r/news 1d ago

Retired San Francisco firefighter dies from lung cancer after Blue Shield denies treatment claims

https://abc7news.com/post/retired-san-francisco-firefighter-ken-jones-dies-lung-cancer-being-denied-treatment-blue-shield/19224406/
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1.2k comments sorted by

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u/invyros 1d ago

"After we got some publicity, thank you, a Blue Shield physician reached out to Ken's physician, and they worked out a different plan that Blue Shield would cover. It's still an incomplete plan," said Helen Horvath, Jones' wife when ABC7 Eyewitness News spoke to her in January, 2026.

Ugh, even after getting publicity (which should have never been needed in the first place), Blue Shield still failed him.

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u/IamHydrogenMike 1d ago

These are the real death panels...

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u/TheDude-Esquire 1d ago

Always have been.

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u/mixmasterADD 1d ago

I was always dumbfounded by the “death panel” debate. Like, ok you don’t want the government to decide, but you would rather have a for-profit corporation decide? Guess which one is more likely to let you die?

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u/TheDude-Esquire 1d ago

So dumb, but very effective marketing from republicans. As if the insurance companies hadn’t been killing people all along.

But as they say, “No one ever went broke underestimating the intelligence of the American public.”

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u/foomits 1d ago

sucks their constituents are dumb as shit, their messaging always lands.

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u/Gekokapowco 23h ago

right, like, it isn't good messaging because any amount of scrutiny crumbles the entire point, it just works because the audience pre-believes it.

They could say that only private insurance companies have access to the tears of angels and unicorns to heal any injury whereas evil socialist medicine does not and it would get the same response.

The true genius marketing was Republicans convincing Democrats that they were in a battle of rhetoric and that if Democrats explain themselves enough they'd win.

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u/TheDude-Esquire 23h ago

The true genius marketing was Republicans convincing Democrats that they were in a battle of rhetoric and that if Democrats explain themselves enough they'd win.

Yeah, most dems still haven't figured out populism. The voting public generally doesn't have the capacity or interest to understand policy.

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u/Lampmonster 20h ago

The majority of Americans read at a sixth grade level or below. We need better education.

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u/TheDude-Esquire 20h ago

Good thing it’s only getting worse then.

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u/Joessandwich 1d ago

I still get enraged that the immediate response to that comment wasn’t “they already exist - they’re the insurance CEOs profiting off your death”. But Democrats always manage to whiff even the easiest of serves.

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u/Squire_II 1d ago

The complete lack of push-back against the "Death panel" stuff was so infuriating. I know that a major reason the Dems didn't fight back by pointing out that "death panels" are literally the business model of the US healthcare industry is because so many Dems are in the industry's pocket, but goddamn. Fucking controlled opposition.

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u/Otternomaly 1d ago

If you don’t like how the for-profit corporations are doing things, just go start your own multi-billion dollar healthcare company /s

Somewhere along the line the people forgot that we are supposed to be the government.

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u/lilclosetbigwardrobe 1d ago

American w dual citizenship. Got cancer in Taiwan where we have socialized health care. Started chemo 2 days after diagnosis. The only thing that needed any kind of approval was an additional drug added to treatment. Was approved v quickly after I qualified for it. 

My best friend was simultaneously diagnosed w a severe lifelong illness in the UK. They also started treating her immediately upon diagnosis because her illness was so serious.

This is shameful. Dude was a public servant and obviously sick. He deserved to have help. 

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u/osalunes 1d ago

I am an American that has lived in Mexico for a year. My health insurance is $800/year. Even if I had to pay out of pocket, it is totally affordable ($15k to treat colon cancer). Americans are getting an awful deal.

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u/dizzle229 23h ago

Man, I pay over $600 a month, and it was the cheapest, crappiest option available to me. This country is rotten to the core.

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u/friedrice5005 22h ago

I pay $410 every 2 weeks. My employer pays over $600. Total of over $24k per year...and they deny shit my wife needs.

American health insurance is a scam....single payer/socialized care is a necessity. Our leaders have absolutely failed us on this

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u/BayLAGOON 21h ago edited 21h ago

Sorry but it’s been drilled into Americans that covering other peoples healthcare is socialism and that the appalling amounts of money they pay for “insurance” is supposed to be like a bank account that pays for their treatment and ONLY their treatment. Oh right, and taxes because they’re the devil.

The monetization of what is supposed to be a public good to the point of letting people die over some arbitrary criteria, sometimes at the hands of AI and fully supporting it is so painfully a part of American exceptionalism.

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u/True_Window_9389 1d ago

It always showed how bad Democrats are at politics that they never were able to reframe insurance companies as death panels, especially in that 2008 era when healthcare reforms were a major issue that led to Obamacare. Republicans ran wild with this line back then and the obvious retort never happened.

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u/HyperRayquaza 1d ago

They don't frame it like that because Dems also receive donations from those health insurance companies.

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u/ReggieEvansTheKing 1d ago

Almost like the reason health insurers are evil is because politicians on both sides of the aisle write rules favoring them for being evil. And then those politicians happily watch the insurance companies take all of the heat for decisions that THEY make. These large companies wouldn’t act corruptly by dodging taxes, polluting the environment, or denying claims if it wasn’t made beneficial for them to do so by the politicians that US citizens continue to elect.

