Anthem drops controversial new plan to cap anesthesia coverage after backlash • Hacker News Board

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#31

Post by ryaniscool » Sun, Dec 08, 2024, 8:28 PM UTC

intrepidlemon wrote: post #16

intrepidlemon wrote: post #15

Earlier quoted context omitted.

This is not an informed perspective. Anesthesiologists are some of the most highly trained physicians in a hospital. Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly an…

The assertion that physicians are a primary driver of excess US healthcare costs requires evidence. See here https://www.commonwealthfund.org/publications/issue-briefs/2... Physician salaries are a driver, but the far bigger portion lies with insurance’s take, and the administrative costs required to respond to insurance shenanigans.

Anesthesiology average salaries

US: $438k/yr Australia: $203k/yr UK: £112k/yr

That seems like a big difference to me.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#32

Post by lotsofpulp » Sun, Dec 08, 2024, 8:30 PM UTC

ImPostingOnHN wrote: post #25

filoeleven wrote: post #18

> "To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services. The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines." Additionally, according to Vox, > Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patien…

"don't worry, we were going to screw over a different innocent victim, not you, so we're cool right?"

This type of post is better suited for Reddit.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#33

Post by ImPostingOnHN » Sun, Dec 08, 2024, 9:57 PM UTC

lotsofpulp wrote: post #29

ImPostingOnHN wrote: post #26

Earlier quoted context omitted.

> It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins Hilarious!!! Or it would be, if making margins by denying lifesaving care, weren't totally different from making margins on a bag of juice.

Why is that relevant? The important piece of information is operating a business at low profit margins is hard (obviously because a zero or negative profit margin is a charity and not a business). People working for software companies with enormous lock in pricing their products (and we can talk about Epic healthcare software’s profit margins here) complaining about profits earned by businesses under much more compet…

> Why is that relevant?

Thank you for asking. I would be happy to help you understand here.

The answer to your question is: The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin. Thus, someone who does the former is bad, and someone who criticizes a bad person is totally okay in doing so.

Compare to marking up a bag of juice at 100%, which is also totally okay because you aren't effectively killing people by doing so. Thus, no contradiction exists.

To dig even deeper: because a life is worth more than the markup on a bag of juice. A thousand bags of juice marked up 100% would be morally better than denying lifesaving care just to increase margins 1%.

> people like to complain

This type of commentary is better suited for Reddit.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#34

Post by lr1970 » Sun, Dec 08, 2024, 10:04 PM UTC

tzs wrote: post #28

lr1970 wrote: post #24

Earlier quoted context omitted.

An Anesthesiologist does not determine the duration of an operation. It depends on the type of operation, how sick the patient is and how fast or slow is the surgeon. Anesthesiologist provides anesthesia for the full duration of the surgery. You cannot blame an anesthesiologist for a surgery than runs extra two hours because surgeons need extra time. It makes no sense.

They were going to still pay for longer than normal procedures. It was just that it would have to be shown than the overtime was medically necessary. The time they were going to allow before justification was required is the same time the Medicare uses for deciding how much to pay.

> was just that it would have to be shown than the overtime was medically necessary.

And then the insurance paid medical adjudicators will find it "not medically necessary". And the vicious cycle continues -- deny, delay, defend.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#35

Post by lotsofpulp » Sun, Dec 08, 2024, 11:11 PM UTC

ImPostingOnHN wrote: post #33

lotsofpulp wrote: post #29

Earlier quoted context omitted.

Why is that relevant? The important piece of information is operating a business at low profit margins is hard (obviously because a zero or negative profit margin is a charity and not a business). People working for software companies with enormous lock in pricing their products (and we can talk about Epic healthcare software’s profit margins here) complaining about profits earned by businesses under much more compet…

> Why is that relevant? Thank you for asking. I would be happy to help you understand here. The answer to your question is: The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin. Thus, someone who does the former is bad , and someone who criticizes a bad person is totally okay in doing so. Compare to marking up a bag of juice at 100%, which is also…

>The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin.

So you want a business to go out of business? This discussion is not about whether or not the government should pay for everyone's healthcare, no matter the cost. The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or not an appropriate amount of healthcare and cost is being distributed.

