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Insurers rely on doctors whose judgments have been criticized by courts

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

#61

Post by kaikai »

Workaccount2 wrote: post #54
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…

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This is just as true for the European systems in the comment you’re replying to as it is in the American system. The problem is political.

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

#62

Post by Der_Einzige »

asdf6969 wrote: post #36
derektank wrote: post #27

Earlier quoted context omitted.

You can negotiate all you want but ultimately the productivity improvements have to come from providers (hospitals, pharmaceutical companies) if you want to lower costs. There are ways to make insurers better agents (one simple step would be to make their customers the actual patients, rather than the employers of patients) but I'm not sure how much power they actually have to keep costs low

Every dollar of profit an insurance company makes is an unnecessary cost. It should be returned to the customers because it means they were over charged. That’s the biggest opportunity for cost savings

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

#63

Post by GiorgioG »

School-Cotton wrote: post #49
GiorgioG wrote: post #37

Earlier quoted context omitted.

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 structura…

At very least the French and Italian people would disagree (I’m French and Italian).

Seems like folks across Europe were pretty upset with the number of asylum seekers and the problems that followed their migration into Europe in the last couple of years. Their governments didn’t seem to give much of a shit and that’s led to more right-wing support.

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

#64

Post by rscho »

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…

Health culture in the US and Danemark are complete opposites. I mean how common people think about the system, and their expectations. Americans basically do not want to pay for anyone else than themselves. Europeans expect a strong social safety net, and accept higher taxes. So, you can't apply the danish system in the US. It would be anathema for a large part of the US population.

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

#65

Post by Spivak »

derektank wrote: post #29
Spivak wrote: post #18

Earlier quoted context omitted.

I mean I guess but it would still be a huge improvement in real people's lives if the burden was flipped and insurance companies had to prove fraud to deny a claim. I think we want the opposite when it comes to negotiations and want instance companies to all have to pay out the cash price. The first step to making it possible to not need insurance for most care is making everyone pay the same.

It would be an improvement until premiums increased and/or there was a shortage of services, likely in the form of longer wait times. That would be a net benefit for some patients and a net loss for others.

Given that claim denials most often happen after the services are rendered the shortage issue is probably not that significant.

But nonetheless health insurance being affordable only because insurance companies can simply choose to not provide service to their customers and if people stopped forgoing necessary medical care there would be shortages aren't I think the points you think your making.

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

#66

Post by Aromasin »

_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…

But that second argument of "saving grandma" isn't an issue in Europe either. You think we just abandoned old people with difficult health care needs to the dogs? They get first class care in most European countries - if anything, the issue is the reverse of what you describe. Most young people resent how much they pay in tax for a system they rarely use, while the elderly spend much of their geriatric life bed bound in hospital getting 24/7 care, all for free on the working person's dime despite them being long retired with no private health coverage. I'm typing this right now from a general practice surgery in the UK. The place is full the brim with older people getting local treatment, fast. I booked this morning and they're seeing me the same day. Much of what Americans get fed on the news about waiting lines is exaggerated from the days of Covid. For most services you get seen in a few weeks. My local allergy checks happened within a week. I broke my ankle playing rugby a few months ago and was seen, xrayed, got surgery, and was out the door within 48 hours. Some specialisms are still struggling to get through the backlog of patients, but it's just that - a backlog from when all the surgeries were closed and running on no funding because everything went into Covid-19 treatment.

If you're so concerned about not getting the latest and greatest treatment, in the UK private and public health care have started to work progressively more hand in hand. My family are all covered by my private insurance through work. We get consultations online through an app, and they refer us to either and NHS surgery or a private one, depending on which is fastest and has the best health outcomes. That's a privilege not everyone has, but everyone gets the next best thing which is free universal health care covered by all tax payers - corporate and individual.

This "decision" that you seems to think exists isn't one. We get the best of both worlds - a society where the poor don't fight tooth and nail for health care with the risk of becoming forever indebted and subjected to poverty, and the rich get whatever level of service they're willing to pay for.

Personally, I think you're all fed a lot of propoganda by folks that make a lot of money out of the misery of your healthcare system.

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

#67

Post by maxerickson »

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…

The payment model probably isn't the biggest problem with the US system.

My belief is that it's the relatively complicated regulation of capacity (federal and state regulations on facilities and providers), which pairs poorly with government programs that increase access to care with direct subsidies.

We should train lots more providers and eliminate barriers to entry (so for instance, if someone wants to open an MRI suite, let them).

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

#68

Post by radlad »

derektank wrote: post #27
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…

You can negotiate all you want but ultimately the productivity improvements have to come from providers (hospitals, pharmaceutical companies) if you want to lower costs. There are ways to make insurers better agents (one simple step would be to make their customers the actual patients, rather than the employers of patients) but I'm not sure how much power they actually have to keep costs low

A huge amount of physician / provider time (cost) is dedicated to insurer billing, coding, and documentation.

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

#69

Post by [deleted] »

Workaccount2 wrote: post #54
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…

[flagged]

[deleted]

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

#70

Post by kaikai »

quasse wrote: post #47
_fat_santa wrote: post #40

Earlier quoted context omitted.

> 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…

Right? It took me a year and a half to find a GP accepting new patients and get my first appointment. I’m in the US. Getting pre approvals and appealing denials has delayed my care multiple times in other situations.
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