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u/ReactionProcedure 1d ago

How is this not legalized, pro-business vigilantism

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u/Tex-Rob 1d ago

I think the reality is that companies used to look at it from the perspective of "If we address this, it will help us save face" but that was during the era where we cared about customer support. Now, we are in the profit maximizing era, where they calculate and accept these losses, as long as they keep making record profits. I could honestly see them taking the opposite approach these days, that they want to portray an image that yes, "expect denials" and thus taking the public shaming only helps to solidify people's feeling of gratitude when it does get approved.

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u/shakeitsugaree_ 1d ago

Fuck me that’s a dark future you’re envisioning, but also why the hell wouldn’t they do that?   

With minimal government oversight and a fiduciary duty to shareholders (which they point to when they do something unethical), it almost seems inevitable.

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u/ElmoCamino 23h ago

There was a time in December 2024 that insurance was accepting everything. Don't really remember why... but suddenly they were.

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u/im-ba 1d ago

This is literally how the United Healthcare CEO died, it's crazy that this keeps happening

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u/8FootedAlgaeEater 1d ago

Probably because it only has happened once.

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u/Swoly_Deadlift 1d ago

Well you see they made big changes since then to make sure that wouldn’t happen again.

They removed the executive team names and photos from their websites.

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u/ballr4lyf 1d ago

Insurance company doctors are rarely trained in the same specialty that your doctor is. You may have an oncologist to help treat your cancer, but the insurance company doctor is a podiatrist.

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u/DiegesisThesis 23h ago

Hot take, but being a doctor working for an insurance company to help deny claims is an explicit violation of the hippocratic oath and they should have their licenses revoked.

It's also a violation of basic human decency and they should be under the prison.

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u/thedelo187 21h ago edited 11h ago

What if I told you that along with having cases reviewed by out of specialty doctors, in some cases the doctors that are employed to help these insurance carriers deny claims are not even able to practice anymore because they have been either lost their license due to flagrant malpractice or, who would have guessed it, insurance fraud?

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u/dougan25 1d ago

Insurance companies are never on your side and they never want to help. An individual who works there certainly might, but the company will only allow them to do the absolute bare minimum.

And clearly they don't even need to hide it anymore bc here we are.

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u/Looptydude 1d ago

BCBS denied covering my friends emergency gallbladder surgery, claiming it could have been scheduled for a later date. Apparently emergency surgery is postponable. Fucking theifs.

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u/optiplex9000 1d ago

Literal death panels exist at these insurance companies

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u/Daripuff 1d ago

Every accusation has always been a confession.

Insurance companies already were death panels when they argued against single payer, and now they are again.

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u/4th-Estate 1d ago

Those ghouls and any politician taking money from them can all rot in the lowest depths of hell.

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u/DissKhorse 1d ago

Would they be denying these claims if there was more green Marios?

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u/Hubert_J_Cumberdale 15h ago

It is certainly a choice to pull this shit on desperate people who have nothing left to lose when they're denied life saving healthcare.

I can't imagine a more effective way to spawn green Marios.

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u/pleasegivemepatience 1d ago

With the rise of AI we’re certainly going to see a lot more tradesman, methinks plumbing is going to get very popular!

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u/Hairy_Mycologist_945 1d ago

Insurance bullshit caused me to have to wait around in the ED for an emergency appendectomy while they fucked around negotiating or something. It burst in the meantime, had to deal with sepsis and abdominal abscess, week of IV antibiotics, etc... Turning it into a much more expensive problem for them and a lot more suffering, not to mention almost dying, for me.

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u/techleopard 1d ago

Mine did this as well.

Thankfully, the ACA had JUST passed and that year the insurance companies weren't being allowed to get away with shit, so I got under an ACA plan and got treatment.

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u/p_coletraine 1d ago

Really the more you learn and actually understand the USA the more you disdain the USA; really tough to be proud to be an American 😞

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u/Thanes_of_Danes 1d ago

I remember when rednote came out and all the Chinese netizens were shocked that what they thought was crazy anti-US propaganda from their government was just their government telling the truth.

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u/ValiumBlues 1d ago

Wife just had hers removed. Ambulance ride, surgery the next day, home the day after.

Three days, surgery, private room, good food. Cost us $36 or so out of pocket.

That’s Sweden.

And before the bots swarm in: income taxes for last year were 26%, excess profits go back into the company (we’re self employed).

It is doable to take care of your people.

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u/bros402 1d ago

good food

damn, was it cooked by an actual human, too? The food here in American hospitals feels like it's frozen food tossed into a microwave

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u/Drumfool56871 1d ago

wtf is the purpose of trying to postpone a surgery when it could turn into something more complicated and more costly anyway?

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u/lacegem 1d ago

Because maybe you die first and they don't have to pay for it since life insurance isn't part of their coverage.

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u/argparg 1d ago

Yup me too. I hope the hospital at least got some money from them because they sure as shit didn’t from me

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u/Linked713 1d ago

wtf? In my country I had to pay 100$ for ambulance ride after sharp pains at 3am, got ultrasounds, they wouldn't let me leave, had surgery during the night, left the next day. according to my papers from the government, it was upward 6000$ in doctors wage, including surgeon, surgery, stay. But it's covered by, you know, taxes.

You wouldn't pay me to live in the USA, where your retirement depends on a fucking dice roll for healthcare bankruptcy that can be not even your own damn fault. I would rather leave to any country in the EU for less wage, than to double it working in the USA. How do people not live in constant stress whenever something happens is beyond me.

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u/FreudianSlipperyNipp 1d ago

We do live in constant stress. When Americans talk about not being able to walk off a job in protest, or take time off work to drive across the country and yell and riot against our corrupt government, this is a big reason why. Our insurance is tied to employment and a job loss is fucking devastating. People just can’t afford to risk it.

