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They’re in a terrible position. We outsourced the rationing of health care to insurance companies because hospitals in the USA are not allowed to turn down patients. I’m sympathetic to the anger, but in my view it’s misdirected as the insurance companies aren’t the ones lying. The rest of the system is. The hospital isn’t going to refuse care, it makes them feel icky and uncomfortable. The government won’t explain to people that it’s simply impossible to give gold plated treatments to 300 million Americans many of whom have other conditions that might well take them out in a couple of years. All of the false promises of infinite care are fake and always have been. We just somehow accidentally ended up with a solution that allows hospitals and the government to heavily imply that there’s capacity in the system for everybody to get whatever they need, and very importantly to not be the people the public is mad at.
Well, we've ended up with a solution via the regulatory state and judicial activism for everyone in elected office except the President to not be the people the public is mad at, so this isn't out of character for Congress at all.
Sometimes the resource allocation decision maker is definitely hospitals or the medical system, like triage and organ donation lists. But the medical system only likes to make decisions like that when it's about scarce medical resources, like livers, lungs, or beds. It hates the idea of making decisions based on scarce monetary resources -- that's not their side of the counter.
I recall during the Obamacare debates, much hay was made over "government death panels," the scary spooky term for making decisions about limited resources using government authority in some cases. My personal view on this has always been that someone has to make these difficult decisions. The medical system doesn't want, and probably shouldn't want, to make monetary decisions for patients. So someone has to do it, and either it's got to be the patient/patient's family (who is rarely a rational economic actor because the most expensive decisions involve literal life or death), or it's got to be the government, or it's got to be some non-governmental organization with fat pockets, usually a corporation.
There's a throughline in American politics where either you end up believing corporations are worse than government, or you believe government is worse than corporations. Everyone instantly knows which political party is associated with which. And for what it's worth, the US's third parties are essentially just more intense versions of the corresponding mainstream party on this measure! (With the Trumpian realignment, we may be creeping towards a point where the parties swap places here.)
I guess if you decide both are bad you end up an anarchist. But I have no idea what you become if you decide both government and corporations aren't that bad. Is this neoliberalism?
Fraud in general is a method of resource allocation; giving you a half pound of flour when you paid for a pound allocates more resources to the seller. If the seller is financially in trouble, the fraud may actually be keeping his business profitable. Yet this doesn't make fraud fine.
Deliberately or recklessly denying valid claims allocates resources, but is still a form of fraud.
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I mean this is how power works. When you hear “should group X be making the decisions” what it tends to mean is “group X shouldn’t be held accountable to the public for making those decisions.” That’s why “shouldn’t be political” is a red flag in my mind. It’s a decision to be made by someone, and that decision will be made. But “not politics” generally should be translated “by people with the power to make the decision, but who face no consequences or responsibility for it.” And generally, if you want terrible outcomes, that’s the best way to get them. When the government is not making the decisions about healthcare, it’s generally someone else who is, and as our system actually works, it’s a bunch of actuaries hidden in the bowls of a giant bureaucracy in a big insurance company who decided how to calculate a formula in excel. Does he face any consequences for the results? Not really, as long as the company makes money and doesn’t get sued.
Government should be involved in those kinds of decisions simply because the government is at least in theory accountable to the public interest. If people’s health care access gets bad enough, eventually the pitchforks come out.
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