healthcare from either side right now. The right has nothing. Their current platform is ignorant views about vaccines. The left has a stronger interest in Palestine and housing abundance right now, though all of that is dwarfed by trying to keep the rule of law going, and preventing us from falling out of a democracy. Healthcare is way way down the list for everyone sadly--even Bernie doesn't talk about it much anymore. The electorate has spoken, and they are not interested.

I have had this experience, but not with healthcare insurers (in Germany). I cannot remember the last time I had to contact them - the last two times they contacted me, was to explain to me, that they have expanded their preventive care offerings and they recommend I go and get them.

Blanket rejections are an extremly efficient measure from the perspective of an entity when the consumer has nowhere else to go and you don't care about ethics. Just tell them no and many people will just give up. If they appeal, you can invest the work to fob them off properly or just pay and not deal with the hassle. I can barely tell the difference with the many public healthcare insurers in germany - if my insurer were to try this nonsense, I would be gone the next month. Universities, some agencies and especially the god-damned GEZ on the other hand...

What frustrates me more, is that it often turns into a class indicator: Do you know how to word your letters or to handle yourself in a way that indicates, that it will be more annoying to not-deal-with-you than to deal-with-you? And if you don't: Do you have a access (network/money) to someone who does?

You are on a high deductible plan. With those plans you pay the first $X and after that a percentage of costs (coinsurance) up to $Y.

Sometimes certain things are covered before you hit your deductible other times not.

These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction.

There’s no reason why this system has to exist. We can make it better any time we want.

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now

I would like to see #1 tried but at this point I’ll gladly accept #2

> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for.

The employees of the managed care organization are often just using the criteria of the payer (often times the federal or state government for Medicaid/Medicare/federal employee or other large self funded plans).

The US government leaders are in a good spot. They get the managed care organizations (MCOs) to take the heat for denying coverage, while setting the rules to deny the coverage. MCOs even get audited and fined for approvals that don’t meet criteria.

In any case, all systems with limited resources will have to have someone approving or denying payments, whether it be a government employee or someone contracted out by the government.

But the most salient metric here is all the MCOs earn only 2% to 3% profit margins. And their market caps are tiny, and returns abysmal. (Except UNH, but that is due to its significant provider and software business).

Blame MCO employees all you want, but you will be doing exactly what government leaders want you to do.

Healthcare, when you actually need it, is an inelastic demand very often combined with an inelastic supply (or more exactly, an inelastic supply of suppliers) due to IP laws and the realities of specialization.

It is not at all surprising that capitalism fails miserably here, IMO.

That's an estimate, not hard numbers.

https://www.yahoo.com/news/no-one-knows-often-health-2020566...

> At the same time, posts on social media have been claiming that UnitedHealthcare’s claim denial rate is the highest in the industry at 32%. This figure comes from the personal finance website Value Penguin, which said it calculated that rate from available in-network data from plans sold on the marketplace.

FYI the shooter has received $1.2m in donations for his defense fund, and counting.