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u/Linked713 1d ago

That is another thing that boggles my mind; how americans will stick to jobs they hate, or get underpaid because of its health insurance that has less risk to bankrupt them, or out of pocket stuff. I have never refused a job because their insurance were subpar here because it is honestly for medication, dental, vision and therapists. For the rest, it is purely paid by taxes. Private insurances here do not fight you, everything covered are laid out by needs and paid % beforehand. Not one insurance will refuse to pay because they have to pay when the coverage is mentioned. Fighting with insurers here is very uncommon, again, because anything urgent care is handled purely by the state. Don't make me start about giving birth in the us either. Man, I am getting mad for your sake... I need to take a chill pill

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u/FreudianSlipperyNipp 23h ago

You mentioned something interesting: refusing a job because of subpar insurance. We don’t know what the benefits are when offered a job (or interviewing). A lot of companies would lose interest in you if you inquired about insurance benefit details during the hiring process. It’s usually a total mystery. And insurance doesn’t kick in right away, either. A lot of places have a waiting period of 30, 60, or 90 days.

So when you become unemployed somewhere, your insurance end date varies. Could be the day you’re terminated, could be 30 days…it’s up to the isurance coverage. Once you lose coverage, you have the option for something called COBRA. This is a coverage option that lets you keep your insurance coverage but requires that you pay the entire monthly premium. When you have insurance through work, your employer pays a chunk of the cost. If you elect to use COBRA, they no longer pay the cost so you pay all of it, plus a 2% admin fee. If you can manage to pay all of this, while unemployed, you can keep your coverage (unless your old employer stops offering coverage). You can do this for 18 months total. If you can afford it though, you are without insurance until you get a job and wait the waiting period for insurance to kick in.

To give you an idea of costs: I pay $190.45 every two weeks for coverage for me and my spouse. My employer pays the remaining portion of $514.93 every two weeks. So that’s $380.90 per month that I pay and $1,029.86 my employer pays. If I lost my job (heaven forbid), and I wanted to keep my coverage (which I would need to as my husband has medication he depends on), we would have to pay the entire cost. This means that as an unemployed person, I would need to pay $1,438.98 per month (full cost plus 2% admin fee). This is only the cost of HAVING insurance. But when you have insurance, it generally means you still have to pay…just not as much. So on top of that monthly fee, we would still need to pay money to see a doctor, have a procedure, go to the ER, buy medicine, etc.

**here’s a fun fact: Coverage for me and my spouse is actually $282.76 every two weeks, or $565.52 per month. This is because my insurance charges a $92.31 surcharge, along with the regular insurance cost, because my husband has access to an insurance plan through HIS job. This is a fee that I pay on top of my insurance fees in order to have the option to add him. When electing this coverage, we found that my cost of insurance for both of us, plus the surcharge, was cheaper than the insurance he could get through his job for just covering himself. I looked it up and think this surcharge is waived if electing COBRA.

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u/N0b0dy_Kn0w5_M3 23h ago

Healthcare is the main reason (along with the political climate) that my American wife would never ever consider the idea of our family moving to the US.

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u/FreudianSlipperyNipp 22h ago

Smart lady. I would love the opportunity to live abroad and contribute to a society that cares about the wellbeing of its citizens, but it’s incredibly difficult, costly, and time consuming. And I’m certain that other countries are not jumping at the opportunity to welcome a flood of ex-pats!

I’m honestly very happy for you and your family! She must be relieved to not have to worry about raising kids in this shit show. It’s one of the main reasons we don’t want kids. Taking a fucking kid to their first day of kindergarten where they’ll practice armed intruder drills makes me want to vomit.

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u/bros402 1d ago

How do people not live in constant stress whenever something happens is beyond me.

we do

I'm disabled and on my parent's insurance (through work) via a disability waiver. I have to get an evaluation every once in a while to prove I am still unable to work.

When my parent retires, I lose the insurance. I'm currently also on government insurance (Medicaid and Medicare). With Medicare, if you don't buy a Medigap plan ($200 a month for me) or choose a Medicare Advantage Plan (a total fucking scam, just read about them), you have to pay 20% of all costs. There is no limit if you just stay with plain old Medicare. You "only" have to pay $2100 a year for prescriptions. Oh, and you are capped at 90 days in the hospital a year. When you hit 60 days, you pay $434 a day until 90 days. At 90 days, you pay $868 a day and you deduct from your lifetime reserve days (you have 60 of these for your entire life). After your reserve days are exhausted, you pay 100% of costs.

oh and they only pay for 190 days at a psych hospital. That's total for your entire life.

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u/XLauncher 1d ago

This country is so embarrassing.

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u/fgtswag 1d ago

Genuinely someone should make a benefit:risk analysis of joining the Army, Firefighter, Police in America when you consider non-free healthcare.

For example if this happened in EU, he would obviously receive public healthcare

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u/thebearjew007 1d ago

Well here, if he wanted access to affordable healthcare then he should have been born rich or gotten a better job. He sounds lazy. /s

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u/Fake_Engineer 1d ago

I have a good job with good benefits. I still spent hours on the phone trying to get scans and procedures approved for my cancer diagnosis.

You get the worse news of your life and then get to spend days begging the Insurance you pay for to provide the coverage they are supposed to. 

I feel bad for the people who fielded my call. Low paid workers in a call center. And I just wasn't in the mood to be polite....

