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A petabyte of health insurance prices per month

blog.turquoise.health

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Re: A petabyte of health insurance prices per month

#121

Post by lotsofpulp »

talldatethrow wrote: post #94
FollowingTheDao wrote: post #2

They are making it impossible to handle the data so everyone gives up trying so they can go on screwing people over.

While there are huge problems, I think the majority of the problem is people expect their health insurance plan to be like a prepaid maintenance plan. If you crash your car today without insurance, you understand it won't be covered by getting insurance tomorrow. Why people think they can finally get healthy "insurance" at 45 from company xyz, knowing they need this pill or that pill, and expect the new insurance com…

In the US, federal law requires the insurance company to offer any applicant insurance coverage and pay for necessary healthcare (after accounting for deductible/out of pocket maximums).

https://www.healthcare.gov/how-plans-set-your-premiums

>Five factors can affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents.

> FYI Your health, medical history, or gender can’t affect your premium

https://www.healthcare.gov/appeal-insurance-company-decision...

Re: A petabyte of health insurance prices per month

#122

Post by ochoseis »

izzydata wrote: post #116
hospitalJail wrote: post #113

The medical cartels need to be destroyed. They are mathematically the most corrupt industry according to open secrets all time lobbying data. Physicians are the richest profession in the US, and limit their supply by weaponizing the ACGME/AMA. Hospitals/clinics make so much money. We own one, and while it was slow to start, the profits are insane. Marketing is the hardest thing, once a patient comes in the door (and…

Aren't there laws that require insurance companies and utility companies to have specific margins? They could in theory just print infinite money so they need to be reigned in by governments.

The ACA caps insurer profitability at 20% by requiring 80% of premiums to go towards healthcare costs. Administrative / operational / marketing costs and profit come out of the remaining 20%. So, if you’re an insurer who wants to increase nominal profits, then you’re ok with spiraling healthcare costs.

https://www.healthcare.gov/health-care-law-protections/rate-...

Re: A petabyte of health insurance prices per month

#123

Post by AnthonyMouse »

ochoseis wrote: post #122
izzydata wrote: post #116

Earlier quoted context omitted.

Aren't there laws that require insurance companies and utility companies to have specific margins? They could in theory just print infinite money so they need to be reigned in by governments.

The ACA caps insurer profitability at 20% by requiring 80% of premiums to go towards healthcare costs. Administrative / operational / marketing costs and profit come out of the remaining 20%. So, if you’re an insurer who wants to increase nominal profits, then you’re ok with spiraling healthcare costs. https://www.healthcare.gov/health-care-law-protections/rate-...

> So, if you’re an insurer who wants to increase nominal profits, then you’re ok with spiraling healthcare costs.

Not just okay, but actively incentivized to cause it, because then you get 20% of a bigger number.

Laws like that are some of the most expensive of the perverse incentives created by naive idealists (or cynical opportunists, since the lobbyists for the medical providers know exactly what that would do).

Re: A petabyte of health insurance prices per month

#124

Post by jmole »

thedougd wrote: post #118
izzydata wrote: post #116

Earlier quoted context omitted.

Aren't there laws that require insurance companies and utility companies to have specific margins? They could in theory just print infinite money so they need to be reigned in by governments.

Yes. https://www.healthcare.gov/health-care-law-protections/rate-... .

So the only way to grow profits is by increasing the base cost of service.

Re: A petabyte of health insurance prices per month

#125

Post by talldatethrow »

lotsofpulp wrote: post #121
talldatethrow wrote: post #94

Earlier quoted context omitted.

While there are huge problems, I think the majority of the problem is people expect their health insurance plan to be like a prepaid maintenance plan. If you crash your car today without insurance, you understand it won't be covered by getting insurance tomorrow. Why people think they can finally get healthy "insurance" at 45 from company xyz, knowing they need this pill or that pill, and expect the new insurance com…

In the US, federal law requires the insurance company to offer any applicant insurance coverage and pay for necessary healthcare (after accounting for deductible/out of pocket maximums). https://www.healthcare.gov/how-plans-set-your-premiums >Five factors can affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents. > FYI Your health, medical history, or gende…

I understand the law says so. My point is this makes no sense as an "insurance". It's basically a service plan now.

Re: A petabyte of health insurance prices per month

#126

Post by Alupis »

galleywest200 wrote: post #90
arcticfox wrote: post #62

Earlier quoted context omitted.

