Here's All the Ways U.S. Healthcare Sucks & How we can Fix it
Watch on YouTube: https://youtu.be/GBiq_q5tgbY
A Gallup poll from November 2024 found that America’s satisfaction with their healthcare is at a 24-year low, and their unhappiness with their health insurance coverage is even worse. This data was assembled right before a certain shadowy figure did his Luigi-ing, and I imagine if we polled people now, those numbers would probably be even worse.
So what gives? Why is it all so bad? And how do we stop the madness? Let’s break it all down.
I’m Kevin Lankes, and I’m your host for the slow, suffocating collapse of the healthcare industry.
I had a recent hospital stay in the fall due to some pretty freaky perfect storm scenario. There’s a giant number on my billing summary that keeps ticking down as the insurance agrees to pay more of it. But there’s still about $42,000 left to go, and the billing details tell me I could be responsible for that if Aetna decides they aren’t going to pay it. They’ve already declined to pay about $2,000 of the total so far, which, you know, why even have insurance at all then?
Just to be clear, so that we’re all on the same page, there is no physical or even metaphysical way it would be possible for me to give $42,000 to anyone for any reason right now. Why do you think I’m doing YouTube, Aetna? This is a hail Mary. I’m broke. It’s the last stop before I just walk into the sea. Turns out there is a step below yoga teacher after all.
The thing is, this kind of perfect storm scenario can happen to anyone at any time. I’ve also had cancer during my lifetime and had to deal with hospitals and health insurance while going through every heart wrenching thing that came along with that. I’ve had enough perfect storms for all of us at this point so if someone else could have the next one, that would be really great.
Honestly, it’s best to go through life without having anything happening to you. Try to manage that, if you can. And that's a funny joke, I don't mean that you should just avoid things that might have serious negative health impacts going forward. Because too many people do that already. The Federal Reserve states that in 2023, 27% of Americans avoided going to the doctor even though they needed to because they couldn’t afford it. And KFF tells us that 60% of uninsured Americans say they’ve avoided care when they needed it. Don’t play these games with your life. We’ll get through it.
Sometimes you have to get help. Sometimes you don’t even have a choice. Maybe you’re unconscious and you just wake up in the ER much like the 2.8 million people who were admitted to critical care from the ER in 2024. Or you do eventually take yourself there because of how serious an injury or sickness becomes, like the 40 million people who visited with those circumstances last year. This kind of morbid calculation of figuring out if you can go get treatment or not is done millions of times a day everywhere across America. Here’s a Reddit thread from a couple years ago that showcases just one person’s extreme dilemma. And there are countless more on forums everywhere across the web, because people genuinely feel trapped and helpless, and don't have anyone to turn to for help except random strangers on the internet.
Part of the problem is access to care. Even though we spend roughly double the average of other wealthy countries on healthcare each year, the U.S. has one of the lowest ratios of doctors and hospital beds per 1,000 people. Close to a third of all Americans don’t have access to primary medical care at all. And of those who do, many can’t afford it or as we’ve already seen, choose to go without. But there is a threshold for most people that when crossed, they’ll get medical care if they really feel like they have to. And that’s kind of the worst part of health insurance.
Insurance companies only make money when people are not going to the doctor, or when they can deny coverage to people who are sick or hurt. In the latter case, they bank on these moments where human beings are in immense danger, and they’re scared, and they don’t have any option except to treat whatever’s gone wrong.
It is disgusting beyond description when real live people have to weigh the possibility of dying of a treatable illness against getting saddled with crippling medical debt from seeing a doctor. And, in the case that they do seek medical care, it could lead to negative health outcomes anyway. On top of countless studies about socio-economics and health outcomes, researchers from the American Cancer Society discovered last year that those with medical debt are not as healthy over their lifetimes as people without it. They experience more sick days, more mental health issues, and live about one year less than their peers.
The biggest issue with healthcare and health insurance nowadays is that the insurance conglomerates have a real stranglehold over everyday people, employers, medical providers, and the legislature. Like lots of other industries in America, we’ve let this one become too unmanageable, and we’ve allowed the companies to grow too big to fail.