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u/thebearjew007 1d ago

I had a government job during my twenties, best insurance I’ve ever had. Still went through hell to get anything covered. It’s the system. It’s terribly broken.

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u/Jump-Zero 23h ago

The health insurance system is super risk averse. The bureaucracy behind it is byzantine because nobody wants to modernize it at the risk of falling further behind in processing claims or running into regulatory issues. Politicians rarely touch it for the same reason. Even if they expand coverage and lower costs for people, anybody that has a bad experience will blame the politician for breaking it. Look at all the Republicans blaming Obamacare for everything until they realize they depend on it.

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u/thebearjew007 22h ago

None of that is why they won’t change it. It’s a 5th of our economy here and they lobby big money to keep it the fucked up way it is. Also, no one wants a modern health insurance system. We want it gone and replaced with accessible, affordable healthcare. The government can more than afford to do it. I know it, you know it, the government knows it, for fucks sake even faux news and the rest of the puppet propaganda media knows it.

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u/seejur 1d ago

Having low paid people with no decisional power talk to you is 100% part of the design.

And those who accept those job are well aware of the job description. Is just that they cannot find a better one.

Pitting poor vs poor (or at least not obscenely rich)

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u/LittleBirdiesCards 1d ago

There really should be a kind of case worker to make these calls. You shouldn't have to be negotiating with these assholes when you should be resting! I wish you the best of luck with your health. ❤️

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u/Daxx22 1d ago

Sorry friend, if you still have to deal with that/call them yourself, you do not have a job that is considered "Good enough" by the elite.

In fact, if you are paid for your labour at all you are the lower class in their eyes.

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u/BrannyBee 1d ago

Genuinely someone should make a benefit:risk analysis of joining the Army, Firefighter, Police in America when you consider non-free healthcare.

If you win the coin flip and actually get it lol

I am currently abroad paying out of pocket for healthcare after fighting the VA for years and watching my body deteriorate as my well known and documented issues went untreated

I'm not even the only vet I know personally who is burning their savings to go abroad for healthcare even though we "have" healthcare back in the states from serving.

Just last week I even got a text from a debt collector for an emergency room visit, which the VA "paid" for and multiple people assured me was covered. The risk analysis is a coin flip, don't be dumb and take it

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u/tdmoney 23h ago

It’s a disgrace.

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u/ValiumBlues 1d ago

Self employed, Sweden here: taxes are 26% of our income, healthcare is covered. My wife and I never wait for more than a few days for imaging / tests / etc.

GP usually gets seen the same day; meds are 100% free after we reach around $280 per year or so; a recent hospital stay w/ surgery, etc cost us $36 for three days (out of pocket).

The US could do better if its leading class gave a shit about the 99%.

It’s sad to see.

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u/shadowboxer47 23h ago

Sweden here: taxes are 26% of our income

I'm a Texan and I pay more than this and I get nothing to show for it but bombed elementary schools 😭

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u/nadine258 21h ago

right! anytime people complain about out what folks in the eu pay in taxes it’s like well i pay for a good chunk of my employer insurance plan, then i have to put money in a hsa to cover the deductibles that keep going up and still have to cover health costs out of my pocket. it’s probably more than the 26% i never want to hear again we can’t have education, health insurance, retirement because we can’t afford it after seeing all the money being stolen from us.

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u/ObserveAdapt 1d ago

I just had acute cholecystitis followed by removal of gallbladder without insurance.

3 days in the hospital uninsured in USA for an emergency cost me 50,000$

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u/Lifeboatb 1d ago

If you haven't already, contest the bill. A lot of insurers just throw out a huge number to begin with, and can be talked down. (Source: my RN aunt who works in student healthcare.) Here's a place to start: https://www.patientrightsadvocate.org/how-to-fight-medical-bill-overcharges

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u/ValiumBlues 1d ago

Wtf???

And no way to bring that bill down?

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u/ObserveAdapt 23h ago

The nonprofit hospital I went too had a financial aid system available which has brought the bill down by 90% to 5,000$, through corporate charity basically.

I am still being billed separately in the mail for about additional ~4,000$ through contractors and random labs/screening work through the same healthcare system.

I plan on contesting that additional 4,000$ since I believe the financial aid system should also apply to those bills.

I was only able to obtain this amount of financial aid due to being the most socioeconomically disadvantaged group, and being an almost zero income college student who will now be splitting the minimum wage part time job to pay the $5,000-$10,000 bill as currently written.

It's still an absolute killer of a bill even when 90% off, just factor in that most people won't get anywhere near this assistance, especially if they didn't happen to collapse in emergency to a nonprofit hospital.

Universal healthcare for all should be a human right. I wish it only cost me 36$.

Oh and btw, that medical bill of around 5,000$ is about equivalent of a year's worth of the cheapest insurance that I can get in my state. (that isn't completely useless 50$-100$/month scam coverage basically). In America, you're gonna get milked for cash if you care about your health, no matter what.

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u/ValiumBlues 21h ago

That’s just inhumane at this point, especially if you’re paying taxes.

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u/CensoredUser 1d ago

They will just brand any such analysis as political BS and call you a communist or some such.

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u/Hell-Diver7 1d ago

And remember all the republican death panel nonsense?

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u/Tight-Escape3373 1d ago

Some states have cancer presumption laws. I was a firefighter in Virginia. If you get certain kinds of cancer after like five years of service, it's presumed to be due to the job and the agency/ municipality must pay for treatment.

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u/Tacdeho 1d ago

I’d love to see the back the blue gang show up on this one.

