ubiquitin

“However, it’s important to realize that insurance companies may not be obligated to cover the cost of these treatments. Since their primary objective is to remain profitable and sustainable, they may reject claims and requests that may be seen as not necessary in order to reduce costs.c

Yes I realize that. I’ve said thst a few times. Thst is EXACTLY the problem putting profit above patient care

“In that world, there are often significant wait times for tests, and appointments can be months away.”

1. In my world I have that too
2. Waiting for a test thst will happen (ie get paid for) is better than an immediate test thst won’t happen (ie get paid for).

(Its easy to say if so important just pay for it for many that’s not an option)

2scents

Tried
a. didn’t work He had no symptoms.
IVe since hinted to patients to exaggerate their symptoms, Its easy to get a CT scan in ED, though I hope you appreciate the absurdity of this suggestion, Lie, commit insurance fraud to get Health care you have paid for already

b. It was more than 500, and no they didn’t have that much lying around. Though perhaps I should have pushed harder. Renal cell carcinoma does not tend to Grow quickly I was optomistic that they would eventually agree to pay for the scan (as they did). Maybe I should have told him to just pay and figth later to get reimbursed. I doubt it would have changed anything (as I mentioned earleir) but it is something I think about

C. Ultrasound was equivocal

CA
no its better for doctors and/or the patients to decide

DrP
“We seem to agree that CEOs make lots of money in their positions and that high paid CEOs are needed for the health insurance companies to function.”
disagree completely

” We also agree that (as unfortunate as it may be) CEOs (and companies) need to either be aggressive in denying claims (lawfully or unlawfully) to keep premiums down or they’ll either go bankrupt or put out of business by the competition. (It’s wrong, I know, but that’s the only way it can function.) ”

Agree but while you view that as a feature. To me hat is a bug. In other words yes That is the way it has to be to function this way. My reply is: It cant be that way there fore it shouldnt function this way. we need a new system. Period.

” We finally seem to agree that a physician should be doing everything for the best interest of a patient and setting aside how his / her decision will affect the bottom line of the company.”
Not sure that was ever in dispute. Though this seems to contradict your previous statement “…CEOs (and companies) need to either be aggressive in denying claims…”

“What we seem to disagree on is who should be running the healthcare in this country.”

Yes becasue of what yyou addmitted was “as unfortunate as it may be” If it is unfortunate, change it! It doesnt HAVE to be this way. We chose this.

“Despite all the problems going on with corporations running healthcare as a business I still think it’s the lesser of the two evils. Just because there are decisions that are being made that are morally wrong doesn’t mean the alternative is better.”

YES! that is where we disagree. As I said from one of my first posts

“In other words, Jean-Paul Sartre stated that anti-Semitism is NOT based on logic!”

I dont understand the point of this thread.

did you think there was some logic to anti-semitism?

Do you think an Anti-semite will say “Oh wait I didnt realize a “highly-respected” philosphper said my views were illogical; I guess Jews are ok after all”

I dont really get it

1) I have never heard it with a cholam, maybe a sh’va na
2) “travesty” might be a bit much. its a song, I don’t hink there is any halachic requirment or even hiddur to pronounce the words correctly.
3) If the vowelezation bothers you wait until you find out the passuk doesnt say “Venahapach venahapahc venahapach venahapach venapachu hu…”

spot

I assume you were talking to mentsch. while what he said was “so patently false” he was being sarcastic. He doesn’t really mean that this content if the height of maturity and not attention thinking.

Avira didnt say anything remotely false

Why not?
Magen Avraham, Mishna Berura say drink is ok – obviously as one min

“Since when is a rebbi off duty from being appropriate?”

Never!

Drinking on Purim though is not inappropriate. In fact it is entirely appropriate

UJM

I was literally going to say the same exact thing (though perhaps with a few typos)

Square

oy you have a low bar for “accomplishment”
Writing articles online? starting websites?

You list as an accomplishment writing a book ” “How to Not Get Married: Break these rules and you have a chance”.” nu, so did the book work did he follow his advice?

“Its hard to imagine an person with intelligence.”