That means they can do pretty much whatever they want without facing any consequences for it. If you watched my previous video on the history of health insurance then you know that we’ve gone from lowering the total cost of healthcare by allowing medical providers to take in stabilizing recurring revenue from people who access their care, to a completely captive system where that recurring contractual payment is not only mandatory and a finable offense to go without, but it steadily rises in cost every year, and covers less and less actual care over time. It used to be that employer-sponsored health plans were worth the price of putting up with a dead-end, soul-killing job you couldn’t wait to retire from, but nowadays they aren’t any better than marketplace plans. This is a very bad situation that we’ve allowed to fester.
Bad capitalism! Bad!
We’ve created a system where there’s no way to win. Providers are super expensive, too. We pay $7,500 per capita to healthcare providers, whereas other countries might pay under $3,000. Even though a lot of hospitals are technically nonprofits, they spend a ton in order to aggressively court patients by building new state of the art facilities and securing the latest tech and equipment. And, of course, by giving obscene piles of gold to their leadership teams.
And both hospitals and insurers have each other by the throats. People get stuck with huge hospital bills even though insurance companies are supposed to negotiate, but they don’t have the leverage to do that anymore, because the real leverage they have is to kick a provider out of their network altogether, and if they do that, it’s regular people who suffer. Either way, it’s the patients who get screwed.
Along with everything else, we’re facing an ever-increasing rate of denials for coverage. Because again, insurance only makes money if it doesn’t pay out. So companies have been coming up with new and novel ways to deny people healthcare coverage. Which is a really morally obsene game to be playing when we’re dealing with people’s lives.
Medicare Advantage, which for some reason is a privately run option for Medicare patients, has been the subject of a report by the Senate Permanent Subcommittee on Investigations. The subcommittee found that denial rates went up from 10.9% to 22.7% in just two years, from 2020 to 2022. They stated in their findings that insurers “are using prior authorization to protect billions in profits while forcing vulnerable patients into impossible choices.” The actual American Senate said that.
Let's not forget how the coolest tech in town is also serving insurance executives their bonuses on a silver platter. UnitedHealthcare, the company in the news for the public execution of their CEO Brian Thompson, recently acquired a company called navihealth that implemented a predictive AI into their approval process.
UnitedHealthcare already had the highest denial rate in the industry before the AI came on board, but to no one's surprise, the AI’s denial rate shot up to 16 times higher than what's expected, and was also found to have a 90% error rate when denying claims. One man with a broken back was allegedly kicked out of his nursing home when the algorithm decided he was cut off from coverage, and without access to vital care he died four days later. The algorithm is now the subject of a class-action lawsuit.
Denials are one thing, but prior authorization--well, that’s a rabid leprechaun full of bath salts. It used to be a moderately reasonable thing for insurers to do in response to cutting-edge medical procedures and technological innovations. They’d find out more information about the requested procedure because all new things in medicine are wildly expensive, and they’d figure out if they wanted to cover it. Now, it’s slithered its way into mainstream care and insurers can use it for whatever they want. All in the name of reducing costs for themselves.
Everybody hates this shit from patients to the actual medical professionals. An American Medical Association survey from last year reported that 78% of doctors had to delay necessary care for a patient due to prior-authorization requirements, and that delay caused the patient to experience a “serious adverse event.” What, like, they had to attend a performance of TK?
This garbage process is expensive, too. Not only does it create insane amounts of stress for patients and families, it causes situations like we faced in 2021 where health insurance companies, along with Medicare and Medicaid, spent $925 per capita on administration costs alone. Studies show that other countries spend just $245 per capita. And this number doesn’t even take into account the time and money that doctors waste just dealing with their own admin hassles in response to this prior authorization bullshit.
There are no consequences for insurance companies. The only backlash they face occurs in the court of public opinion. And since the court of public opinion really has no sway, and can’t materially harm gigantic insurance agencies, because people have to be insured if they want the best shot at you know, being alive, we all just count on the sole motivator of shame for pulling health insurance executives back from the brink. I think that we should have a better system where the thin veil of shame isn’t the only way to keep predatory practices at bay. Maybe some laws and things would be good, I don’t know. But sure, every now and then, shame has been enough.
Like the uproar we just saw from the latest anasthesia disaster designed by Anthem Blue Cross Blue Shield.
