I wish it were that simple. Almost since its inception, Medicare (the closest thing to a single-payer universal health insurance that America has) has faced a projected shortfall and eventual insolvency, which some project to occur as soon as 2026 (source: https://crsreports.congress.gov/product/pdf/R/R43122). The real problem (in my opinion) is the fee-for-service (FFS) model, which guarantees payments to physicians & pharmacies regardless of treatment outcome, efficacy, or patient satisfaction. A results-based healthcare model was originally part of the Affordable Care Act, but unsurprisingly, the American Medical Association and pharmaceutical companies lobbied heavily against it, and it was eliminated from the bill almost immediately.
Plainly put, there's too much money to be made from keeping people sick, and not enough profit in helping people stay healthy. As a popular saying going around on social media states, "To understand a problem in America, don't look at who suffers from it - look at who profits from it."
I'm thrilled to hear about success stories such as this one, and applaud Claimable's noble mission & fascinating approach to helping patients obtain the benefits they deserve, but the root problem is that we have a healthcare system that rewards the management of illness and disincentives true cures. At nearly $600/month for RA medication, if a cure emerged tomorrow, it would be doomed at any price point. Either patients would be unable to afford it, or it would make less profit compared to the current methods and thus stand no chance of out-maneuvering the combined political & marketing might of those invested in perpetuating them.
It's tempting to say the system is broken, but that's not the truth. It's doing exactly what it was designed to do - maximize profits at the expense of those who are suffering. 😓
Not sure why no one understands no doctor ever read this woman’s case. A nurse or you hope it’s a nurse types up a summary that could be a couple of sentences long from a medical record. Example: 60 year old with pain in her hands. Pmhx: arthritis. v/s wnl. Physical: n/a lab wnl xray: arthritic changes in hands. Plan: med prescribed . Pain : controlled . . Medical necessity not met due to IQ general medical or escalated to for medical director diagnosis on escalation list. No doctor ever read the chart .
Now we have AI on behalf of patients against AI on behalf of insurers. Why not simply the mess and pass single-payer universal health insurance.
I wish it were that simple. Almost since its inception, Medicare (the closest thing to a single-payer universal health insurance that America has) has faced a projected shortfall and eventual insolvency, which some project to occur as soon as 2026 (source: https://crsreports.congress.gov/product/pdf/R/R43122). The real problem (in my opinion) is the fee-for-service (FFS) model, which guarantees payments to physicians & pharmacies regardless of treatment outcome, efficacy, or patient satisfaction. A results-based healthcare model was originally part of the Affordable Care Act, but unsurprisingly, the American Medical Association and pharmaceutical companies lobbied heavily against it, and it was eliminated from the bill almost immediately.
Plainly put, there's too much money to be made from keeping people sick, and not enough profit in helping people stay healthy. As a popular saying going around on social media states, "To understand a problem in America, don't look at who suffers from it - look at who profits from it."
I'm thrilled to hear about success stories such as this one, and applaud Claimable's noble mission & fascinating approach to helping patients obtain the benefits they deserve, but the root problem is that we have a healthcare system that rewards the management of illness and disincentives true cures. At nearly $600/month for RA medication, if a cure emerged tomorrow, it would be doomed at any price point. Either patients would be unable to afford it, or it would make less profit compared to the current methods and thus stand no chance of out-maneuvering the combined political & marketing might of those invested in perpetuating them.
It's tempting to say the system is broken, but that's not the truth. It's doing exactly what it was designed to do - maximize profits at the expense of those who are suffering. 😓
Well said, Alan
Not sure why no one understands no doctor ever read this woman’s case. A nurse or you hope it’s a nurse types up a summary that could be a couple of sentences long from a medical record. Example: 60 year old with pain in her hands. Pmhx: arthritis. v/s wnl. Physical: n/a lab wnl xray: arthritic changes in hands. Plan: med prescribed . Pain : controlled . . Medical necessity not met due to IQ general medical or escalated to for medical director diagnosis on escalation list. No doctor ever read the chart .