Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies.
They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight.
Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies
We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient.
This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country
The often repeated slogan ‘healthcare is a human right’ misses the point. Caring for your health begins as a moral and personal obligation.
A society also functions better when its population is healthy, so there is a clear collective interest. How we deliver care is a blend of personal choice and what creates the most stable outcomes for the public.
The difficulty is that when someone cannot meet their obligation to maintain their own health the cost of sustaining that care becomes extraordinarily high. The burden shifts to the system in ways that strain everyone else.
There are responsibilities on both sides. Society supports a workable structure. Individuals engage in their own health to keep that structure viable.
When the argument is framed as healthcare being a right and health itself being a right it erases the personal responsibility that keeps the system functioning. The result is a model that becomes expensive, inefficient, and increasingly detached from the choices that actually improve health.
How is @Disney, the supposedly family friendly streaming network, gonna have a standup comedy special advertised with a bad word spelled out as an ad on chromecast? They know kids can read, right?