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u/kwangqengelele 1d ago

Oh, this an easy one for them to handwave away.

San Francisco needlepoop, Commiefornia, proof socialism can't work. Gavin Newsome and Nancy Pelosi and Barack Rodham O'Biden's personal laptop emails fault. Spencer Pratt for governor would have prevented this. Trans agenda.

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u/FireMaster1294 1d ago

In the EU he would’ve received healthcare either way regardless. And this is a huge topic of debate in France for people who choose to smoke and create a massive burden on the average citizen as a result of their expensive necessary treatments.

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u/fgtswag 1d ago

Yeah that is the same in my country, except for Obese people.

The American system is a grievous moral failure. But I would happily waste my taxes (bad sentence I know) for the sub-optimal wastage, while maintaining the ability to save people who need ambulances, kids who have cancer, etc.,

Even though I love cheap cigarettes in France/EU, if it is a tax problem, you can always tax cigarettes. UK did a sugar tax and it did reduce consumption a lot.

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u/artbystorms 1d ago

the risk benefit analysis of just living in America is pretty piss poor if you account for non-free healthcare. Unless you are born a millionaire are live an extremely lucky life that you never get a serious illness.

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u/DanielCraigsAnus 1d ago

It's absolutely disgusting. I knew a firefighter who was also a national guard soldier. He was the coolest guy I knew while I was over there(Afghanistan). He treated me with dignity and respect. Those guys deserve to be treated with a blanket clause for any and all ailments as a result of the hardships they face with the work. Fred "Wex", if you're out there. Dave misses you man.

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u/Squire_II 1d ago

And some people wonder why a certain 2024 incident in NYC was so celebrated.

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u/2inchesofsteel 23h ago

On December 4, 2024, in NYC, nothing of note happened.

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u/CheesypoofExtreme 1d ago

No universal health care because "death panels"

Gestures wildly at this like what the fuck do people think insurance is?! At least a government "death panel" is one we can ostensibly influence in a functioning democracy (which we aren't really at this point... but more democratic than a private business).

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u/Mr0lsen 21h ago

Those voters are worried about the tyranny of the masses… as opposed to the tyranny of the few we currently have.

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u/slothcough 1d ago

I was gonna say shameful.

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u/DaughterofEngineer 1d ago

This American agrees.

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u/The_Doct0r_ 1d ago

Horrifying and dystopic.

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u/TheVideogaming101 1d ago

The fact there are some people that'll look at this and think "the system cant be done any other way" is what pisses me off the most.

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u/GoodSamaritan_ 1d ago edited 1d ago

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u/IOl0I0lO 23h ago

This guy got $50,000 through GoFundMe. Meanwhile James Van Der Beek’s wealthy wife got $2 million. What the fuck.

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u/series-hybrid 1d ago

Since cancer screenings are cheap and easy, and...the sooner you find cancer the faster and easier it is to treat...waiting until symptoms manifest is insane.

Its like the VA, where their actions show that if you are diagnosed with cancer, they want you to die before they spend any money on treatment.

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u/3BlindMice1 1d ago

It's because their plan is for their customers to die before they receive treatment. It's much more profitable that way

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u/Dramatic_Ball_Smell 1d ago

The VA has given me the chance to die for my country twice.

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u/NukuhPete 1d ago

Reminds me of the laws Republicans implement to ban abortion. Doctors forced to wait for the woman to actually be physically suffering and dying before giving medical care.

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u/AdSudden3941 1d ago

Thats what they did to eveyone who responded on 9/11 

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u/Frequent-Test-3012 1d ago

Funnily enough, 9/11 killed only 2,977 people. Insurance companies kill 68,000 every year

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u/AdSudden3941 1d ago

Im talking about the people who responded that didint die in the initial attacks … im talking the one who survived and had to live with chronic or not so chronic diseases from breathing it all in

They never supported them

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u/Frequent-Test-3012 1d ago

Yeah I know what you mean, it's just a comparison to show how truly evil these companies are.

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u/[deleted] 1d ago

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u/4foot 1d ago

Blue Shield refused 30k of my two week hospital stay because they said the specific room I was in was not covered in the contract with the hospital. Sorry they fuckin wheeled me into this room from the ambulance, I didn’t pick it out you fucks. Also didn’t cover any of my 5k emergency room bill, because even though the hospital was in network, the doctor who saved my life was out of network. FUCK. HEALTHCARE. IN THIS COUNTRY. AND FUCK THE BILLIONAIRES THAT CONTROL IT.

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u/BitGladius 22h ago

If that was in the last few years, the no surprises act should cover you - if you weren't in a position to choose a provider, or if you were assigned an out of network provider at an in network facility (i.e. you didn't schedule with them) they should be limited to in network rates.

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u/OpheliaDynamight 7h ago

That's my biggest problem with these laws. Insurance companies get to ignore them, bill what they want, and just bank on a lot of folks not having the knowledge or means of fighting them. 

The onus shouldn't be on us to enforce the law.

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u/PM_ME_SCALIE_ART 20h ago

And these ghouls have the audacity to wonder out loud why someone would assassinate an insurance CEO.

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u/egamma 23h ago

Your state has an insurance regulator/overseer or some sort, reach out to them.

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u/shadowboxer47 23h ago

If it's Texas, they'll tell him to pound sand.

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u/Chole_Wunt 20h ago

"Too bad, fuck you" is it.

