Cigna saves millions by having its doctors reject claims without reading them

I am an early adopter of concierge care. It's been tremendous.

I had a bone marrow transplant +30 years ago. Continuity of care has been an ongoing challenge.

From my reading and my own experience, having a patient advocate greatly improves outcomes. Someone who just keeps everything on track. Could be family member, friend, or a nurse / case worker. For me, it's now my concierge doctor. (Over the years, I've served as advocate for other patients many times.)

My current issue with concierge (patient advocates) is that it's rare. Everyone should have this. In times past, it was a family's doctor. But as everyone knows, that relationship is no longer stable, due to how healthcare in the USA has been commodified and "optimized".

Further, according to the research (like what Atul Gawanda has written about), specialty "wrap-around" practices greatly improve outcomes. Like for diabetes, cystic fibrosis, and other chronic life threatening conditions. Most all of a patient's care is done by these multidisciplinary primary clinics. One stop shopping. Instead of bouncing patients around, delegating the coordination and whatnot onto the patients themselves.

Again, thank you for this example. It's an interesting edge case. Today, I think most concierge arrangements are private. Whereas it should be the default, public or private.

FWIW, maybe about 10 years ago, Medicare and the VA had started to adopt the capitation model (preventative care vs fee-for-service). Now I'm curious what they (or any other large orgs) are doing wrt concierge (patient advocates).

If you have no competition, the problem shifts the other way. The MRI machine is ten years old, so buy a new one even if it still works, because there is no competition so nothing stops them from raising premiums to pay for it. Then the MRI manufacturer declares that they're only supported for five years and by the way the price has gone up, because they know the non-profit isn't price-sensitive and the patients have no other choice. (Unless you put government pressure on them to keep costs down, and then you're back to cost cutting.)

The underlying problem is that you need an objective way to measure whether some cost is worth incurring. The best metric we have for that is whether the patient is willing to pay that amount of money for it, having been informed of the consequences by their doctor. Sometimes the answer is no -- it really might not be worth spending a million dollars to extend the life of a 78-year-old by six months.

But it probably is worth spending $100,000 to extend the life of an 8-year-old by 70 years, even if the 8-year-old doesn't have $100,000. Which is where you want some kind of insurance.

Where we screwed up is in making "insurance" cover minor procedures that really ought to only cost tens to hundreds of dollars out of pocket, because then the insurance causes those costs to balloon up to thousands by providing a deep pocket that can fund excessive bureaucratic inefficiency. (It also doesn't help that the AMA engineered a doctor shortage so now doctors are overworked, patients are less informed and prices are higher because of supply and demand.)

Going all philosophical here is, what, you making excuses for being a monster? Because what you're saying is that ruining other people's lives for your own profit is fine.

And yeah, violence is an extreme and distasteful solution, as I said. But if the only other option is to suck it up and let the exploiters win, then that's on them. You don't get to have a hypocritical morality system where it is ok for you to inflict harm on others for your own profit and not ok for them to inflict harm back in self defense.