[scrubs]

Here and in taxes complexity is a problem. Any chem Eng or Drucker/Ishikawa/Deming person will want to simplify.

Second, and as a commentor here reminds, patients are often on the line for money (accountability) when the axis of control (the other side of same coin) is between the hospital and insurer.

Every time accountability is separated from control you've get big problems, and incentives to do the wrong thing.

Variations include providers over billing, billing wrong procedure etc. or denying claims on the other side.

All that stuff is done electronically between the provider and insurer (an axis of control) without the insured ever even knowing. Thus bad providers see the patient's policy like a wallet found on the ground.

Contrast with most commercial transactions: the service provider has no/none/zero access to any customer money directly or indirectly. All the provider can do is bill the customer (with an itemized bill). This way the customer decides if they part with money instead of the provider helping themselves to money.

I could add my own horror stories .. but will not waste your time.

I would love to see in the next 20 years,

- accurate itemized bills from hospitals/providers

- bills submitted to patients and only patients. Provider access to patient's insurance cutoff.

- patients if they agree electronically submit to their insurance giving them incentive to not commit fraud and use their benefits smartly

- providers and insurers who mostly work between each other put the insured in the center of the picture

- which requires providers and insurers to simplify and bring their business practice more in line with everybody else.

Yes, health care billing is more complicated than buying a car or upgrading your bathroom, but I harbor the suspicion that patients can do a lot more and insurance people act like it's impenetrable through self inflicted and self injected complexity.

[monkburger]

The angle I would love to hear is that these people denying medical care are not culpable for the consequences. If I don’t order a test/surgery/whatever and the patient is harmed, I may face civil or criminal liability. But if the insurer refuses to authorize care (which, in practice, means the care doesn’t happen) and the patient suffers harm they have no recourse. The argument is that the insurance company isn’t making a medical decision - you can still get the surgery your doctor recommended, we just won’t pay for it! - although in practice their decision /does/ dictates care.

So if they are making medical decisions, why aren’t they liable for the consequences? Sometimes the “peer” denying care doesn’t even have a medical license!

[scrubs]

Decent point. Here again the goal is to align accountability with control, which has got to be management 101.