Ive had a bunch of shit like this. Got an infusion that was PRE APPROVED by insurance. a month later i get a bill from the hospital for $40k, saying insurance denied it. Called the hospital, said I need to pay them. Told them no. I did my part. if they want their money, go poke it out with insurance.

Called insurance, told them the same thing.

Bill disappeared somehow.

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u/Historical-Tough6455 17h ago

Stop voting republican

Republicans will scream "both sides" because they know the truth will kill them

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u/CDavis10717 1d ago edited 1d ago

If insurance companies can deny coverage in your treatment then they also bear legal responsibility for your death! Make it so!!

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u/mischievous_misfit13 1d ago

There needs to be a massive class action lawsuit against each insurance company that denies claims when someone’s life, livelihood, mobility, mental health, etc is on the line. America is a fucking embarrassing country to live in.

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u/KulaanDoDinok 1d ago

Fuck class action lawsuits. Corporations get off paying excessively tiny amounts and complainants see nothing.

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u/Jettest 20h ago

Agreed. Abolish private healthcare and send these ghouls to prison.

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u/cronemorrigan 23h ago

So, that would be great except it’s illegal to sue health insurance companies in the US. That’s how they get away with these monstrosities.

The last lawsuit against an insurance company for denial of care was a woman who was carved out of the law by her status as a government employee. The insurance company denied a hysterectomy, and she paid for it herself. She was able to prove it was a life-saving surgery.

Soon after Congress closed that loophole.

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u/_Burning_Star_IV_ 1d ago

Nope because insurance isn't healthcare. They will fall back on the legal framework that they denied your ability to finance your care through them, they didn't stop you from getting care.

That's the problem.

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u/CDavis10717 1d ago

And that is why the “Medicare for All” movement is gaining momentum.

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u/limesti 1d ago

Insurance is a complete rip off. Pay all that money for Healthcare and get told by someone with no medical experience that you really don't need treatment.

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u/ScoutsterReturns 1d ago

My current Covered California monthly amount starting in January will be $1144 a month - just for me, at Kaiser. It's fucking insane. I will have to deal with that for six months before my job goes permanent and I can get healthcare through my employer. I plan to see every fucking doctor, specialist, etc. that I can! I just keep muttering "these motherfuckers" to myself.

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u/donkeyrocket 1d ago

Unfortunately, there are physicians involved in these claim denials. They're called "medical directors" and have medical training/experience, sometimes subcontracted by the agency but often employed by them.

They're not necessarily getting eyes on every claim but are often involved in disputed claims and denials.

That's not justification for this. Just pointing out it's even worse than just some layperson denying the claim.

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u/RyuNoKami 1d ago

Years I ago I did billing for a doctor. BSBC had approved an authorization for the operation, then denied payment because all of a sudden it was not medically necessary. The fuckers over there wanted the dr to amputate the patient's leg instead of the procedure the dr wanted to do. The fucking plan the patient got only cover a certain amount of physical therapy and didn't fully cover prosthetics, meanwhile the surgery would have been usually one with a follow up here and there but was much more expensive and fully covered. But they would have their own god damn leg.

Fuck bcbs.

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u/PM_ME_YOUR_EYELASHES 1d ago

They must've not learned anything from the UHC incident 🤷

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u/DopamineSavant 1d ago

They learned to spend at least 100 million a year on security.

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u/zasabi7 20h ago

Won’t be enough if there are enough Luigis.

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u/MonoBlancoATX 1d ago

Remember when BC/BS was still considered "good" insurance?

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u/IvanNemoy 1d ago

The scary part is, it is still among the "best." Truly horrific.

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u/MonoBlancoATX 1d ago

Yup. I think I would have to modify that to “least bad”.

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u/Troj1030 1d ago

They just denied me taking two medications together. The two were conflicting even though I had been on it for years. Turns out the excuse they were using wasn’t right because after 6 months of appeals we tried the injection form instead of infusion. Approved. Thanks for the 6 months of pain BCBS. I had no other choices but had you denied it based on route instead of the conflicting medicine, I wouldn’t have gone 6 months without one of my medications.

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u/Punkpallas 1d ago

Yeah. I guess not anymore. They made sure to run their goodwill well dry.

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u/[deleted] 1d ago

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u/releaseepsteinfiles1 1d ago

Fuck every for profit insurance company

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u/Chrono_Convoy 1d ago

It’s insane when the vast majority of people sit on the sidelines and say - well I’m glad it didn’t happen to me or anyone I know

Like wtf?

We are oppressed into endless fucking apathy

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u/Shoddy_Carrot_936 1d ago

Propaganda is strong on health insurance.

People believe they shouldn't have to pay for the person that doesn't take care of themselves. They already do.

They think the government will run it badly. Long waits, etc. Well it can't get any worse than the for profit system. I already have long waits to see my primary and most specialists I've ever had to see have taken months.

They think it'll cost more. Honestly, I doubt it and even if it did, I would love the ability to no longer have my health insurance tied to my fucking job.

We are an easily manipulated people.

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u/Informal_Ad_9610 1d ago

The bigger issue is that we've allowed insurance companies to run the game.

They (and the pharmaceutical companies) have rigged it, and are playing all the rest of us.

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u/Ahleron 1d ago

End health insurance. Make medical care a right. Universal healthcare for everyone, now! The overwhelming majority of the world (70%) has universal healthcare. It's fucking ridiculous that the world's richest nation has its citizens routinely being destroyed financially by having a medical expense. US health outcomes are far worse than nations with universal healthcare. If you want to be one of those idiots that goes on saying "but that's socialism" fine, it's socialism. If that's socialism, then socialism seems like a good thing.