Lol thats an admittedly funny “sentence”

MDG
I get that but it quickly turns into a long screed, with barely a coherent point.
Shidduch resumes are just a way to keep basic information about individuals straight. Nothing more nothing less. It is not reasonable to expect shadchanim to memorize where everyone who contacted them went to Yeshiva/seminary not to mention their phone numbers. So they are written down. that’s it . That’s all it is.
you don’t like it and want to only use people who know that stuff about you? no problem go for it. n o need to write over 3000 words about it.

incidentally this was written in 2018. Presumably he followed his advice and got rid of his resume. did it help?

Dr P

The bottom line is I don;t think free market could or should be in charge of healthcare

We have touched on many reasons here are a few:
1) Healthcare is largely not driven by supply and demand
2) The information asymmetry is close to insurmountable
3) When its an emergency you cant exactly price shop
4) Having a business decide who lives and who dies Is as you said “wrong, I agree”

So If not the private sector who should run it?
t o that I say it should be the government.

The response to that is one of two things:

A – Thats not the government’s role
B- A government run system wopuldnt work

To A I reply hear, I disagree but if you dont view it as the governments role. You favor “limited government” therefore havign a business run it even if it doesnt work because of the reaosns outlined above but “that’s how it needs to be ” I hear completely. disagree, but hear (though be prepared to explain why you give the government other roles like paying for education, roads defense etc I’m not saying you cant provide a difference you just need one)

To B my reply is well Private sector doesn’t work either. so lets make the government system work .

“As I mentioned earlier, they cannot raise premiums at their whim and 80% or 85% of premiums must go to providers, any additional premiums collected are returned.”

Percentage alone isnt everything

The Ceo’s and Presidents of insurance companies get paid multiple millions of dollars At one Point Mark Bertoloni received almost 28 million dollars in one year. while running a company that denies claims that could have saved lives. That year I had spent months trying to get a CT scan approved for a patient wit ha suspicious lesion. Renal cell carcinoma is essentially curable if caught early enough before it spreads. by the time it was approved it had spread. (Admittedly there is no way to know for sure if it spread during that delay). The patient is dead now. the few thousand dollars his company should have spent in timely error is a rounding error in his salary. This is but one story I have dozens my colleagues have more.

The truth is I don’t fault him or the company. that is their job they profit by denying healthcare that is there entire business model. I fault the business model.

“As far as the story you mentioned is concerned- I hope that’s the exception and not the norm”
Thanks for reading it.
What I was most outraged about whas the physician who just rubber stamps what nurse had previously denied. what is the poitn of having a physician reviewer if he isnt actually reviewing it?

You say you hope its the exception . It is a lot of exceptions close enough to being the norm . It is their business model . Yes they have t pay 85% that still leaves millions and million and millions for their top executives .

DrP

The only point I said wasn’t true was this
““no politiican would dream of raising taxes that much (for the average worker who didnt get a 10 fold increase in salary .”
Do you recall a former President named Barak Hussein Obama? He did exactly that…”

That wasn’t true. He didnt Do “EXACTLY THAT”
As you acknowledged in your post. I didnt say you were a liar, becasue you knew what you were saying, I would characterize it as misleading more than lying. I pointed out that what you were saying was “not true” it wasnt and isnt

” from my point of view this thread has run its course”
Yep along time ago

“I didn’t read the story you mentioned but I’ll agree with you that there can be some bad apples out there just like there is in any industry, that doesn’t mean that the insurance industry is rotten to the core”
you should read it.
I deal with insurance companies multiple times weekly (more often as a provider) . rotten to the core is an understatement

AAQ

“Competition is the “thing” that typically stops suppliers from raising prices. Econ 101.”

Problem is after Econ 101 you need to take more advanced courses.

Many basic tenets of Econ 101 do not apply to healthcare.

Take the most basic tenet, that of supply and demand . In Econ 101 you are taught if strawberries are too expensive then people will stop eating strawberries and buy blueberries forcing the price of Strawberries to come down.

If stents become expensive its not like the demand for them (ie Heart attacks) will go down. Furthermore if someone is having a heart attack they can’t exactly shop around for the cheapest care.

