The Product is . . . Comprehensenility - eviltoast
  • The Snark Urge@lemmy.world
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    3 months ago

    It’s supposed to be that insurance converts inherent risk into a predictable cost, but health insurance is not really doing that. The costs remain unpredictable.

    • Nougat@fedia.io
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      3 months ago

      The costs remain unpredictable.

      I wholly disagree. I predict that the costs will be unnecessarily high.

    • Milk_Sheikh@lemm.ee
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      3 months ago

      But they know that, which is why healthcare costs have consistently increased higher than inflation.

      Healthcare is one of THE MOST demand inelastic commodities or services. People do not say “oooh that’s a lot of money - is there a worse doctor who is cheaper?”, instead they say “100% yes I will remortgage my home and sell assets to pay for the cancer treatment my child needs.” Nobody is at the free clinic by choice, they’re there because they cannot afford or borrow to pay for better care.

      Capitalism is incompatible with ‘rational consumer purchasing choices’ that apply to clothes, food, TVs, etc. because when there’s death or life altering negative outcomes, the only rational decision is to pay WHATEVER the price demanded is. Healthcare has a demand wall, not a demand curve.

      • capital@lemmy.world
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        3 months ago

        People do not say “oooh that’s a lot of money - is there a worse doctor who is cheaper?”, instead they say “100% yes I will remortgage my home and sell assets to pay for the cancer treatment my child needs.”

        I can’t believe how many times I had to make this exact point to dipshits I worked with any time they uttered the term “free market”.

        What am I going to do in an emergency in the back of an ambulance on the way to the ER? Hey, can you guys pull over for a sec? I need to check if the current ER doc is in network. Fuuuck ooooffff.

        I then recount the time I needed a non-emergency procedure (MRI for my back) which affords me plenty of time to shop around. I proceeded to call around to try to get prices (LOL) and then I got my insurance and MRI place on the phone all at once and I STILL couldn’t get a solid number for how much it would cost me. Who the fuck else needs to be on the call to get a number???

      • uis@lemm.ee
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        3 months ago

        For mathematics wall is a curve. But yeah, completely agree.

        • ilinamorato@lemmy.world
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          3 months ago

          No, in theory, they work like a well-funded savings account: you put in a predictable amount of money every month, and they store it for you until you need to withdraw it; with an added benefit that they would allow you to withdraw more than you have (internally using other people’s money to cover the difference) under the assumption that any shortfalls that result will all come out in the wash eventually; some people overpay, some people underpay, and you invest what you have in low-risk investments in the meantime. All insurance companies work like that in theory, or at least that’s what they tell regulators. But in reality, they don’t pay out nearly enough to provide the consistency people need.

  • xantoxis@lemmy.world
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    3 months ago

    Insurance is, at its core, a reasonable halfway measure towards public control of a critical resource. If you need something only very rarely, but it’s something that needs to exist ALL THE TIME just in case, insurance allows you to pool your resources with other people in the same boat and afford to keep an industry around just in case. Somebody will always be using it right now, and it’ll be there when you need it, because you paid into the pool.

    The problem is, as always, the insertion of capitalism into the solution. If someone has to profit from this set of relationships, the motivation to provide the resource is in competition with the motivation to extract more profit. This is what happened to healthcare.

    Insurance is only a halfway measure because we already have an organization capable of managing common resources that individuals use only rarely but which the public needs all the time: that organization is the government, or the governments at various levels. We manage lots of things this way: fixing roads, stopping houses from burning down, pulling people out of floodwaters, that kind of thing. You don’t need it all the time, but it’s there when you need it because you’re paying taxes to a government that has no profit motive from it. Insurance should only ever have existed temporarily while government infrastructure was debated and organized, but the for-profit industry managed to capture enough of the government to keep itself alive indefinitely.

    In short, insurance isn’t inherently bad, just not meant to be a permanent fix. Capitalism is bad.

    • Phil_in_here@lemmy.ca
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      3 months ago

      Private insurance should only exist for things that are both a) completely optional, and b) not inevitable (so… evitable?).

      Auto insurance? Well, if it’s the law to have it, why is a private company involved whose sole model is to collect money and deny payments?

      Health insurance? Well, it’s optional, but you will absolutely need to pay for Healthcare at some point (or you die early). Why, again, should we put an institution in charge whose sole purpose is to make the average person pay more than they get out of it?