The company unveiled a fun new policy in November of last year where they weren’t going to pay for anasthetia during surgical procedures if the procedure lasts longer than a set amount of time. Of course those time limits would be determined by them, the insurance company, though they claimed they were simply following guidelines set forth by the Centers for Medicare and Medicaid Services, but some of the peeps who worked there were like, nah, that’s not on us. So if your doctor finds something that needs to be addressed or just takes a little longer that day due to a number or reasons, maybe they’re just trying to be careful and not rush, or if there are complications, or whatever, I guess you just need to have a family member nearby who can step in and stop the doctor and wake you up so you don’t have to drown in medical debt.
Billion dollar medical industrial complex idea. Maybe we can just install a zipper in everybody so we can save in surgery. Just zip me down and filp whatever switches inside you need to (what, you guys don’t have switches?) fluff my pillow feathers or whatever, and then zip me right back up. Done and done. No incisions, no stitches, just savings. I have just become a biotech billionaire. I will use my powers for good.
I firmly believe that insurers would push for more unbelievably inhumane solutions like that before they ever gave an inch on their ever-growing profit margins. The opposition to this batshit insane new policy actually had bipartisan support and it came from governors, congress, state officials, anasthesiologists, and well, pretty much everybody. I think my dog was even pissed about it. So sure, every now and then shame works, when a policy is just completely nuts and comes directly from the main office in the mountain volcano lair. But we shouldn’t have to count on that as our only defense against these predators.
Again, if you’ve watched my previous video about the history of health insurance, then we know where health insurance came from and why. We now also know just how monstrous and frankly stupid the current system is. And now that we all feel like just walking into the sea, what can we possibly do about any of it?
In your personal medical existence you can appeal claim denials. Surprisingly, it’s been shown to actually work a majority of the time. The data we have comes from Medicare Advantage plans, where appeals work 80% of the time. Nine out of ten people don’t do it because it’s burdensome and complicated and it’s hard to figure out where to even start. But doing a bit of legwork here could save you a lot of money and trouble going forward. Just think if everyone did that.
Another thing you can do is negotiate. Don’t be afraid to start making deals like Darth Vader in Cloud City. It may sound ridiculous to modern ears, but most things really are still negotiable. Get your best pioneer racoon hat and start haggling and bartering for deer hides in the winter time. Say you’ll pay a big chunk up front right now in exchange for an aggressive discount on the overall total. Or tell them you can put down five bucks and month, and that’s what you can do. If they don’t like it, tell them your personal AI algorithm denied their billing request.
Before you do that, though, make sure to carefully read over every bill you get. Look through all the explanations of benefits. Make sure that everything is actually correct. Studies done over the years have found that medical bills can come with errors attached. Estimates of error frequency go from 49% to 80%.
In some cities and states there are programs available for people to take advantage of. In New York City, for example, you can call to set up an appointment with an NYC Health + Hospitals financial counselor who can walk you through your options to deal with medical debt.
I’ve probably said this in every single episode I think so far but the very best thing you can do is vote for the candidates who actually want to help. Yes, you have to research their policies to find out who they are, because there’s a ton of noise out there. Yes, you’re going to have to vote in down ballot races to get some of those candidates to the top of the ticket someday because it does look like a lot of the current politically relevant candidates for top spots are very much in bed with the insurance companies. It’s going to take time to change that. We are all too comfortable. Sitting around and watching another episode of America’s Got Syphillis or whatever isn’t going to change shit. Volunteer, organize, and advocate. We’ve had some really cool policies take effect in the last couple years like keeping repaid medical debt off of credit reports, but there’s so much more that can be done.
Let’s get out there and make a difference in the healthcare sector and reign in medical costs and insurance company profits. Let’s do some f*cking good about health insurance in America.
Okay, so fun update, that $42,000 on my online billing summary from the hospital just disappeared one day recently. It’s just gone. I have no idea where it went or why, and if I’ll eventually see it again and have to pay it, I don’t know anything because no one has said a word at all about it. I guess maybe I could turn out to be really, really lucky and the hospital has just written it off, which they sometimes do for massive outstanding bills that have no hope of ever being paid. I don’t know. Maybe I’ll never know. And maybe I’ll know next week when two nihilists with a ferret come over to pee on my rug. (we believe in nothing clip) Medical coverage in America is just one of those unknowable mysteries like what happened before the Big Bang, and why anyone is even licking a tootsie pop in the first place, bro, put the whole thing in your mouth. What, are you savoring this thing until like 2051? Eat it, it’s candy. It’s delicious. It’s a tootsie roll inside of hard candy!
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