I used to run a doctor's office. If your doctor's office hasn't explained this to you, let me do it for them.
You probably don't know how much time your doctor and their staff spend fighting with insurance companies for routine, ordinary things. The stories you see online might leave you thinking that these fights are, if not rare, maybe occasional. A sometimes sort of challenge.
It's every day. It's all day. Your doctor's office has employees who fight with insurance companies as a full time job.
This isn't an accident or a side effect of other market forces at work - this is the deliberate, calculated plan the insurance companies have chosen to implement. They know very well it is hurting patients and providers, and they're okay with that because their priority is to maximize ROI for investors and other stakeholders. They're in the business of business, and they don't give a single fuck about human beings or health care.
They've lowered reimbursements in primary care so effectively that primary care has only survived in many parts of the US by becoming a loss leader for larger health systems. You know how the local retail store gets you in the building by selling something at slightly below cost because they know you're likely to buy more once you're inside? It's like that, a loss leader.
The health system where you get your primary care often loses money when you see your PCP, but since your PCP refers you to speciality care inside their own organization, the system makes up the money when your doctor sends you to see their own systems' surgeons, endocrinologists, dermatologists, etc.
Smaller primary care practices literally can't survive. That's why there are almost no independent family doctors any longer. That's why it is so hard to see the same provider with consistency, someone with whom you can develop trust over time, who knows you and knows your challenges. United Healthcare and it's private healthcare insurance competitors have nearly finished killing off that kind of primary care.
Larger primary care practices (30-40 providers) might still be able to make ends meet independently through economies of scale and/or what they earn by doing their own lab/testing/imaging services in-house, but that won't work much longer if current trends continue. We're headed in the direction of just a handful of vertically integrated businesses running healthcare, and they are in the business of business, not health care.
The insurance companies deliberately create administrative barriers which make it expensive for your doctor's office to advocate for you because it moves administrative costs away from the insurance company and onto your doctor's office. This results in fewer paid claims when your doctor's office can't afford to hire another full time position whose only job is to argue with insurance companies and jump through their deliberately obstructive hoops. They want your PCP to be struggling to stay open. They want your PCP unable to afford the cost of overcoming the administrative burdens they have deliberately created for the purpose of denying you the health care your doctor thinks you need.
There are other words for this, but the most appropriate one is "evil."
I don't want to glorify murder or lionize Luigi Mangione, but Brian Thompson was a ghoul, his senior team are ghouls, and the for-profit health insurance industry is a disaster for Americans, even those Americans who don't yet see the problem affecting themselves. They will.
We need universal, single-payer health coverage, just like every other wealthy nation.
We're not going to get it any time soon, and things are about to get worse for healthcare in the US.
Set aside the damage RFK Jr is likely to do to an already patchwork public health system by attacking regulations and spreading misinformation. Let's look at other ways Trump and the GOP plan to worsen health care.
1. They're going to go after Medicare and Medicaid benefits. They'll seek to lower them and raise the bar which must be cleared to receive them.
2. They're going to seek to raise the age for social security benefits (above 70!), and reduce benefits paid, so the most financially vulnerable seniors will have greater out-of-pocket costs. Those seniors are going to struggle harder with out-of-pocket costs.
3. They're going to attempt to cripple the Affordable Care Act (AKA 'Obamacare'), despite the fact that the ACA has been a HUGE money maker for the private insurance companies.
4. This administration will be run by hyper capitalist billionaires. It will seek to deregulate wherever possible and promote supply-side economics (tax breaks for the rich and large corporations) at every opportunity. United Healthcare and its competitors, which already weild an obscene, horrific amount of control over US Healthcare, are about to get substantially more power.
It's bad, folks. It's a very bad time to be sick and it's going to get worse.
Alan Grayson was right in 2009. The Republican health care plan has been and remains:
* If you do get sick, die quickly.
