Post-apocalyptic life in American health care

I hate to be so cynical, but I'll suggest an alternate thesis to the article: the American for-profit healthcare system is functioning exactly as designed. If you consider its primary goal being extraction of capital instead of taking care of people's health, everything that was confusing starts to make sense.

> at least seven experts spent roughly ten full-time days trying to find out a basic fact about my mother’s insurance, and finally failed. Meanwhile, many thousands of dollars were wasted on unnecessary hospitalization.

The money wasn't wasted -- the broken communication and intricate rule sets delay things for as long as possible, meanwhile the patient is charged, and someone is making a profit.

> On day six, I said “if she doesn’t go to a SNF today, I’m taking her home—the risk of her dying there seems less now than the risk of her dying here.” That got results: the other SNF agreed to take her “on spec.”

And here it is: when there was a credible threat that the money would stop flowing, the system acquiesced, insurmountable bureaucratic problems lifted.

> Are the confused rules Anthem’s fault? I imagine that the 1600 pages try to reconcile federal, state, and local legislation, plus the rules of three federal regulatory agencies, nine state agencies, and fifteen local agencies. All those are vague and conflicting and constantly changing, but Anthem’s rule-writing department does their best.

Here lies an opportunity to rip the spine out of the entire scam. Steal the rule books, leverage a LLM with RAG or other information retrieval architecture, and get answers in minutes, not days. Offer this as a service to (relatively) seamlessly slice through the obscure-by-design bureaucracies -- only of course to be hindered by the entrenched players and the politicians they have lobbied, who will fight tooth and nail to maintain the status quo.

> Why with single payer would there not still be instances of treatment being denied?

The most common failure mode for single-payer is scarcity. You won't be denied, but you'll have to wait many months for an appointment.

> Would this not be replaced with faceless automata in government?

They are controlled by politicians, who are directly responsible to their electorate. Brexit is a good example, using money sent to EU for NHS was one of the more influential ads. Of course, the outcome turned out to be... different.

With the current insurance system, you don't have ANY levers. You can't usually change your insurance company because it's provided by your employer. And even if you want to buy medical insurance yourself via the ACA, you can switch it only once a year. With no way to tell in advance if your new company is going to cover your treatment.

You also can't even sue your insurance company if it denies you the treatment because _all_ insurance companies require binding arbitration. And arbitrators basically always side with the insurance company, because your contract says that the insurance company is always right. That's how UnitedHealthcare can get away with just randomly denying treatment.

> Just look at how the VA is run and complains about it.

The VA system has on average delivers better outcomes than private insurance: https://www.rand.org/news/press/2018/04/26.html

It's the usual "review effect", you only see negatives about the VA, not positives.

Does this mean that someone with diabetes effectively has to pay 50k/yr for health insurance? Or do you mean diabetics can pay more than 50k/yr because no individual vial of insulin costs over 50k, so a diabetic is expected to pay for all of their insulin out of pocket for their entire life?

>It's better to have triple price, have insurer pay third of it and sell the debt of remaining two thirds as half-price. This way you get all the income and zero taxes.

I'm sorry but this sounds like someone invoking "they'll write it off" without knowing how write offs work. In that scenario your revenue will be 2/3rds of the list price. Taxes payable is dependent on your profit, not your revenue. Profit is revenue minus costs. Inflating the list price doesn't change anything in this equation, and thus won't affect your taxes payable.