this right here. all the people in this thread acting like "everything is fine" and things aren't so bad for most people...i sincerely hope they get the reality check they deserve but not like this. to see a loved one - who did nothing wrong other than existing - to be murdered by the system? i've witnessed this first hand and to say one's blood boils is understatement of the century. all preventable but when profits are always always always always the most important thing...you're nothing but a cost; an expense to others' egregious profit motives. and as such....expendable.

I will freely admit, I didn't know shit about medicare advantage plans prior to this shit show happening. Most people don't have a clue. But if you talk to a social worker at a hospital, they see it every single day. They are beat down trying to fight for their patients while watching them get fucked by insurance.

Never go HMO, PPO is worth the extra $ when you want to choose hospitals and specialists.

How's that work? My employer doesn't offer health insurance, just reimbursement and every plan on the marketplace is an HMO.

What state are you in? You should be able to get PPO plans in the healthcare marketplace. Expect to pay considerably more a month of it isn’t subsidized

I'm not sure all of this is profit seeking caused given their small margins. It feels like it could be a down stream effect of business sustainability and competition. The bag is necessarily covered by those who have less long running health complications, and so you need to provide a competitive price to them so they pay in with you. The price offered when you don't need care becomes lower than the amount needed to cover everyone when you do. Which would incentive denials out of necessity as well.

I wonder if there is a niche to ameliorate this sort of thing by offering payday loans on insurance payouts.

The incentives are pro-social: insurance companies have an incentive to delay payouts, because their profits come from interest (they pay out more money than they take in) so the longer they can hold onto money the better. But that's reversed for this hypothetical loan issuer - they want to make the payout as fast as possible in order to earn as much interest as possible as quickly as possible.

And if there's a systematic tendency for medicaid advantage plans to deny claims that eventually get approved, and if you could predict which ones will get approved 'just' by really understanding what medicaid would approve, then this might be self-sustaining or even profitable?

The solution is disallow private insurance being the middle man between medicare and the patient.

What possible benefit to the patient is having a whole bureaucracy sit between the gov't insurance and the person in need of medical care? It only exists to make money off the backs of the people they are harming.

Now, if you don't know why people sign up for them, you don't understand what they are doing. My mom, like many others, was on a fixed income. If you sign up for a medicare advantage plan, they will do things like give you an extra $100 a month to you directly. Why would insurance be willing to PAY you? Because they make all their money billing medicare and denying you coverage.

18 billion in profits last year running a middle man between patients and medicare

> Why would insurance be willing to PAY you?

Why would the government introduce an intermediary in the first place?

Network effects. They outsource all the medical billing and management to the big insurance racket companies. Protip: go with a PPO Medicare plan and medigap supplemental plan if you want your loved ones to see any specialists and go to any hospital. I switched mine off the HMO advantage plans to BCBS PPO cause HMO Medicare advantage plans deny everything by default fighting tooth and nail.

Wikipedia says the government introduced intermediaries to cut costs (i.e. create a scapegoat people can blame for denying claims or reducing payments to providers and not have the finger point at the government).

https://en.wikipedia.org/wiki/Balanced_Budget_Act_of_1997

> The act had a five-year savings goal and a ten-year savings goal following its enactment in 1997. The five-year savings goal was $116.4 billion which would be achieved by limiting growth rates in payments to hospitals and physicians under fee-for-service arrangements.[7]

>This plan also involved the change of the methods of payment made to rehabilitation hospitals, home health agencies, skilled nursing facilities, and outpatient service agencies as well as the reduction of payments to Medicare managed care plans and the slowing of growth rates of these same care plans.[7]

>The ten-year savings goal was $393.8 billion using the same savings methods as the five-year goal to achieve the savings in 2007.[7]

Is it just me or does this sound like a terrible bill? I've gone through the page and it just sounds like it was trying to save money by making healthcare beneficiaries worse off.

I haven't researched how all these came to exist but I assume it is the typical conservative talking point about the free market being more efficient so why wouldn't we want this. It will save us all money. And no, I don't believe any of that BS.

Or, I don’t know, maybe we do what every other Western nation has done and just present a public option for healthcare coverage to the average person?

Nah, better to have millionaires lying to the sick and dying about the company not having the money to pay for the coverage that the sick person paid a hefty monthly premium to provide.

There is no niche, that makes a fundamentally inefficient system, more efficient.

If any such niche existed, for any system, then this niche would be the system.