Even if it ISN’t an emergency shopping around is almost impossible,. This experiment has been done. One of the most frequent reasons people go to a hospital is for childbirth. OF course there are occasionally complications, but generlaly the stay is pretty routine and predictable. Furthermore you have a 9 month headstart to plan where to give birth. You would think finding he cheapest place is straightforward. Yet it is near impossible. There was an attempt to chaneg this with the Hospital Price Transparency Law signed by President Trump, but it is still near impossible to find this information.

Furthermore there is a Knowledge discrepancy between you and the healthcare system, underming basic economic principals (which assume a level playing field). Yo ucan easily dewtermine the difference between strawberries and blueberries. IT is much harder to determine the difference between getting a few stents vs bypass surgery

“If you can’t afford a chasunah, you should not be in shidduchim.”

It is impossible to beleive that a ben Avraham V’Yitzchak could say something so insane..

To say you shouldnt have a chasuna ie just get married in shul with a minyan is one thing (it would be wrong but not crazy) .
But not to be involved in shiddduchim ??? impossible that a frum Jew could suggest such a thing

“Do you recall a former President named Barak Hussein Obama? He did exactly that. It may not have been in income tax or sales tax but it was a forced tax on the hard working makers to pay the premiums for the lazy takers and yes, my salary remained relatively the same but my health insurance costs skyrocketed by around $10,000 a year.”

This is not true
The increase in tax was $695 that is ti . And it ONLY applied if you dindnt have health insurance .

“Once you don’t get insurance through your employer you’re not in that same group anymore.”

right , a complelty insane system. so if I change jobs I may need a new doctor. If my employer gets a better deal I and chanegs companies I may need a new doctor it is crazy.
what on Earth does my insirance have to do with my employer

“I’ll mention again what I’ve been writing all along. The government should be involved in health care … Not for lazy people who want society to do everything for them.”
Yes youve said that the problem is it isnt the just the “lazy” who get cancer . Read the recent Propublica story “UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.” The fellow involved doesnt sound lazy.

“Again, this will not work until people start taking responsibility for themselves and the ratio of avoidable medical expenses to unavoidable expenses gets flipped.”
and Again if it got you on board, Id support increased oversight on halthier diet/excerices increased regulations on smoking etc

DrP

“Next question- could the government collect to the extent that a hard working family would lose their house?”

I have a pending answer
to be clear, this isn’t limited to Healthcare
The Government can raise taxes for los of things that fall into their purview. If the government feels they need to raise taxes to better arm Ukraine, even if I don’t care about Ukraine they can do that.
Same thing here IF (big IF, as I said this is THE key to all the other questions) it is the governments role to fund healthcare for all. then they can raise taxes even if an overextended few may lose their houses

DrP

Glad to hear things are doing better

To answer your question
Yes without question We should collect from the A’s (and the B’s) to fund the healthcare of the B’s (and the A’s).

The reason for this is I don’t think there is any realistic way to ensure the B’s behave. Nor is there a real way to sepperate health costs based on “irresponsible choices” vs “bad luck” That said, As I mentioned I could be convinced to have more government oversight on behavior to ensure the B’s “behave” perhaps some financial penalty for smoking, not excercising , eating too much meat etc etc .

I cant say I love it, but if this would get you on board I’m in. Is that your suggestion?

DRP

“..to admit that there are times when the govermnent shouldn’t step in (i.e. when Mr. A and his family would suffer the loss of their house and savings due to the shear utter irresponsibility of Mr. B).”

