301–310 of 311 posts
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So why is physical force so important here? If I poison someone, they’re just as dead as if I’d stuck a knife in them.
I would categorize that with violent activities. You’re taking action that physically harms someone with an obvious causal chain. Give me some leeway here, by the way—I am allowing myself to be “socratized”…
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Poisoning someone is using physical force. Why would you think otherwise?
What if you are poisoning them through knowingly through by dumping toxic chemicals into the air or their water supply? That doesn’t require physical force.
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Denying claims generally doesn't improve health insurance company profits. It's not like auto or homeowner's insurance. Due to the minimum medical loss ratio rule, insurers can generally increase their profits by approving more claims. Their most important customers are self-funded employers. https://www.cms.gov/marketplace/private-health-insurance/med... When insurers tighten their claim approval policies it's usual…
> Denying claims generally doesn't improve health insurance company profits. If this is true, why do several of the larger companies deny so many claims? I can't imagine they would do this if what you were saying were true; the board would have leadership's heads.
Payers do make errors in claims processing and improperly deny some claims, but the majority of denials are due to errors on the provider side. They often fail to code claims correctly or don't obtain required prior authorization or don't follow step therapy or fail to attach enough clinical documentation to establish medical necessity. Many of those initial denials are later approved once the provider corrects the errors and resubmits the claim. But in fairness to the providers, it's hard to get everything right the first time because every payer has different rules and they're sometimes ambiguous.
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How many Go Fund Me sites were brought up because of high medical costs for some accident or cancer? Is foregoing insurance an improvement over that if it isn't even possibly one of the big causes?
> Is foregoing insurance an improvement over that No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk. I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
In too many instances, people pay the premiums and then do not get the benefits of the insurance.
An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount of legalese would make it acceptable, and in fact Congress regulates air travel such that practices like this hypothetical are not allowed.
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> Is foregoing insurance an improvement over that No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk. I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
You missed the point of my comment. The "services" I was referring to was "health insurance," and the "for money" is the monthly premiums. In too many instances, people pay the premiums and then do not get the benefits of the insurance. An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount…
Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter.
These aren't really an issue with airline tickets, not because we don't regulate insurance, but because the contract is exponentially more simple and understandable.
But I do think more should be done.
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I think you are sidestepping the argument here. Tell me, if I outsource the physical act of harm, say by paying someone to beat someone else up, would you say I am not violent?
Yes
So assuming that you are saying that hiring a hit man isn't violent, but the hit man doing the deeds is:
We are now looking at a definition of "violence" that apparently includes the tantrum of a four year old (physical attack with the intent to do harm) but does not capture hiring killers or the actions of most dictators of the last 150 years.
To be honest this doesn't sound like a useful definition and certainly doesn't match the emotional reaction the word "violence" evokes. What is the word meant for then?
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> The free market generally solves these questiins, but it's notoriously deficient when it comes to healthcare. Can you please elaborate on this part? I don't see how this could be solved by market forces. EDIT: Making healthcare for profit, would always put someone's life against someone else's new yacht. Is this how we want to assess these situations?
It can't, that's why I said it's deficient when it comes to healthcare. Market forces are good at balancing capital allocations in general.
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You missed the point of my comment. The "services" I was referring to was "health insurance," and the "for money" is the monthly premiums. In too many instances, people pay the premiums and then do not get the benefits of the insurance. An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount…
Ah, I didn't interpret your comment that way. Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter. These aren't…
I use the colloquial "cheat" intentionally, as it is a valid descriptor.
Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
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Ah, I didn't interpret your comment that way. Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter. These aren't…
Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares. Similarly, they are not expected to plead their case in order to not be cheated by airlines. I use the colloquial "cheat" intentionally, as it is a valid descriptor. Notably, however: most insurance delays/denials will have in common that the patient is represente…
Correct. But it doesn't matter because the contract of carriage doesn't hinge on that. There's no confusion about what a ticket actually entails. If a ticket covers "one ride at the airport, from Cleveland to Omaha", it's pretty understandable what you are getting. If health insurance was just as simple, and covered "one ride at a hospital, from sickness to health", it would be likewise as accessible. But it isn't that way (although maybe it should be a lot closer)
> Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
I understand but that's not what I'm talking about here. I'm talking about a broader information and accessibility disparity.
Having a physician isn't any help if your insurer is deadlocking you on coverage you legally have coverage for, you need a lawyer. That's a contract law problem, not a healthcare problem.
But if you don't actually have coverage for what you need, having a physician argue that you need it, isn't going to help you. Most people buy their health insurance policy all by themselves, without any legal or medical help.