      Famous athlete leg insurance? High value possession insurance? Have at it, private insurance.

      • Delphia@lemmy.world
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        3 months ago

        Auto insurance being mandatory makes sense in that the wronged person shouldn’t have their life destroyed because someone can’t drive and afford to replace a car.

        • Revan343@lemmy.ca
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          3 months ago

          They didn’t say auto insurance shouldn’t be mandatory, they said that it shouldn’t be privately run

            • Phil_in_here@lemmy.ca
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              3 months ago

              You’re right. Why would I want a public entity to keep any extra money in the country when I could pay a private mego corporation to funnel it off shore?

              Why would I want to fund a public entity to keep publicly available records when I could pay a private company to deny my $1200 claim and boast $104 billion profit?

              Is it the choice I get to make between 3 companies that all run the same statistical algorithm for risk assessment and collectively agree to have the same pricing? That’s so much better than having a government beholden to it’s voters and public option control it, right?

              • Delphia@lemmy.world
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                3 months ago

                You are assuming that the government will run the insurance process competently. The government already is beholden to the voters and public opinion and they are just so efficient and devoid of red tape right? You’re also assuming the government will run the insurance industry as some sort of benevolent not for profit as opposed to a new form of tax. Not to mention what happens when the republicans get in and decide to raise insurance on electric vehicles or manipulate the price of insurance on cars from certain countries as a form of ersatz import tariff, or install political appointment figureheads who can take kickbacks to make certain manufacturers cheaper to insure. Not to mention the formation of a government department of adjusters and estimators to run the whole deal.

                The existing system sucks buy I dont see the government having total control and no alternatives being some sort of magical panacea.

    • aesthelete@lemmy.world
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      3 months ago

      I just thought of a funny concept which is that when you’re born in the country you’re automatically given life insurance. Then when a doctor says “you need this operation” and the health insurance company is like “your doctor is wrong” your life insurance company can come in and be like “you can’t kill my guy, because he’d be owed a gigantic payout!” and then go to war with each other.

      It would never work in reality, but I find the idea funny.

      • ℍ𝕂-𝟞𝟝@sopuli.xyz
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        3 months ago

        What would predictably happen is that the health insurance company would still withhold care, and the life insurance company would deny the payout based on the care being withheld. Then they both would be like “sue me”.

        And eventually they would merge and be just one company.

        • aidan@lemmy.world
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          3 months ago

          This is a genuine concern with over regulation of any industry. If they can just say they were following the regulation, which inevitably will lack in some areas, then that is a strong defense for them.

          • uis@lemm.ee
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            3 months ago

            concern with over regulation of any industry

            Usually mergers happen and monopolies form because there is no regulation of industry

              • uis@lemm.ee
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                3 months ago

                I don’t think thought property laws help Nestle at all. Or reional monopolies.

                • aidan@lemmy.world
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                  3 months ago

                  I don’t think thought property laws help Nestle at all.

                  How is Nestle a monopoly?

    • EatATaco@lemm.ee
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      3 months ago

      I know I’ll be hated for this, but my wife works for an insurance company, as a doctor, doing chart review. She was always very responsible as a doctor, but the shit she talks about that doctors prescribe is ridiculous.

      One case that sticks with me (not even the most egregious, but because of the berating she got from the doctor and the patient), the patient needed a special car seat, which they approved. The doctor also prescribed a 200 dollar car seat cover. Now the seat already comes with a removable and washable cover, this additional one would just make it easier to remove and wash. It was denied as not medically necessary, which it clearly is not. The doctor demanded a consult and then yelled at her the whole time. The patient also called her and yelled at her.

      Im a firm supporter of universal healthcare, but the idea that doctors never do ridiculously unnecessary shit, regardless of the reason, requires one to be completely ignorant of how any of this actually works. And so, even with universal health care, some bureaucrat stepping in to determine if a doctor made the right decision would absolutely still be necessary.

      • expr@programming.dev
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        3 months ago

        Yeah, no, fuck off with that. The doctor is the care provider, not the insurance company, and an insurance company has no fucking business deciding what is or isn’t medically necessary.

        • aidan@lemmy.world
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          3 months ago

          They decide what they pay for, it is factually true that doctors will treat so they get paid more, this is especially a concern in private practice.

