As usual, South Park tells the truth in a way that others can’t—in this case about the complexities and inefficiencies of the U.S. healthcare system, which can be a nightmare for the average consumer trying to get coverage for treatment.
A YouTube clip from the South Park episode “The End of Obesity” shows Kenny, Kyle, and Cartman entering a large health insurer’s office. A man in a suit excitedly asks if they’re there for insurance. They say they want a claim paid, not to pay a bill.
After saying that, instead of paying their bill, they are shuffled off into a dark cramped office. Inside, an elderly man sits at a simple desk surrounded by filing cabinets, open claims, and piles of papers. The man pecks away at a typewriter and then dials the company’s medical director on a rotary phone.
The claim is immediately denied. “The medical director’s job is just to say no,” he tells the boys.
They protest and the claims’ agent assures them that with a ‘little more work’ they may be able to get it paid after all.
“You see, the doctors and the pharmaceutical companies and the insurance companies all kind of work together, so all you have to do is navigate the American healthcare system”, he says.
And so the trio embarks on a series of visits to doctors, specialists, the claims agent office, in-network providers, without ever reaching any kind of a resolution. Eventually, the dizzying array of trips turns into one of those M.C. Escher drawings of endless stairs.
The medical condition at the center of the video is obesity, but the story could just as easily be about how complex and inefficient the American healthcare system is in general, and for personal injury patients in particular.
A recent KFF survey of 3605 U.S. adults who have health insurance found that they face numerous obstacles when attempting to access care, such as “denied claims, provider network problems, and pre-authorization problems.” The survey, which was released in June 2023, found that two thirds of adults in fair or poor health had difficulty with their insurance in the past month.
The survey underscores a fundamental reality that confronts many patients—the sheer complexity of the U.S. healthcare system, and the insurance companies who exercise an over-sized influence on who is able to receive care and funding for it. As the Journal of the American Medical Association noted, “many people are hopelessly confused by how their insurance works. About half of consumers say they do not understand some aspect of their coverage, including about one-third who do not understand what costs their plan covers or what costs they will owe.”
Some of the factors that make insurance and healthcare difficult to understand, according to one Harvard Medical School professor, include:
A wide variation in prices: Differences in prices between providers—and between insurers’ rates—make it difficult to compare prices and values and make informed and financially prudent decisions about your treatment. Tracking who is in and out of network and what the different costs may be adds another layer of complexity.
Multiplication of specialists: Most doctors are trained in specialties. The multiplication of specialties leads to a corresponding increase in insurance company bureaucracy. According to a report in TIME, three quarters of doctors were generalists in 1940; by 1970 the ratio had flipped, with three quarters who were specialists and only a quarter who were general practitioners. As the doctor who authored the piece put it, “The consequences for patients are troubling. Besides high costs, having too many consultants leads to sloppiness and disorganization. As Drs. Donald Berwick and Allan Detsky recently wrote in the Journal of the American Medical Association, inpatient care at hospitals has become a relay race for physicians and consultants, and patients are the batons.”
Fragmented care: A closely related problem is how fragmented care can be. Patients seeking treatment for one problem may see a variety of providers in a diversity of settings. In one account reported by a group of researchers, a patient ticked off the list of 10 doctors they saw that included a urologist, pulmonologist, and cardiologist. That isn’t the exception, as the typical Medicare patient has seven providers – including five specialists – that operate in four different settings, according to the report.
Drugs over other treatments: The U.S. system tends to favor pharmaceutical options over other treatments. In the example offered by the Harvard professor, cortisone shots for tendinitis usually is covered; a shoe insert would not be. One survey of doctors found that 22% of prescribed medicine was unnecessary.
The Burden on Personal Injury Patients
At this nexus of high cost, confusion, and complexity are personal injury patients. Did you badly fracture your shoulder in an accident? You may need to see an orthopedist and a pain management specialist. You may need to go to imaging center. If the pain medications conflict with other prescriptions you may have to check with those specialists. Do you need physical therapy? That’s another kind of provider in a different setting.
America’s labyrinthine healthcare system can be especially burdensome on personal injury patients. For many fighting to recovery from their injuries, just getting access to care can be a battle in of itself.
Gain: Leveling the Insurance Playing Field
Gain is leveling the playing field against insurance companies by providing a comprehensive, AI-enhanced servicing platform. Our platform simplifies the coordination of care and financial support. We ensure that personal injury patients receive the medical attention they need without the added stress of navigating complex insurance processes. By connecting healthcare providers, attorneys, and patients in a seamless ecosystem, Gain makes healthcare more accessible and equitable.
Talk to a specialist today to learn how we can help you gain.