>This type of commentary is better suited for Reddit.

Not really. The root of the issue is that the American public wants something it cannot afford (or at least wants it for themselves but not for others). This manifests as nonsensical complaints about the entity that earns the lowest profit margins. The MCO raises the premium/deductible, complaints. The MCO denies coverage, complaints. And this will actually go all the way back to an untenable population histogram where fewer and fewer young people will be bled to support more and more old people.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#36

Post by lotsofpulp » Sun, Dec 08, 2024, 11:18 PM UTC

anotherhue wrote: post #14

ryaniscool wrote: post #9

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for. I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties. Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not s…

Remove / equalise the reasons that it makes sense for your employer to control your insurance provider. It was an act of government that caused it in the first place. ACA needs 2 sequels before anything resembling a market can emerge.

Everyone is free to buy whatever insurance they want. But they won't be able to pay for it with pre-tax income like their employer is able to.

It's an explicit pro-big business tax policy that hurts businesses that aren't big enough to afford the paperwork and HR involved with administering insurance and other benefits, and also to prevent people from being able to easily compare compensation offers from various employers.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#37

Post by jliptzin » Sun, Dec 08, 2024, 11:24 PM UTC

ryaniscool wrote: post #30

jliptzin wrote: post #23

Earlier quoted context omitted.

I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause…

This is a straw man argument. Yes they shouldn't deny a prescription if your doctor says you need it. What I'm talking about is capping the costs of a supporting doctor for a surgical procedure. From my quick research, there is no significant cost basis for surgery running longer than planned besides the anesthesiologist's time. So the doctor would make $400k instead of $500k per year. Here is some perspective. The a…

I agree. I'm just saying that instead of reducing healthcare costs by having insurance companies deny necessary procedures and medications seemingly randomly, there should be serious regulations capping healthcare costs. Generally speaking I am against any form of government-set price controls, but healthcare costs are so completely out of control that I don't know of any other way to deal with it. It's also a unique situation where the customer has no way of shopping around for a competitor - if you're having an emergency, your only choice is the nearest hospital - they should not be taking advantage of that situation and making you pay through the nose.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#38

Post by ImPostingOnHN » Sun, Dec 08, 2024, 11:30 PM UTC

lotsofpulp wrote: post #35

ImPostingOnHN wrote: post #33

Earlier quoted context omitted.

> Why is that relevant? Thank you for asking. I would be happy to help you understand here. The answer to your question is: The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin. Thus, someone who does the former is bad , and someone who criticizes a bad person is totally okay in doing so. Compare to marking up a bag of juice at 100%, which is also…

>The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin. So you want a business to go out of business? This discussion is not about whether or not the government should pay for everyone's healthcare, no matter the cost. The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or n…

> So you want a business to go out of business?

I didn't say that. They can raise premiums, or they can decide that being in a position where you effectively kill people for profit isn't a great place for a company to operate, and abdicate to the government. Either way, profiting off death you contribute to, is generally a Bad Thing. Based off the UHC CEO's murder and the reactions to it, it seems I am not the only one who thinks this.

> This discussion is not about whether or not the government should pay for everyone's healthcare

Actually, that's precisely one of the options I'm discussing! :)

Point being, pointing out "this is hard for a corporation to do and still make money" doesn't excuse the badness of profiting off your contributions to killing people. Like maybe don't do it as a corporation if it's so hard?

> The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or not an appropriate amount of healthcare and cost is being distributed.

Have they? I must have missed that individual question was explicitly on the ballot as you describe.

Re: Anthem drops controversial new plan to cap anesthesia coverage after backlash

#39

Post by rifty » Mon, Dec 09, 2024, 7:46 AM UTC

bushbaba wrote: post #6

ndsipa_pomu wrote: post #3

Just how is the U.S. healthcare system so broken that this can even be considered? It sounds like some dystopian fiction.

The profit margin of anthem insurance is ~5%. The profit margin of all state insurance is ~7%. The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease. The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middl…

Given that a lot of the reoccurring is not just for emergency coverage but standard healthcare services and purchases. It might also be interesting if there was an investing account that you could withdraw from tax free to use for those types of things. This might minimize some of the incentive to lean on your employment and insurance as a middle man for this.