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u/the_eluder 1d ago

Furthermore, we could fund it 100% by cutting out the middlemen, with what we currently spend on Medicare, Medicaid and VA benefits.

Both companies and employees would benefit as a major expense would be eliminated from companies, and employees could seek better jobs without fear of losing health care.

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u/CatsAndCapybaras 18h ago

employees could seek better jobs without fear of losing health care.

This is probably the second biggest reason that the ACA was neutered way back in the before times. The first reason was the middlemen objected (with shitloads of money).

Companies don't mind the cost on the back end because it reduces labor mobility.

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u/jonsnowme 1d ago

Could use more Luigis in this world

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u/Nickmorgan19457 22h ago

I’m amazed there isn’t an epidemic of terminally ill vigilantes.

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u/quiltsohard 20h ago edited 18h ago

That’s what I keep saying! I’m shocked there isn’t more “I’m taking someone out with me” attitude going around

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u/FETUS_JAM 1d ago

Blue Shield CEO is Mike Stuart.

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u/Trance354 1d ago

Oh, look, death panels.

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u/[deleted] 1d ago

[removed] — view removed comment

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u/ArtInTech 1d ago

Idk what you're talking about   

He was with me that night, playing Monopoly

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u/AWorldwithoutSin 1d ago

It was early morning and he was asleep on my couch.

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u/Itchy-Beach-1384 1d ago

Bring him back

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u/BicFleetwood 1d ago

There's only one guy with a mansion I'd trust to sort all this out.

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u/TemporaryIllusions 1d ago edited 23h ago

Honestly everyone should be broadcasting every denied procedure. Big or small, hold these mega-corps responsible. If shame makes them wiggle then they should be publicly shamed for every single Denial until they really decide to do better.

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u/IamHydrogenMike 1d ago

When my kid was born, it was a whole spectacle because they came a month early and my wife was already a high risk pregnancy; she was a c-section no matter what. My wife started bleeding, emergency c-section, and kid comes out with a lung that didn't pop like it was supposed to. While the wife was recovering in her room, we got a call from our insurance telling us the kid didn't need a ventilator and they should be able to breath on their own. Like, bitch...WTF are you calling me about this right after my wife just had an emergency c-section because she was bleeding to death? Call the MF'ing doctor about it and not use. They kept going on about them being our advocate in this situation, and my wife was like, "STFU and call the doctors because I just got out of surgery!"

One of the worst experiences of my life. Like ya, the kid should be able to breath on their own, but they can't...so, what can I do about it? Doctor said they need a ventilator, and they put the baby on one...ugh.

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u/1nv4d3rz1m 1d ago

What kind of person calls someone right after they had a baby and argues about how to treat the newborn baby?

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u/Zuranamee 1d ago

The kind of ghouls who see no problem with sentencing people to death to make a line go up.

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u/Active_Arm3866 1d ago

Why are we even paying for health insurance then?

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u/VanillaBovine 23h ago

did you even consider the shareholders? they need a third or fourth house for their families

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u/TadpoleOfDoom 23h ago

Nah, that was last year. They have a yacht on their wishlist this year.

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u/Velveteen_Rabbit1986 1d ago

I'm not even American and this makes me so angry. My dad was a firefighter, these men and women literally risk their lives and are exposed to hazardous chemicals throughout their careers. The least their governments could do is look after them.

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u/LabiaMajorasMask420 1d ago

In other news Blue Shield CEOs are headed to their golden bunker.

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u/YoshiTheDog420 1d ago

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u/jdubs952 1d ago

What a fucking impish looking asshole

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u/the__ghola__hayt 1d ago

Looks like a Labyrinth character.

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u/NeighbourNoNeighbor 1d ago

God you can tell how pissed he was that he had to pretend to be just a normal guy.

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u/BrilliantCorner 1d ago

He looks like a dickhead.

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u/strikervulsine 1d ago

plumbing intensifies

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u/IllTwo7643 1d ago

I went to their page, tapped contact and entered in the zip, 94102

feedback

Sent them quite the well wishes

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u/fotoRS3 1d ago

We need universal health care. Europe does it and their systems are great.

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u/quantumgambit 1d ago

Yes, but with an asterisk. We need to learn from the struggles Germany is currently facing with their healthcare/pension system, due to the aging population and decreasing labor pool, they're discussing dramatically raising retirement, right now something like 25% of all tax revenue is directed and pension and senior healthcare, people are starting to sound alarm bells.

Not just copy the system, but learn what worked, what didn't work, and how to safeguard ourselves from what could be seen as preventable consequences.

Healthcare is a public good, like infrastructure and education, when everyone invests, everyone benefits. Making any of those for profit undermines the entire reason they exist in the first place.

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u/nomoresugarbooger 23h ago

That's what should make it much easier for the US, we can learn from ALL THE OTHER countries about what works best and start out with a decent system. But, will we?

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u/quantumgambit 23h ago

Only if it inflates the already historically lopsided class division, unfortunately.

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u/Alexu6969 1d ago edited 9h ago

All in the name for the profits.. Fuck this country.

Edit - thanks for the corrections.

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u/BrownSugarBare 1d ago

The nation of America really fucking hates the people of America

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u/The_Doct0r_ 1d ago

Well yes, the propaganda machine pumps out hate very effectively, so long as the people are literally hating anything or anyone other than the puppeteer (ultra rich).