        • EatATaco@lemm.ee
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          3 months ago

          I notice how you didn’t actually address my point all, just reiterated the claim.

          I don’t believe this happens that often, but what happens in the case that a doctor prescribes completely unnecessary procedures and visits, which makes them rich. Still the insurance company shouldn’t do anything?

          • Pips@lemmy.sdf.org
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            3 months ago

            If your wife has not seen or treated the patient, she has no basis to deny the claim as medically unnecessary. She has no idea what conditions the patient may have that would necessitate having a different seat cover. I get that you love your wife, but her job leads to significantly more pain than benefit.

            • EatATaco@lemm.ee
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              3 months ago

              she has no basis

              You’re just wrong. I assume it because you have no medical experience and don’t have any knowledge of how any of this works, but doctors are supposed to take good notes throughout their care that go into charts. This is done so any doctor, especially if we are talking about in a hospital, can step in and read what has been done, why it was done, so they know what they should do next. There are also standards of care for certain conditions that have been established and reviewed by many other doctors.

              So she can absolutely read these charts and the standards of care and have a very good basis for what is and what is not necessary. Is it 100%? Of course not, which is why doctors and patients can appeal. But if they can’t justify why it is medically necessary, which was certainly the case here and it was clearly just a case of quality of life, then it makes sense not to waste resources…this would be true with or without private medical insurance.

              • Pips@lemmy.sdf.org
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                3 months ago

                Yes, of course you’re right. That’s why my surgeon friend who works in oncology has to frequently waste his time calling insurance over denied claims regarding fucking treatments for cancer patients. Truly medically unnecessary, which is why they’re pretty much always reversed and when they’re not, he gets to tell the patient they are going to die because someone who has never met them denied their claim as medically unnecessary. Same goes for my friend in the PICU, except she gets the added bonus of telling a little kid’s parents.

                And my guess is it would have literally been cheaper for everyone involved for insurance to just pay for the $200 seat cover. Modern American insurance companies are capitalist enterprises providing a socialist benefit. And the doctors denying claims on behalf of the insurance companies are not seeing the patients in question so are basing their decision on questionable documentation and “industry standards” that are based on heavy insurance influence. All to maximize value for the company rather than ensure patient welfare, which is the fucking point of insurance.

                There is plenty of abuse of the system through over billing, but somehow fucking Medicare is the most efficient health insurance system in America. If private insurance is so great, why are they more inefficient with worse outcomes?

                • EatATaco@lemm.ee
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                  3 months ago

                  Medicare is the most efficient health insurance system in America.

                  Are you under the impression that medicare does not do chart review nor deny claims? I assure you this is incorrect because, the irony being, my wife works on the medicare side of chart review.

                  As I’ve been saying, this doesn’t go away, nor should it, if we move to universal health care. Something I strongly support, btw, I dislike insurance companies as much as you do. The difference between you and me is that I recognize that doctors are not infallible and omniscient and can make mistakes.

                  If private insurance is so great, why are they more inefficient with worse outcomes?

                  I started off very clearly and explicitly saying Im a strong supporter of universal healthcare. Why do you think you came to the conclusion that I think private insurance is so great?

          • expr@programming.dev
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            3 months ago

            Insurance companies shouldn’t exist. Healthcare should not be a for-profit institution.

            • EatATaco@lemm.ee
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              3 months ago

              Agreed. But as I pointed out, even without insurance companies, there would still be standards of care and there would still be people reviewing charts to make sure doctors aren’t overdoing things and wasting resources.

      • ramirezmike@programming.dev
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        3 months ago

        The thing that’s missing here is context. It’s hard to care about a random doctor prescribing an extra $200 for a patient that is taken out of the tens of billions of dollars of profit a year that health insurance companies make.

        Like, this car seat anecdote costs as much as an hour meeting of a few of their higher paid employees.

        Does that really matter? Should it matter?

        • EatATaco@lemm.ee
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          3 months ago

          These are different questions, I was responding to the implicit claim that it’s ridiculous that someone other than a doctor could understand what is medically necessary.

          Although one thing my wife has expressed shock about since taking this role is how much waste there is, and how much doctors prescribe that is just clearly not medically necessary.

        • aidan@lemmy.world
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          3 months ago

          The real thing is many regular preventative checks are a huge money maker for physicians while not actually being that effective for patient outcomes. IIRC its been argued prostate exams are an example of this. IMO, routine removal of wisdom teeth is another, and routine circumcision is an obvious one.

