Lawyers, Doctors and C-Level corporate types are the only people who "win" in the insurance game. (unless your a manager and you enjoy making peoples lives difficult, then every time you deny someone you get a cookie.)

Doctors often lose with insurance.

They still get paid. Either out of your own pocket, or by the insurance, or a lien against your injury. That sounds like a win to me.

It really isn't. They have to do various unpleasant things to qualify for the insurance, and they often can't practice the way they want to.

Plus, if the insurance company won't cover something that is medically necessary the doctor is in a bind. If they don't recommend it, they can be sued for malpractice, but the person is being told by a bunch of non-doctors that they don't need it.

Modern insurance is hell for most doctors. Whether or not it is profitable, it is certainly stressful and unpleasant. Many people are less interested in becoming doctors because of the current state of insurance.

The insurance game is big and has many broken pieces. There's also useful pieces. In the absence of regulation, however, they tend to be occluded by the crappy parts.

D'A

I suppose it's their own fault for choosing such a nasty occupation.
Do you really think they didn't know that after years of medical school, they wouldn't have to deal with these issues?
Also much of the unpleasant stuff is done by non-doctors who specialize processing the claims, sometimes even receiving a percentage of the amount paid to the medical group, or doctor for their "hardwork".
When was the last time you saw a doctor actually filling out a claim form, with billing codes, and requested payment?
They ultimately know what their doing, that's why they are paid so well overall.

If a doctor doesn't wish to deal with the insurance companies they do not have to. They can choose to be paid directly by their patients, or even refuse their services to a patient based on their insurance coverage, or provider and even medical status.

a) Not all doctors did know this would happen. When my father started working, it usually didn't work this way. Plus not all med students are necessarily told how awful the field actually is in many cases.

b) Of course they can refuse to accept insurance. But that severely limits their patient pool. Plus, it sucks to have to deny good care to people. However, if you accept a patient who has insurance, you usually have to give them inferior care based on what their insurance thinks is okay, which also sucks.

Almost anyway you look at it the patient loses.
Which is more or less my point to all this.

When the care rendered is inappropriate who is ultimately responsible?

The only way med students would not know about the awful state of things is if they've never been to a doctor themselves, or claim blind ignorance.

By "limiting" their patient pool, they make less money.
By not limiting their patient pool, they make more money.
We certainly have no shortage of sick people being treated by those willing to jump through hoops to get paid well.

And further, those patients won't get better care elsewhere. Blaming doctors for the health insurance mess in the US is dumb.

D'A

No... most people only know how their insurance works, not how insurance can work. It's not reasonable to expect doctors to be experts in insurance.

And yes, I agree that every which way the patient loses. I'm just saying that in most cases the doctors don't win either.

I didn't say anything about better care.
I don't just blame the doctors, hence the title of my claim.
If the doctors really wanted to change things they have more power to do such than me, or an insurance company. There is more doctors, than insurance companies. ( i dont know about lawyers to doctors) Maybe they should form a union? They've just become complacent in their practices, and seem unwilling to change things.

What's the point of knowing how something "can work" if it doesn't work properly anyway.
Even if people knew how insurance can work, they would still think it's corrupt by the amount of profit it sustains had they known this information.

$.66 of every $1 spent on premiums is profit to most insurance companies. By fighting with doctors and lawyers, they can squeeze every last penny out of everyone for their own pocket.

Lawyers blame the doctors, who blame the insurance companies, who blame the lawyers. Rinse Repeat.

I have a personal friendship with a doctor who has practiced for about 15 years now. She is not "living large" off insurance. Most of the health care money does not go to the doctors. They often have to wait weeks -- if not months -- for the money they do get from the insurance company.

Most of the money is going to these healthcare organizations who are run as a for-profit company. This is very different than the world we lived in 20 years ago where most healthcare was not for-profit.

When you are for-profit, do you think your interests are with the patient or with how you can make the most money?

Doctors are for-profit, how else could they afford a Mercedes Benz, or pay off student loans?