this post was submitted on 11 Jan 2024
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People with health insurance may now represent the majority of debtors American hospitals struggle to collect from, according to medical billing analysts.

This marks a sea change from just a few years ago, when people with health insurance represented only about one in 10 bills hospitals considered “bad debt”, analysts said.

“We always used to consider bad debt, especially bad debt write-offs from a hospital perspective, those [patients] that have the ability to pay but don’t,” said Colleen Hall, senior vice-president for Kodiak Solutions, a billing, accounting and consulting firm that works closely with hospitals and performed the analysis.

“Now, it’s not as if these patients across the board are even able to pay, because [out-of-pocket costs are] such an astronomical amount related to what their general income might be.”

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[–] [email protected] 45 points 10 months ago
  • 1.6 Trillion dollar market
  • Middle man that creates more work for the patient and the doctor than if it didn't exist
  • Capitalist solution for an inelastic demand
  • Unable to see prices ahead of services
  • checks notes You can't change insurance provider unless you change jobs

This is an idiotic system that was never going to work for anyone but puppet master pulling the strings.

[–] [email protected] 38 points 10 months ago

Very cool, normal, high-functioning healthcare system. Such free market efficiency. I'm so glad we fuck everyone to death so that rich people the world over can get top-notch healthcare at, like, two very specific private hospitals. No way we could achieve that without fucking everyone to death, no sir. God bless America.

[–] [email protected] 9 points 10 months ago

Our healthcare system is completely fucking broken.

[–] [email protected] 8 points 10 months ago (1 children)

Insurance is mostly a discount program against destructively unaffordable services.

I have found private health providers for things like physical therapy often completely refuse insurance at all because medical billing is more expensive and troublesome than directly charging the clients. The demand is high enough they're stil too busy with the clients that can afford no insurance.

Insurance in any way being a more expensive option than not having it at all is insane but our reality.

[–] [email protected] 2 points 10 months ago (1 children)

A lot of dentists also take this approach. Our dentists takes no insurance whatsoever. They were saying at the conferences they attend more and more of their peers are doing the same thing.

[–] [email protected] 1 points 10 months ago* (last edited 10 months ago)

Angers me to think the end result is that this is the norm and employers no longer offer dental coverage at all, putting the full burden of that cost entirely on the individual.

[–] [email protected] 7 points 10 months ago (2 children)

I mean..

Thanks Obama?

I get it. We're never supposed to criticize democrats.

But it sure does seem that at every opportunity to go hard, they as a team, simply don't.

Obama could have made single payer a priority. He could have made codifying RvW a priority. He could have made lots of things priorities, but he didn't. He made compromise his priority as if they were ever going to give him an inch. The only thing truly progressive about him was his marketing.

Not going full stop into your priorities has consequences. This is one of them.

The counterargument is always that the democrats don't have the votes, so they shouldn't try. Democratic strategy has put us into a ratcheting crab walk towards fascism and totalitarianism. This happens as a function of 'compromise' and as a function of the insistence we run 'safe' candidates, when realistically, you aren't capturing any centrist voters on a D ticket, ever, and haven't been since before they year 2000.

We need to kick the blue dogs out of the party and run leftists down ticket in ever race. We can't have spoilers taking D seats. They aren't D's but we're not giving the people of those places any other options. Let those blue dogs run as Republicans. They won't win. They're too moderate. Crab-walking the Democratic party further and further right trying to cater to a non-existent center is a major factor for why things are continually getting worse.

[–] [email protected] 20 points 10 months ago (1 children)

My understanding was that the plan was to baby step it in.

Start with getting everyone insured, then move on to patching things until the insurers are not part of it at all anymore, and it's just the medicare paying for it all, and being able to negotiate prices, and directly hire doctors themselves and buy out hospitals. The end goal would be for healthcare to become a service like the post office, with every address serviced regardless of the cost.

That was the dream rather.

Democrats had about 90 days in 2009 to get it done, not knowing that it would just be 90 days.

That was the last Democratic super-majority, republicans then went hard into State legislatures in order to gerrymander the US so that a Democratic super majority of both houses could never happen again.

They also went hard on the racism, because the southern strategy worked the first time.

[–] [email protected] -3 points 10 months ago (3 children)

That was the last Democratic super-majority, republicans then went hard into State legislatures in order to gerrymander the US so that a Democratic super majority of both houses could never happen again.

I get that you are making these points in good faith, but its really not our job to make excuses for the inability of democrats to get the work they are elected to do, done. They can't keep getting apologized for on their own behalf. If these are the excuses they want to use, they need to be the ones to make them, because even these excuses demand further accountability.

[–] [email protected] 2 points 10 months ago (1 children)

Several states have had their election laws ruled unconstitutional due to partisan gerrymandering. Republicans in several states said to the courts, "fuck you, we're using the unconstitutional maps". If those maps had been thrown out, 2022 would have seen the Democrats take the House.

Instead we had to sit and watch as Republicans have fucked around and hindered any attempts at actually running a functional government.

[–] [email protected] 2 points 10 months ago (1 children)

Theres always an excuse.

Somehow the Republicans are the most capable, strategic, smart, and competent players to be able to accomplish these goals.

Meanwhile Democratic strategy amounts to:

sit and watch

Pretending that your current and previously elected Democratic officials aren't a major reason why things are the way that they are is to also give Republicans credit for being masters of strategy and craft.

Neither of those things is true.

