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Notes -
Having read through this whole thread, I wanted to say that I consider myself a strict capitalist in most things, but the whole industry of medical billing is so ridiculous for so many inscrutable reasons with everyone pointing fingers at each other that I find I'm unwilling to make any moral judgements at all for anything any particular patient chooses to do.
It is indeed pretty incredible that the situation is seen as ridiculous universally enough that the credit bureaus are now ignoring medical debt.
I don't know that I'm inclined or qualified to really defend any particular party in this mess. But I do notice that everyone seems to love to make the insurance companies the boogiemen. Aren't they all publicly traded though? If they're wildly profitable, can I invest in them and get some of that sweet healthcare cheat money? If not, well where's all the money going? What if they're just struggling to eke out some tiny profit while being constrained by an ever-changing maze of legislation and trying to juggle the conflicting demands of a dozen different groups, as the sole party with some responsibility to actually make the books balance somehow with the totality of everything that's going on?
Nothing about a market this regulated can really be described as capitalist. I don't understand how hard it is for people to draw the, to me, obvious line between level of regulation and dysfunction. Do people just think it's a coincidence that housing, medicine, schooling and banking are the industries everyone seems to constantly have problems with and costs seem absurd?
I agree, and that's why I don't consider the overall American healthcare market to be meaningfully capitalist from a consumer's viewpoint, and so in that case the morality of a capitalist system does not apply, in so far as owing the person doing a job for you a fair wage for the work that they performed.
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That's only if one believes that capitalism and regulation are somehow opposite to each other.
This so where the scope creep of what counts as "capitalism" makes the conversation impossible. The previous post seemed moderately in favor of "capitalism" so I interpreted as "relatively free markets". If we're going to switch to using the "cabal of capitalists control everything" then the response is "of course that's bad but it's never existed and no one would ever claim to be usually in favor of that".
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Everyone has an opinion about healthcare, almost nobody expressing this opinion has the slightest idea what's going on and that often includes people in healthcare, often this is downstream of politics (ex: docs foaming at the mouth at anti-vaxxers, or advocating for "socialized" healthcare without knowing what that means) or arrogance (the "medicine isn't hard or complicated" crowd you see here frequently).
Yes follow the money. Some high resource health systems are doing well, but many health systems are being bailed out or going under. Salaries are decreasing relative to inflation (or just overall), burnout is increasing and we've had a bunch of major major strikes/threats of strikes over poor pay and working conditions (like unsafe nursing staffing ratios). Meanwhile:
"The nation's largest insurers, UnitedHealth Group and Elevance Health, reported profits that were 28 percent and 7 percent higher than the same period last year, respectively. UnitedHealth raked in $5.3 billion, while Elevance took in $1.6 billion.
In contrast, some of the nation's largest health systems, HCA and Tenet, saw their profits fall dramatically compared to the third quarter of 2021. HCA reported $1.13 billion in profits, a decrease of 50 percent. Tenet took in $131 million, which is down 70 percent since last year."
Notably HCA and Tenet are both pretty evil companies (large for profit health systems) that will do WHATEVER to make a buck (and have been in legal trouble over it).
Medical billing isn't "ridiculous" okay well it is, but it makes sense and is a well defined system that a lot of people don't understand... but again people don't understand it but everyone is forced to interact and therefore has opinions. Providers become the punching bag for appropriate medical decisions patients don't understand and administrative/billing decisions that providers have zero control or influence over (having being pushed out of medical leadership and admin for decades, sometimes by complicated government mandate).
Speaking of which why is this shit so expensive? People like to blame salaries and labor shortages but that's a lack of understanding at best and jealousy at worst. Our population is getting less healthy (and other countries are catching up in costs as they become like us) and care is getting more complicated and expensive for good reasons. Additionally regulatory and administrative burden means lots of extra hands sucking at the teat. It's similar to academia (think professor to admin ratios, self-inflicted wounds like DEI staff etc).
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