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Insurers rely on doctors whose judgments have been criticized by courts

propublica.org

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

#81

Post by liontwist »

liontwist wrote: post #39
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 does each of these cost tens or hundreds of thousands of dollars? Because money is just a tool for allocating resources. And having well trained people with equipment ready to attend to every person in that situation requires a lot of resources. I’m not justifying our systems inefficiency - let’s just be clear that medical care costs a lot of money. So the challenging political question is how to manage access…

Note that what constitutes healthcare is culturally defined. Different groups have varying expectations of procedures which is then conflated with other services.

When my baby was born my wife and I stayed in the hospital for two nights during which we received constant checks and meals. I was ready to go because my baby was healthy and I knew it was expensive.

Is this level of service required medical care? I don’t think so. Many choose to have a medical professional at home to help with a delivery for a day or so.

If it is deemed required, how many nights should be offered? I’m sure people with a bad home environment would stay as long as they could. If we set a hard cap of a few days, that’s also bad because some babies need to be at the hospital and it’s very helpful to have that.

Alternatively imagine if the beds are occupied who don’t really need to be there and then a new baby needs to be born?

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

#83

Post by betenoire »

ashoeafoot wrote: post #73
asdf6969 wrote: post #30

Earlier quoted context omitted.

> Why don't you change it? There is no general “you” with agency. The few people who have the ability to change it have no incentive to do that.

80% majority in a democracy can not change whatever they want? Or.. the ideology people inhalate is so strong ,it hacks democracy itself?

agreeing to change and agreeing how to change aren't the same thing at all though

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

#84

Post by FireBeyond »

cool_dude85 wrote: post #57
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…

Nobody, not this article or any other reasonable person, thinks that claim denial is the reason healthcare is expensive. Rather, they think it is fundamentally fraudulent that someone can pay their premiums, etc. and then when they need treatment, be arbitrarily denied by an in-house doctor employed by their insurer to deny treatment. This is a story of the fraud in the health insurance industry, not the racket part…

> be arbitrarily denied by an in-house doctor employed by their insurer to deny treatment.

Oftentimes by a doctor who cannot or doesn't practice in "the real world" (some physicians employed by insurers go straight to working from them after becoming licensed). Or a nurse (technically with "oversight" by a doctor who might "supervise" the decisions of dozens of nurses or more).

And now these companies if not using AI directly, will present these providers "notes" along with the claim for review with an AI summary, replete with hallucinations, as bullet points "guiding" them towards the "correct" decision.

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

#86

Post by ashoeafoot »

cjbgkagh wrote: post #28
bgnn wrote: post #23

Earlier quoted context omitted.

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.

The US should not be used as an example of a small government. Some people in the US may profess to wanting a small government, but they definitely don’t have one. Haven’t run the numbers but I would suspect the US government is the largest government in human history.

You goto seperate the imperial machine of world policing (paid in the dollats used and held by the world for trade)from the government managing the citizens of the us (parially paid in taxes by the citizens)

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

#87

Post by FireBeyond »

clcaev wrote: post #24
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…

> The ACA mandates that at least 80% of premiums must go towards medical expenses. This is not precisely accurate. The medical loss ratio (80% for individual plans) can also be spent on quality improvement. There is a blurry line between administrative costs and QI initiatives. For example, a plan-provided coordinator could be QI rather than administrative.

Now all that money will go into AI QI bots and training...

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

#88

Post by xyst »

ceejayoz wrote: post #2

This seems like a good spot to start with policy changes: > In interviews with ProPublica, federal judges criticized a system that fails to address problems that arise in court case after court case. They faulted the Employee Retirement Income Security Act, which governs many insurance claims in court, for not allowing for punitive damages, the sort that can rise into the millions of dollars and deter companies from…

Middle class Americans have been dealing with this awful middleman for decades. Peaceful protesting got us nowhere. Politicians are bought by these conglomerates. Court systems give these companies a slap on the wrist.

Only thing I have seen work: full sending 3 bullets into a healthcare industry CEO. The subsequent public indifference was quite eye opening. Didn’t matter if you identified as Liberal, Democrat, Progressive, Conservative, Republican - it was a unified response across the nation. Conservative talking heads getting ripped apart by own audience for being “out of touch.” Democratic leaders (Tim Walz for example) getting ripped a new one for fake sympathy.

We are well beyond “policy changes”, especially as we go into this next administration.

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

#89

Post by Workaccount2 »

kaikai wrote: post #61
Workaccount2 wrote: post #54

Earlier quoted context omitted.

[flagged]

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.

The problem with the European system is that it is contingent on the American system keeping the status quo. Without high prices in the US, European governments can't negotiate for the same lower prices.

The US is a goldmine for medical corporations, which the EU gets to ride on the coat tails of.

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

#90

Post by School-Cotton »

ashoeafoot wrote: post #79
School-Cotton wrote: post #56

Earlier quoted context omitted.

Who is “they”, exactly? What specific group of people do you think is in charge of the system and should do this?

We, the people ?

The US isn’t a pure direct democracy with referenda on every topic, so what does that mean, concretely? Who specifically should take what action?
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