        • ivanafterall ☑️@lemmy.world
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          3 months ago

          Better yet, let the doctor tell me, rather than someone one step removed from insurance company payroll. Which brings us full circle.

        • EatATaco@lemm.ee
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          3 months ago

          Doctors can, and often do, request consults where they make their case. My wife will occasionally change her mind after hearing from the doctor on why they think it is necessary. She will often even reach out to the doctor if she is unsure about the outcome.

          In this case the doctor just yelled at her and didn’t make a case at all.

      • aidan@lemmy.world
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        3 months ago

        I had an ear infection, the doctor thought I was lying for pain killers(she said people my age shouldn’t get ear infections, and I could’ve just used a hairdryer), I told her no the pain is fine I just want antibiotics so it doesn’t get worse. She then decided to prescribe codeine and oral antiobiotics but not ear drops.

        When I went to the pharmacist they filled the codeine prescription even though I didn’t want it.

        • uis@lemm.ee
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          3 months ago

          the doctor thought I was lying for pain killers

          What the fuck? I see it often in english-speaking places, but I want to know why doctors say “oh, you just want pain killers”. Them being concerned about painkillers more than about biological nukes infections can become resistant to greatly concerns me.

              • aidan@lemmy.world
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                3 months ago

                Well it is true, many drug addicts are dependent on prescription pain killers. Which other people will intentionally get prescribed so they can sell. Y’know, the whole opioid crisis thing.

  • blackn1ght@feddit.uk
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    3 months ago

    Insurance must be the only industry that actively tries not to deliver the service that its customers pay them for.

      • archchan@lemmy.ml
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        3 months ago

        And car insurance. And wall street. And Google with Pixel Pass. Actually I think capitalism just fails to deliver in general.

    • 【J】【u】【s】【t】【Z】@lemmy.world
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      3 months ago

      No no, you’re confusing the product and the customer. The customer is the stockholder and investor who owns equity in the insurance company, or in its bank. The product is quite literally denying care.

    • jj4211@lemmy.world
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      3 months ago

      I think every industry strives to be able to not deliver something after being paid, they usually just can’t get away with it.

  • Pacattack57@lemmy.world
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    3 months ago

    Want to hear something crazier? They don’t even have doctors. Non doctors are telling your doctor what is medically necessary.

    • Asafum@feddit.nl
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      3 months ago

      I had an issue with my foot and the doctor requested an MRI as an ultrasound wouldn’t show them anything they needed to see. The fucking insurance company says no, do the ultrasound… So I paid for a fucking useless ultrasound and then they refused to move forward with anything else… The issue kinda went away thankfully but there’s still something odd with my foot that I guess I just won’t fix until I can pay completely out of pocket.

      I’m so fucking happy that at least $1,200 monthly is taken out of my potential pay to cover a fucking useless insurance scam, because remember even if your employer “pays” it’s factored into your total compensation so you’re still the one paying.

      • Lets_Eat_Grandma@lemm.ee
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        3 months ago

        it’s factored into your total compensation so you’re still the one paying.

        I never understand why so many people assume insurance is “free” from the employer or that they pay 0-1000 per week/month. What we see is the tip of the iceberg. Insurance companies are perfectly lucrative and they pay tons and TONS of money to workers that make sure they make as much as possible.

        80% of premium revenues must be spent on treatment, the other 20% is what they have to profit off of. If they don’t spend 80% of the premiums on treatment they MUST refund excess earnings. See: https://www.healthcare.gov/health-care-law-protections/rate-review/

        This means if they took in 100 billion in premiums in a year, they MUST spend 80 billion dollars on treatments. The 20 billion left over is where they can make money. So they will make sure 4/5ths of everything they make goes into treatment so they never give refunds and they maximize potential profits. If they can convince companies to raise premiums 10% next year, costs will rise 10%, profits will rise 10%. It’s so obviously designed to raise the cost of premiums and treatments at the expense of all else it’s insane.

        They also don’t spend a dime over 80% of what they make if they can help it. There’s where claim rejections come in. They have mathematicians figuring out the ideal numbers and those guys make stupid amounts of money.

