Insurers rely on doctors whose judgments have been criticized by courts • Hacker News Board

Re: Insurers rely on doctors whose judgments have been criticized by courts

#41

Post by foivoh » Mon, Dec 30, 2024, 4:23 PM UTC

bgnn wrote: post #23

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

not an American, but it seems to me that the reason is purely ideological. They like a small state, especially the federal government. This would give too much power to the government. The idea of federal government providing care for citizens is not acceptable to people. Now, weird thing is this doesn't work for the military somehow.

We don’t have a small state. It intentionally meddles in everything from mail delivery to medical care, to make them worse for the masses and better for the agents of the state.

Those agents really just being normal self selecting biology like everywhere else.

Functional illiteracy where people can only understand life through a job and paying bills is a carefully crafted propaganda. America been at the forefront of converting wartime propaganda research into advertising and marketing. A big government military industrial complex is the backbone of the economy. We just look away because wtf else we gonna do?

Re: Insurers rely on doctors whose judgments have been criticized by courts

#42

Post by potato3732842 » Mon, Dec 30, 2024, 4:24 PM UTC

afthonos wrote: post #21

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

And it has only gotten worse with time.

https://www.statista.com/statistics/184968/us-health-expendi...

That's 20% of the country that will be less well off if you "fix" healthcare in any meaningful way and the overwhelming majority of them will fight tooth and nail to prevent that from happening.

That is a hell of a minority to overcome when the issue is one of personal economics (i.e one everyone will experience directly, not some abstract social policy thing that people will ignore as long as their lives are good), dare I say basically impossible in a democracy.

(yes I know I'm assuming that the healthcare industry is a cross section of the country, no I don't care if that isn't 100% accurate)

Re: Insurers rely on doctors whose judgments have been criticized by courts

#43

Post by Someone1234 » Mon, Dec 30, 2024, 4:25 PM UTC

ShinyNewFeature wrote: post #31

In many jurisdictions in the US, there is a requirement for the casino and lottery operators to pay a certain percentage (typically 90+%) back as winnings. Do health insurance companies have to follow similar requirements? If so, individual cases of insurances denying insurance would be bad, but would indicate that the overall system is still working reasonably well.

Indeed, they do. The ACA set a 80% requirement.

Unfortunately unintended consequences have resulted in that meaning it benefits health insurance companies to increase the cost of care so their 20% share is more.

Re: Insurers rely on doctors whose judgments have been criticized by courts

#44

Post by throw10920 » Mon, Dec 30, 2024, 4:25 PM UTC

Aunche wrote: post #12

Ironically, I think that the increased attention to the denial of claims plays straight into insurer's hands. Healthcare isn't expensive because insurers don't pay enough to healthcare providers. In fact, it's the opposite. The ACA mandates that at least 80% of premiums must go towards medical expenses. This means that insurers are actually incentivized to overpay for care to maximize the size of their 20% slice. If…

This is one of the drivers of cost disease[1] in healthcare, which is a huge problem that won't completely go away even if insurance is radically reworked.

[1] https://slatestarcodex.com/2017/02/09/considerations-on-cost...?

Re: Insurers rely on doctors whose judgments have been criticized by courts

#45

Post by brookst » Mon, Dec 30, 2024, 4:26 PM UTC

School-Cotton wrote: post #25

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

> Why don’t you change it? Who do you think should change it, exactly? You’re making the classic mistake of assuming the US works like the average European country: a functioning democracy where if something makes sense, politicians will promise it in their manifestos, and then implement it once they get elected. In reality the US works completely differently and is not a functioning democracy. Making any major refor…

The only hope for reform in the US is to position it as furthering the transfer of wealth to the ultra-rich. Then, you might get some traction. But it’s hard to frame a legitimately good policy in these terms.

Re: Insurers rely on doctors whose judgments have been criticized by courts

#46

Post by tomrod » Mon, Dec 30, 2024, 4:26 PM UTC

_fat_santa wrote: post #40

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

> Why don't you change it? What are the reasons why moving to a single payer system is so bad? The best way I can describe our healthcare is that it's freakishly complicated, so complicated that pretty much every argument made by any side at any given time is both correct and incorrect. For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get im…

I mean, call a spade a spade. Single Payor can have programs set up to specifically address specific issues, like turnaround time to see a GP when sick (e.g virtual visits to clear up demand that can be routed that way).

Whereas the disjointed system the US currently "enjoys" STILL has GP rationing -- and worse, whole specialties disappearing or otherwise rejecting a payor because it sucks.

It's bogus that "single payor won't cover people in 60s/70s with chronic needs." That is 100% a policy decision. Versus the entrenched broken system we have now, where often needs are covered despite urgency.

Re: Insurers rely on doctors whose judgments have been criticized by courts

#47

Post by quasse » Mon, Dec 30, 2024, 4:26 PM UTC

_fat_santa wrote: post #40

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

> Why don't you change it? What are the reasons why moving to a single payer system is so bad? The best way I can describe our healthcare is that it's freakishly complicated, so complicated that pretty much every argument made by any side at any given time is both correct and incorrect. For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get im…

> For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling)

I am curious, why is this accepted as a "given" of single payer health care? I know it's a a problem in Canada and Britain, but those systems seem to be victims of something between neglect and outright political sabotage.

As a side note, my partner is currently about half way through a two month wait to see her GP in the good old US of A (on United Health Care). I would love to only have to wait a few days.

Re: Insurers rely on doctors whose judgments have been criticized by courts

#48

Post by cute_boi » Mon, Dec 30, 2024, 4:28 PM UTC

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

> The implicit question is – if everyone hates the current system, who perpetuates it? And Ginsberg answers: “Moloch”. It’s powerful not because it’s correct – nobody literally thinks an ancient Carthaginian demon causes everything – but because thinking of the system as an agent throws into relief the degree to which the system isn’t an agent.

Re: Insurers rely on doctors whose judgments have been criticized by courts

#49

Post by School-Cotton » Mon, Dec 30, 2024, 4:29 PM UTC

GiorgioG wrote: post #37

School-Cotton wrote: post #25

Earlier quoted context omitted.

> Why don’t you change it? Who do you think should change it, exactly? You’re making the classic mistake of assuming the US works like the average European country: a functioning democracy where if something makes sense, politicians will promise it in their manifestos, and then implement it once they get elected. In reality the US works completely differently and is not a functioning democracy. Making any major refor…

As an American born to European immigrant parents I can assure you that the grass is not always greener on the other side. All systems have problems. I say this as the parent of a child with a chronic illness (t1d) who is extremely frustrated with our health(insurance)care system.

Not everything is better about Europe than the US, I agree (and the extent to which this is true depends on where in Europe you’re talking about - Bulgaria is not much like Switzerland).

But one of the things that I think is unambiguously better (at least in highly developed Northern and Western Europe) is the quality of democratic institutions and their responsiveness to the people’s will. In the US, it is structurally almost impossible for Congress to legislate meaningfully, so effectively no one is in charge.

Re: Insurers rely on doctors whose judgments have been criticized by courts

#50

Post by htk » Mon, Dec 30, 2024, 4:30 PM UTC

afthonos wrote: post #21

azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

Excellent comment, succinctly summarizing how a systems thinking perspective translates the monster of health care in a large system of interconnected parts, each with its own stakeholders. Trying to change a single part triggers a reaction from everyone.

Tough ecosystem to change. But, at the same time, seems to be the one needing change the most.