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I hate to be so cynical, but I'll suggest an alternate thesis to the article: the American for-profit healthcare system is functioning exactly as designed. If you consider its primary goal being extraction of capital instead of taking care of people's health, everything that was confusing starts to make sense. > at least seven experts spent roughly ten full-time days trying to find out a basic fact about my mother’s insurance, and finally failed. Meanwhile, many thousands of dollars were wasted on unnecessary hospitalization. The money wasn't wasted -- the broken communication and intricate rule sets delay things for as long as possible, meanwhile the patient is charged, and someone is making a profit. > On day six, I said “if she doesn’t go to a SNF today, I’m taking her home—the risk of her dying there seems less now than the risk of her dying here.” That got results: the other SNF agreed to take her “on spec.” And here it is: when there was a credible threat that the money would stop flowing, the system acquiesced, insurmountable bureaucratic problems lifted. > Are the confused rules Anthem’s fault? I imagine that the 1600 pages try to reconcile federal, state, and local legislation, plus the rules of three federal regulatory agencies, nine state agencies, and fifteen local agencies. All those are vague and conflicting and constantly changing, but Anthem’s rule-writing department does their best. Here lies an opportunity to rip the spine out of the entire scam. Steal the rule books, leverage a LLM with RAG or other information retrieval architecture, and get answers in minutes, not days. Offer this as a service to (relatively) seamlessly slice through the obscure-by-design bureaucracies -- only of course to be hindered by the entrenched players and the politicians they have lobbied, who will fight tooth and nail to maintain the status quo. |