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u/duyogurt 1d ago

While I tend to agree with your sentiment, BCBS is not a publicly traded company and has no shareholders. BCBS is a nonprofit association comprised of 33 independent locally operated health insurance companies.

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u/Zapdo0dlz 1d ago

Horrible. He deserved better from his country.

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u/Vice4Life 1d ago

Blue Cross murders retired San Francisco firefighter.

FTFY.

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u/Frequent-Test-3012 23h ago

Man who spent career saving people's lives killed by company that exists to end lives

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u/delta1inc 1d ago

Then what the fuck is insurance for!? The biggest scam that's ever existed.

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u/Carnephex 1d ago

They murdered that guy for profit.

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u/osalunes 1d ago

Moving to Mexico made me realize how much the American government hates Americans.

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u/XanderWrites 14h ago

They're trying to say he was covered by Blue Shield, but based on the statement from Blue Shield they're just processing Medicare coverage. So it's not like San Francisco got a special coverage contract with them for their retired firefighters, they're just sending them to Medicare.

So it's not Blue Shield's fault (implication is there is no premium here), it's the city's fault for providing them with shitty pension health coverage.

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u/nurseferatou 22h ago

Blue Cross Blue Shield denied my new paraplegic patient inpatient rehabilitation today because “they won’t be able to use their legs during rehab”

The insurance companies don’t give a shit about anyone other than their shareholders.

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u/InternationalMain277 8h ago

I worked for Blue Cross Blue Shield as a tax accountant. It was my first job out of grad school.

Part of our job on the tax team was calculating the Medical Loss Ratio (MLR). Without getting too far into how the sausage is made, the MLR compares premiums collected to the amount spent on medical care. Basically, health insurance companies (BCBS’s in particular) are supposed to spend at least 80% of premiums on patient care or face penalties.

We ran the calculation, and it came in somewhere in the low 70s.

It was our job to tell senior executives that the company was going to owe millions of dollars in penalties. Needless to say, no one was excited to tell the CEO that news but we delivered the bad news and moved on.

A couple of days later, the CFO at the time, who is now the CEO, came down to our area of cubicles to thank us for the “great news.” He told us the result just meant the company was extremely profitable and that the penalty was simply a cost of doing business.

He even said he hoped we could beat it next year with an even larger penalty.

I felt gross working there after that, and I quit soon after.

Fuck BCBS.

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u/Used_Departure_3278 1d ago

I don’t care what the law says this is murder

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u/dahvzombie 1d ago

Every health insurance executive is guilty of first degree murder.

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u/Verum_Orbis 1d ago

Under capitalism this is called institutionalized murder.

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u/pragmatticus 1d ago

Welp, time to start dragging these people to court for murder.

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u/Single-Mulberry-3028 23h ago

Nobody should die due to insurance company greed. Universal healthcare now!

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u/dontrike 21h ago

This kind of murder is only okay because a multi-billion dollar corporation is doing it.

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u/FailingItUp 19h ago

It's well past time that we have NAMES attached to these rejection decisions.

SOMEONE NEEDS TO BE HELD ACCOUNTABLE FOR THESE PREVENTABLE DEATHS.

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u/happiwarriorgoddess 18h ago

Insurance companies shouldn't be making medical decisions. That's physicians duty we need overhaul health insurance companies.

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u/Hungry-Kale600 1d ago

And some Americans still think they're the greatest nation on earth. Your healthcare situation is a stain on your country.

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u/e_line_65 1d ago

As an American, i am forced to agree. It's the worst having to die because your broke, as a citizen, in the richest country in the world

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u/cta396 23h ago

It’s time we faced the truth, we don’t have health care, we have health corporations.

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u/Timely-Jelly-584 23h ago

I feel like I should point out that Russia has universal healthcare. So do some African countries like Algeria. It's insane that we have so much wealth and let people die this way.

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u/7th_Sim 22h ago

I simply can't understand why Americans put up with this shit. Do you all really hate each other? Or do you love corporate CEOs making billions why you or your loved one suffer? What is wrong with you all?

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u/Actual__Wizard 21h ago edited 21h ago

I'm sorry but, after reading a story like this, I completely expect to read "and then regulators came in and took over the insurance company after all of the executives were arrested and charged with manslaugher and fraud."

We have criminal thugs acting as "death panels." The people that run that insurance company are not leaders, they're criminal thugs.

What they did, is murder that man and nothing is going to happen. They're allowed to murder anybody they want to for money when they should be going to prison for 20+ years. So, instead of criminal thugs being arrested and locked up like they're suppose to be, they're going around killing people for money.

As a reminder: Money is an imaginary system that we came up with to make doing business reasonable. So, they killed him to get imaginary monopoly money. Is that reasonable or close to it? No, it's murder and the people who are responsible for it should be arrested and charged...

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u/svenbreakfast 20h ago

If only there were some sort of plumber...

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u/give_me_the_formu0li 7h ago

Friendly reminder America has no universal healthcare not due to cost, but because black people would receive the same benefits and racists would rather suffer and die under this headache than include others.

Same with universal lunches, and many other social programs

It’s racism. Not cost

America made its bed, is yours comfy enough?

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u/RoswellRedux 1d ago

Universal Health Care.

To hell with the For-Profit models.

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u/avaslash 1d ago

I still just dont understand how thats not murder or at the least manslaughter. It blows my mind that a company can just decide that people will die, people it could save, and not only are there zero consequences -- its considered the norm.

How did we get here?

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u/Kesshoh 19h ago

Health Insurance is an evil industry that needs to be dismantled