As others have explained, the subsequent encounter is for a follow-up visit, not a repeated duck attack.

This is still silly.

It's not when you want statistics about all injury types, treatments, etc.

Re: A petabyte of health insurance prices per month

#127

Post by lotsofpulp »

AnthonyMouse wrote: post #123
ochoseis wrote: post #122

Earlier quoted context omitted.

The ACA caps insurer profitability at 20% by requiring 80% of premiums to go towards healthcare costs. Administrative / operational / marketing costs and profit come out of the remaining 20%. So, if you’re an insurer who wants to increase nominal profits, then you’re ok with spiraling healthcare costs. https://www.healthcare.gov/health-care-law-protections/rate-...

> So, if you’re an insurer who wants to increase nominal profits, then you’re ok with spiraling healthcare costs. Not just okay, but actively incentivized to cause it, because then you get 20% of a bigger number. Laws like that are some of the most expensive of the perverse incentives created by naive idealists (or cynical opportunists, since the lobbyists for the medical providers know exactly what that would do).

In reality, there is sufficient competition such that the 7 largest publicly listed health insurance companies have 4% or less profit margins, and one has 6%.

I always find it funny when people on this forum act like a certain business is so powerful when it can only earn low single digit profit margins, yet tech company employees work for companies so powerful they can earn 20%+ and 30%+ profit margins for years and years.

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...

https://www.macrotrends.net/stocks/charts/CVS/cvs-health/pro...

https://www.macrotrends.net/stocks/charts/CI/cigna-group/net...

https://www.macrotrends.net/stocks/charts/HUM/humana/profit-...

https://www.macrotrends.net/stocks/charts/CNC/centene/profit...

https://www.macrotrends.net/stocks/charts/MOH/molina-healthc...

Re: A petabyte of health insurance prices per month

#128

Post by elcritch »

Buttons840 wrote: post #102

Companies are going to grow around this data. An entire industry might grow around this data, and it will be an industry that I support every time I pay an insanely high insurance premium or medical bill. 15% of our workers are in the medical system [0], and this doesn't even include the surrounding insurance industries or pharma industries (I think). Someone has to pay all these people, and that someone is me when I…

There's a similar issue in academia. Tuition costs have risen far faster than inflaction but the number of professors per student is roughly similar. Where does all the extra go? Administrators and bureaucracy!

Re: A petabyte of health insurance prices per month

#129

Post by skissane »

abeppu wrote: post #79
thomascgalvin wrote: post #15

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Ok, so it's _broken_. As a system of recording stuff is it also ... incoherent? Slapping on a bandaid or giving someone tylenol are _services_. "Bitten by duck" is a _cause_, and different people bitten by ducks could need different services, and people impacted by different causes could need the same services. If I have a laceration, I'm guessing that how I'm treated should depend on how deep/large/severe it is, rat…

> Ok, so it's _broken_. As a system of recording stuff is it also ... incoherent? Slapping on a bandaid or giving someone tylenol are _services_. "Bitten by duck" is a _cause_, and different people bitten by ducks could need different services, and people impacted by different causes could need the same services.

As others have explained, these are diagnosis codes; there are also procedure codes. Procedure codes are the primary thing billed for, the diagnosis code is just to justify the procedure - some doctors will perform (or falsely claim to have performed) medically irrelevant procedures as a form of billing fraud, and cross-checking the procedure and diagnosis is meant to prevent that.

And the reason why there are so many diagnosis codes, is because their primary purpose is public health statistics not insurance billing; and ICD codes are global (although the US also adds its own US-specific ones.) Probably, somewhere in the world, some bureaucrat is tracking the public health cost of animal attacks by species, and those species-specific animal attack codes exist to enable them to do that.

Re: A petabyte of health insurance prices per month

#130

Post by brendanyounger »

kasey_junk wrote: post #92

It’s interesting that so many commentators are blaming the insurers here. The whole article is about how insurers use rules engines and lookups to define these prices and that the data explosion was a result of the legislation requiring price lists instead of an open standard for describing rules and lookups.

Having worked with this data extensively (tynbil.com) and talked to several payers and providers, I don't think any of this intentional. CMS did their best at guessing what format the payer data could be exported to (with little to no help from the payers themselves). None of the payers have exactly the same schema for defining these rates as they all have home-grown solutions developed over decades. That said, most insurers have gone out of their way to bury us in data. The result is messy and annoying, but not impossible to work with. It's the best we can expect in this imperfect world.
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