Nice, a hyper capitalistic solution to a problem which only exists because of a hyper capitalistic system. Why not add another middleman with a financial incentive to a system overburdened by middlemen with financial incentives?

The solution would be to remove useless leeches providing no value or benefit to anyone other than shareholders, not add more of them.

And what do you know, most of the rest of the developed world has managed to do that. And even the parts that have private healthcare have managed to put strict rules controlling it, and costs and outcomes are much better.

Lotsa words, mostly BS.

It's bureaucratic violence. Slow. With maximum kafkaesque torture to draw it out.

How many people die for greed? Is that not violence?

"The noble person that goes to work and pray like they s'posed to? Slaughter people too, your murder's just a bit slower."

- Kendrick Lamar

that sounds like a true nightmare. i'm sorry that happened.

Yep, and it is preventable. The one thing I can say is NEVER let your parents sign up for a "medicare" advantage plan. There is no advantage. The company my mom was with is one of the largest and profited something like 18 BILLION off medicare last year. How do you think that is possible? Because they overcharge medicare and deny coverage.

Source? UNH’s entire net income in 2023 was $22.3B, and their market cap is more than 5x the next biggest managed care organization (MCO).

The other MCOs all had net income less than $8B (CVS/Elevance/Cigna/Humana/etc).

There is no way a business earned a profit of $18B just from Medicare and it not being visible on their net income figures.

That is not to say Medicare Advantage is good for most customers (the common advice is to stay away from it), but fantastical numbers don’t help arguments.

Profit is not income. That $18B could be spend on salaries, bonuses, company assests, etc, and I'm not an accountant but if it's getting spent on the business it doesn't have to be included in their income reports.

Profit without a qualifier is assumed to mean net income, which is all revenue minus all expenses.

But even supposing that the business earns $18B from Medicare Advantage after all is said and done, it doesn’t pass the smell test because at that level of profit, these businesses should shut everything else down and just do Medicare Advantage.

Wish I could upvote this more. Switched mine to BCBS PPO with medigap supplemental plan for their Medicare provider. They got to go to the best cancer hospital and specialists you can just call up the office and schedule. It costs like $900 a month though and they pay 20% with 80% plan coverage up to catastrophic out of pocket limit. PPO if you want to give your loved ones a fighting chance.

People sign up for (or are tempted to sign up for) Medicare C because traditional Medicare is too complex and bafflingly bad. Traditional Medicare requires paying for your Part B premium, a separate Part D plan and premium (from the private insurance companies), likely a third “Medigap” plan and premium (also from the private insurance companies IIRC) and then separate private vision and dental coverages.

And for all of that, you’re stuck paying at least 20% of everything, on top of separate deductibles for each part and no out of pocket caps at all (meaning Medicare isn’t even an ACA compliant health care plan). Part C simplifies this for so many people by rolling all of Part B, Part D and usually vision and dental into a single premium and puts out of pocket caps on the amount of money you might need to shell out. Is it any wonder people keep choosing Part C even if it means their providers have to fight the insurance more?

It makes me want to commit a murder just reading this.

I'm so sorry about what happened to your mom. I'd be furious, too. It sounds like you did everything you possibly could and really fought for her.

It really makes me sad, but thank you for sharing your story.

This is my story, just replacing "mom" with "dad". Thanks for telling it and sorry for your loss.

Medicare Advantage is HMO right? I just switch my folks to BCBS PPO with Medicare and a “medigap” supplemental plan to cover things that Medicare won’t. My head is still spinning up to my neck in paperwork for the cancer and hemorrhagic stroke bills from out of network physician groups billing, truly 24/7 job. Sorry for your loss. You did a lot to help I can tell after going through this myself. Be kind to yourself. They denied my mom’s chemo drugs it’s absurd. She paid into the system for decades without incident.

I'm genuinely amazed by the distribution of opinions in this thread.

If y'all feel that way, why don't you vote for a "socialist" healthcare system like we have over here in communist Europe?

I mean, I'm over here in Germany and I'm not going to claim the system is that great, but it's really not half bad either, and it does seem to prevent the most extreme tragedies.

Vote where? Do you see that on the ballot?

It's on the ballot a lot; Obama wanted, but was ultimately unable to, implement a broad individual mandate within the ACA; Bernie Sanders and Elizabeth Warren supported medicare for all.

A number of states have implemented individual mandates; including Massachusetts under Mitt Romney.

It seems quite clear that you'd get it if you (collectively) voted that way, or not for candidates who very actively oppose it.