I don’t think anyone here has ever suggested anything like that. that you needed them to “admit” they wouldn’t support that. T ohave one neighbor “chosen” to sponsor his neighbor ? Thats a made up thing that doesnt happen in any socity and I dont think has ever ben seriously suggested to happen

DP

“I agree that the government is supposed to help the population”

Great so we fundamentally agree.
We can hammer out nitty gritty details another day, if you want the Government to deter people from smoking, deter people who don’t exercise or eat too much red meat, I can get behind that. It makes me a bit squeamish (I love government oversight but even I have my limits) but if that ‘s what it takes to get you on board, I can get behind increased government oversight on diet/exercise etc

AAQ

Happy to help

Explain to your kid that society needs certain things to function. roads is an easy example that he can see. We all need roads, to get to school, work fun places. Even someone how doesn’t have a car needs roads for the bus that he takes.
Even someone who says I’ll never take busses still needs roads for deliveries to his local store, and of course for emergencies like fire department.

so how should we pay for roads? We can’t just hope everyone will on their own understand this. Many have trouble with this simple concept. so we have the government in charge they collect taxes from everybody and use that money to pay for things that we all need including roads.

S oalthough it feels free to use roads, they do in fact cost money, this is a cost that is paid by all of us

where it gets a little trickier is what “jobs” fall into the governments purview.
Many believe healthcare is such a thing. Just like we all pay taxes to be used for roads that we as a society need, regardless of how much you personally use the road. Same thing for healthcare we all pay taxes to fund healthcare that we as a society need.

now before you get nervous that this would cause taxes to go up by a lot, keep in mind we already pay a ton for healthcare it isn’t “free” I pay 11,000 in premiums my employer (boss) pays the same for me. My taxes could go up by a bit over 20,000 dollars and I’d still end up ahead

hope this helps, Once your kid gets it have him explain it to you.

To be clear I’m not arguing

I think reasonable people can disagree.

Your examples though are designed to bias and not really to inform.

If you maintain that it isn’t the Government’s job to get involved whether you worked out and saved (Mr A.) or didn’t (Mr. B) I understand that. I disagree (as to most people Even Trump running as a Republican promised to provide “the best healthcare plan” and Medicare is wildly popular )
But again I think people can disagree as to the role of government.

so make your case. no need to make it seem as if Mr B “deserves” it. that is entirely irrelevant. If Mr. B did work out , and never smoked and his insurance won’t cover because xyz. STILL not the governments job to provide

Dr Peper

While on vacation ponder these not-hypothetical situations:

Use your same Family A and B only instead of Family B getting sick

Mr A suffered a heart attack. Ambulance took rushed him to the hospital a stent was placed and he did well beiung discharged 3 days later. Unfortunately the hospital was out of network. His Three day hospital stay now costs him 250,000. (His fault for not chckign with his insurance while having his heart attack, I mena how lazy can he be!?)

Does the government have the right to put a $250,000 lien on Mr. B’s house and seize the $10 he has in savings in order to save Mr. A?

Or

Mr A. gets diagnosed with Colon Cancer. It is operable but needs to be done quickly. His insurance company denies the claim because they looked bakc at hsi application and he wrote no medical condions yet as a child he had asthma (“grew out of it” and wsn;t on meds for years when filled out form)
Does the government have the right to put a $3000,000 lien on Mr. B’s house and seize the $10 he has in savings in order to save Mr. A?
(spoiler alert they didn’t, and by the time he got insurance company to agree to pay the tumor had spread and was no longer operable)

We could go on. but the point is , Health problems are more driven by “bad luck” than by how prepared you are (thats not to say living a healthier life style doesnt play a role)

So it has to work both ways if Mr B should help Mr A then the reverse is true.
Now you could argue no in those cases too bad on Mr A. It’s each man for himself. Consistency is key

UJM

“We once again learn, the hard way r’l, the valuable lesson against Mesira. An innocent Yid was falsely accused and reported to the goyim. …”

how did we learn that?
don’t we see the opposite?
He was falsely accused and walked home free that same day? You say “Something that could have potentially …” yeah but it didn’t. how do you see the opposite? IF anythign we see the system works. If concerned for a child’s wellfare report first. If in fact he was innocent he’ll walk that same day.

Avira

As far as I’m aware the first amendment protects you from government compelled speech not employer

Whitecar
its a bad assuption an employee can make almost anything hhe/she wants a requirement. unless it discriminates based on a “protected ” group so cant have you profess belief in yoshke that would discriminate based on religion(same for gender etc. Unless you argued that putting in pronouns was against your religion.