    • frezik@midwest.social
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      3 months ago

      I’ll do you one worse. Sometimes, they do have doctors. In cases where people are trying to get coverage, especially for a severe workplace injury with lifetime effects, the insurance company will send you to a doctor who barely passed med school. They’ll have you do a “physical” that’s basically turn your head and cough. Then they write up a report that says you don’t need coverage.

      Since they are technically a licensed doctor, this is still considered “expert” opinion in court (if it comes to that). The doctors involved can make way more money at this then they can working their mediocre asses in any real capacity.

    • Drusas@fedia.io
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      3 months ago

      Well, they also profit from healthy people who don’t use their insurance much.

        • MentalEdge@sopuli.xyz
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          3 months ago

          They literally do?

          Customers that pay their premiums for years without actually needing healthcare is literally free money for them.

          • originalucifer@moist.catsweat.com
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            3 months ago

            im not sure why you think the money coming in from premiums isnt the same money used to pay claims, but you go ahead and believe whatever you want.

            the fact is we have to pass laws forcing them to spend a percentage of their profits on claims. their income is premiums their output is either claims, profit or operating costs.

            their profit comes solely from them denying claims. if they paid all claims they would have no profit.

            • skibidi@lemmy.world
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              The argument the person above you is making is that they also profit off people who never file claims in the first place. In fact those people are more profitable since they do not consume labor to process claims.

              The Byzantine system of rules and coverage exemptions exists to disincentive people from filing claims just as it exists to give leeway to deny them.

              Of course the overall point that paid claims must be less than premiums charged (and investment income) is correct.

            • MentalEdge@sopuli.xyz
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              im not sure why you think the money coming in from premiums isnt the same money used to pay claims

              And I’m not sure why you’d assume I think that.

              You’re saying they make their money from denying claims, rather than from premiums paid by the healthy, which they then keep by denying claims from the sick (who also pay them premiums), is a distinction without a difference.

            • Mossy Feathers (She/They)@pawb.social
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              their profit comes solely from them denying claims. if they paid all claims they would have no profit.

              Well, yeah. If someone claimed I owed them $20m because their dog died, I’d deny that too (unless it was life insurance for a show dog or something).

              Insurance was originally profitable because the idea was to bring in more money than you pay out, but set the margins so it’s worth paying for as a service (covering things so the cost of a payout is high to make the service worthwhile, but the chances of actually paying out are low, to make the service profitable).

              However, over time you are correct that it shifted to focusing on finding ways of putting profits over quality; which came with all kinds of legalese to avoid payouts, among other things (like rigging the healthcare system so the cost is always high, so their costs appear low in comparison).

              So you’re kinda right, but you seem to be conflating the American insurance market with insurance as a concept.

    • qjkxbmwvz@startrek.website
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      3 months ago

      No, they make a profit if your premiums are more than your care+overhead. Preventative care is sometimes offered with no co-pay — presumably because you end up costing them less over the long haul if you keep up to date with your Dr. appointments.

      It’s not a great system; but it does work very well for some customers, and failing to recognize that tends to preclude having a productive discussion.

      • originalucifer@moist.catsweat.com
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        3 months ago

        the united states is #1 in medical bankruptcy, including people with insurance.

        insurance is a scam youve been taught to not see as a scam. its a terrible middleman which extracts profits from sick and hurt humans by denying them care. if they paid all the claims, they would have no profit. and why should they? how can anyone defend such a gross money grab.

        giving the scam credibility keeps those costs high . pretending it has value keeps us from moving to a cheaper, more universal system.

    • Asafum@feddit.nl
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      3 months ago

      Yeah in the United States of Billionaires healthcare is a product to extract profit from in every way possible.

      Pharma companies get public funding for research and then turn around and charge insane prices for the final product infuriatingly referring to research costs to justify their pricing.

      Hospitals are bought and run by investment companies.

      “Insurance” scammers corporations have their own fiefdoms that they control so there’s very little competition and their sole reason for existing is to take your money and deny coverage for absolutely anything they can possibly deny you for so they keep the most money possible.

      We have The Best System In The World™ (for the ultra wealthy)

    • Optional@lemmy.worldOP
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      3 months ago

      Apparently, yeah.

      You probably haven’t even shot up a school or anything have you.

  • vga@sopuli.xyz
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    3 months ago

    Pooling everybody’s money so that the ones who are unfortunate get money to help with their situation definitely is a product. Just because you don’t understand something doesn’t mean it doesn’t exist.