[–] [email protected] 4 points 10 months ago (1 children)

Direct action will only spark a civil war.

One is likely already coming, but the side that kicks it off will be seen as the aggressor, and will likely receive less aid from the military. And whoever holds the military will be the winner.

Trump already sits in an odd place with the military. He's liked far more than he should be among the rank and file, but also hated by the officers.

Don't get me wrong, a lot of the rank and file hate Trump as well. Dude has earned that hate. The fucker skipped the 100 anniversary of Armistice Day because of a light rain.

Anyway, all we can do is follow the rule of law as meticulously as possible. That means a bunch of legal wrangling, and getting people to actually vote.

Here's the thing, we don't have to do it forever, the republican party is disintegrating. The in-fighting and lack of anything approaching an idea, that shit, wears on their base.

If Trump loses again, the republican party will not survive it.

That's not to say that conservatism will die. Far from it, but the current batch of them will have to scramble to reinvent themselves, and during that scramble, the left will actually be able to get shit done. probably.

[–] [email protected] 1 points 10 months ago (1 children)

Direct action will only spark a civil war.

This statement directly contradicts almost all of the progress that has been made in this country since its foundation.

Practically nothing has come as a result of "voting correctly" and almost everything we have can be attributed directly to direct action campaigns.

The 8 hour work day, then end of slavery, womens right to vote, social welfare programs, gay rights, rights for blacks in the south.

All a result of direct action. If anything the "incrementalism" has proved to be the exact opposite.

[–] [email protected] 2 points 10 months ago (1 children)

I'm sorry, I meant direct action by say, Biden.

If the Democrats were to follow the Republican playbook, and start fighting dirty.

That would kick off the civil war, and in the bloodiest way possible. But make no mistake, the Republicans will try to start the war anyway. When they do it, the military will almost certainly not be on their side.

That's why Tuberville was blocking military promotions. The only reason that shit stopped was because Trump is mostl likely not going to win again. Trump is too far gone into his own toxic bullshit. He has die hard fans, but has been scaring away the more moderate side of the republican party.

[–] [email protected] 2 points 10 months ago

That would kick off the civil war, and in the bloodiest way possible. But make no mistake, the Republicans will try to start the war anyway. When they do it, the military will almost certainly not be on their side.

Thank you for the clarification. I also agree with your third point, and to some extent, this might be the Dems saving grace, being that the Republicans cant seem to protect themselves from themselves.

[–] [email protected] 0 points 10 months ago (1 children)

Republican obstruction and wanton destruction is responsible for the lack of progress. Refusing Medicaid expansions and then overturning the individual mandate is what gutted the plan.

And sure you could jump right into single payer without any incremental change. But you're going to put the 400,000 Americans currently working in the health insurance industry out of work, if you do that. Which is not a small consideration. (That's per a CBO analysis of the feasibility of single payer, which does conclude it would save money, but it will require a massive work transition.)

https://www.healthaffairs.org/content/forefront/congressional-budget-office-scores-medicare-for-all-universal-coverage-less-spending

[–] [email protected] 4 points 10 months ago* (last edited 10 months ago)

The broader point that I'm making is that incrementalism as a philosophy has resulted in us going backwards. The acceptance of it as a viable strategy when it consistently fails to yield results is a serious problem.

A majority of successful social programs in the US did so in broad sweeping reforms that dramatically changed the way people interacted with systems.

Arguing that 400k jobs in an industry that is basically parasitic to the process seems Stockholm syndrome ludicrous, and yet unsurprising, because this is about the best that branded, 'Democrat with a capital D' , Democrats seem to be able to come up with.

Incrementalism sounds great on paper, it fails for two primary reasons. The first is the opponents to a program have to do far less to dismantle it, so its easy to work against. The second is that it fails to create its own proof points for why something was necessary in the first place. Obamacare is a great example of this second kind of failure. We're still utterly fucked in terms of healthcare. Most people are more fucked than they've ever been in terms of healthcare. We're worse off than we were because at least in 2008, although I didn't have healthcare, I wasn't paying several hundred dollars a month to basically not have healthcare. Incrementalism fails to make enough of a difference in peoples lives to show them that a given project is worth investing in.

[–] [email protected] 0 points 10 months ago

The Democrats + Independents had this "super majority" for a very small amount of time and that's the only reason we even got ACA.

Americas problem is our democracy isn't representative and too many people who should be voting choose not to.

I can blame Obama and Dems for a lot but not this and I also can't discount all the good they've done.

You want better things get your friends, family, acquaintances, and neighbors to vote. Go canvas. Get an actual supermajority that stays around for at least a few years because that's what it now takes in our polarized country.

[–] [email protected] 7 points 10 months ago (1 children)

I'd take Obama any day over the alternative, but the fact that he's heralded as one of the greatest after authorizing the murder of an American citizen without due process is pretty remarkable. His presidency was marked with failure, but he's a charismatic media darling, and the liberals eat it up just like the right.

When you campaign on hope and change only to deliver more of the same and champion the status quo you pave the way for shitheels like trump.

[–] [email protected] -2 points 10 months ago* (last edited 10 months ago)

Bernies healthcare plans were crazy unrealistic, and based on rogue states such as France, The UK, or Denmark. Luckily we dodged that bullet and got a sensible moderate who *checks notes* supports ethnic cleansing.

Yeah not gonna be surprised when Trump wins this one, I see no positive case for Biden being put out there.