Thread by @doctorow

The USPS will send you 4 covid tests free if you complete a form that asks for your name and address. This is @Cigna's reimbursement form. It's three pages long and must be completed, printed, and mailed or faxed (a process that involves inventing a time machine).

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A third of US health care spending is gobbled up by administrative costs, and that's only the part that gets paid for. Far more admin work is done for free, by patients.

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As Fipi Lele quipped: "after 3 months processing, Cigna will deny these via a 36 page letter that is mostly 'this page intentionally left blank' in 9 languages."

Former Cigna customer here, can confirm.

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Here's the Cigna form:

cigna.com/coronavirus/

Here's the USPS form:

special.usps.com/testkits

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Here's @davidcrosss's video for the @GravelInstitute, "Why America Sucks at Everything," in which he breaks down the incredibly high costs that Americans pay for incredibly poor health care.



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Every other high income nation spends less to get more. Even systems that have been gutted by right-wing pol, like @NHSuk, are far more efficient than the private health-care system (don't @ me unless you, like me, have more than a decade's personal experience with both)

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What's more, these state-run or state-administered services are waaaay less Soviet and bureaucratized than the "free market" system the US has produced. They have fewer lines, fewer forms, fewer administrators, fewer blank refusals of care by nonmedical bean-counters.

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They also ration less. Look at the comments under that Gravel Institute video, it's full of right-wing know-nothings saying, "What about all the rationing in foreign countries?"

Well, it's true, every health care system has some form of rationing, even if it's just triage.

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But as someone who with a decade+ under Ontario's OHIP, the NHS, and US private care, I can personally attest that under the US system, my doctor's recommended course of care is routinely vetoed by private insurers, and this was effectively unheard of in the UK and Canada.

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Even where the US system offered more care, it was clearly motivated by profit, not outcomes. When my wife got pregnant in LA, @CedarsSinai gobbled up all $10k in employer-provided prenatal care in the first trimester.

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We had batteries of tests, including full panels of genetic tests, and weekly visits to the hospital, etc. Having run out of money to continue the pregnancy, we moved back to the UK to have the baby on the NHS.

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Our GP took one look at my wife and said, "Right, you're pregnant, not sick. You don't need a doctor. Go home and the midwives will call on you twice a week, at your convenience, at home, before work if that's most convenient."

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For the remainder of the pregnancy, we were attended at home by two midwives, twice a week, who performed ultrasound, checked the progress of the pregnancy, etc. It was entirely free.

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Also, our total tax bill in the US the previous year was slightly higher than our total tax bill in the UK the next year - but in the UK, we got free health care, with twice weekly house-calls.

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Back in 2015, @davidgraeber (rest in power) blew my mind with his essay "The Utopia of Rules." Graeber pointed out that all the ills that had been ascribed to communism during the Cold War were, in fact, endemic to late-stage capitalism.

memex.craphound.com/2015/02/02/dav…

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We were told that capitalism was better than communism because under communism, everyone stood in lines, filled in interminable forms, and could only shop at one store that had the same things all the time.

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Fast forward to today, and insurance companies, private companies that contract to provide public services (like welfare and medicare), etc, have created a paperwork tsnuami that even Stalin might have balked at.

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I remember visiting my family in Leningrad in 1984, and seeing the many manifestations of bureaucracy there, and even by those standards, the EULA you have to agree to just to play World of Warcraft is so extreme it might as well be a parody.

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To be alive and online under capitalism is to click "I agree" to a thousand forms a day, in a funhouse mirror version of consent and contract. When you're signing your rights away, you just need to scroll to the end and click "I agree."

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It's the contractual equivalent of a one-party state election with only one box to tick on every ballot.

But when this paper-chase is supposed to confer benefits to you, the process has an infinitude of hurdles.

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You can sign up for the @nytimes with three clicks, but to unsubscribe you have to phone a customer service number, wait on hold, and then justify your decision to cancel.

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Or, you know, go back to Cigna's reimbursement form, which you have to mail or fax.

FAX!

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It is blindingly obvious that this is not more efficient for Cigna. There's no way that paying someone to key in reimbursement orders from paper forms is cheaper than just capturing that info via a web-form.

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The mail-or-fax requirement in obviously inefficient, and not just because of labor costs and data-entry errors:

* A certain percentage will go missing;

* #HIPAA compliance means treating all this paperwork like nuclear waste, ensuring its secure handling and disposal

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There's no conceivable GOOD reason to require paper form submission, not even "We need to serve patients who don't have computers." To get the form, you have to download and print a PDF - they're ALREADY excluding those patients.

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But there's an obvious BAD reason to do this: many patients will not print, complete and mail (or fax, I suppose) these forms, which means they will not get the money that Cigna owes them (also, Cigna can plausibly claim not to have received some of these forms).

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Cigna can ration care, in other words - you know, the thing that state health care is supposed to do, and private healthcare is not?

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Graeber was really onto something.

Here in late-stage capitalism. our retail has collapsed into the same global chains - walking down a retail strip or visiting a mall is like being in one of those Flintstones loops where the same background repeats and repeats.

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We stand in line. Oh god, do we stand in line. Not just poor people waiting for food banks, either - the relatively affluent visitors to an airport are told that they should leave THREE HOURS to complete check-in and security.

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And our health care is rationed. We pay a lot more and get a lot less than our foreign counterparts with state-managed health care. The most Soviet institutions in America are private health insurers.

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Every sin attributed to public health care is actually committed by private health care bureaucracies. These are top-heavy, focused on hitting nonsensical benchmarks, and riddled with red-tape that can threaten patients' very lives.

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They are wedded to outmoded technology (fax machines! Seriously, FUCKING FAX MACHINES!), and the MORE they are exposed to markets, the worse they get - private equity rollups of the health system supply chain have been attended by idiotic procurements and expensive errors.

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Health care isn't disciplined by the market: patients and health care workers are. Every one of these costs is externalized onto the productive workforce (doctors, nurses, etc - but not paper-pushers and execs) and the patients who rely on the service.

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Remember: the 1/3 administration overhead stat for health care doesn't include the admin costs borne by patients. You and I are the ones who have to fill in that Soviet-style reimbursement form for our covid tests - we are conscripted as unpaid medical admin support.

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The private sector is efficient at producing profit, but not at productivity itself. Left to its own, the private sector merges to monopoly, suborns its regulators, corrupts our political process, and serves its investors - everything else is incidental.

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A system's purpose is what it does. The US health care system produces incredible profits: up 41% in 2020, to $31 billion (!!), but it does not produce incredible health care. It produces exploited docs and nurses and sick patients and so. much. paperwork.

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American private care has tremendous margins that it could use to streamline its processes, improve its working conditions, and improve patient outcomes. Those margins are instead diverted to dividends and stock buybacks.

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The system IS disciplined by the market, but not in the way that we want it to be. A health care entity that took from its shareholders in order to give to its patients and workers would soon find itself with a new management team and a new set of priorities.

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Here is Graeber's thesis again - that the sins of the Soviet Union are the sins of late-stage capitalism. What could be more Potemkin than all the simps for US health care braying about "choice" and "rationing" and so on, even as they pay more to get less?

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What greater triumph of brainwashing than a population who will fill in that Cigna form and fax (!!!) it to a data-entry center while extolling the efficiencies of the market and cracking snide about the bureaucratic molasses of the USPS, with its ten-second online form?

eof/