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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

#91

Post by kstrauser »

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…

As an American watching Brexit and other self-owns pouring out of the UK, I’m not completely sold on this. If our system is insane — and it is — I’d say it’s a family disorder we inherited.

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

#92

Post by jandrese »

hahamrfunnyguy wrote: post #3

These "doctors" should be barred from practicing medicine. I am not a lawyer, but it would seem that this practice also borders on criminal negligence.

Or maybe the opposite. The doctors should be turned into GPs who then have to deal with insurance companies to get paid for their work.

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

#93

Post by toasted-subs »

The entire medical system when it comes to the court system is unbelievable. I live in one of the largest medical centered cities in America.

Yet I had multiple doctors tell me and did things to me other doctors told me should be considered medical malpractice.

When I went to try to sue I found there's literally one judge who could deal with it but they refuse to even try to deal with my case in the court system.

Then the doctors try to shame me for dealing with my issues without taking the meds which the Doctors themselves told me would make my situation worse.

Instead I get a ride through Charlie's Chocolate factory showing me how America works.

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

#94

Post by Workaccount2 »

ceejayoz wrote: post #74
Workaccount2 wrote: post #60

Earlier quoted context omitted.

The tragedy at the heart of this "hate health insurance companies" is that they aren't even very profitable businesses. Their margins are actually below average, and pretty poor investments compared to things like tech and finance.

Walmart has low margins, too. Still a very profitable business, because the raw revenue numbers are so huge. The same applies to health insurance.

Right, but with a low profit margin you get stagnation and monopolies.

No one is looking at absolute raw numbers, investors/owners usually only own small slices, so they care about what percentage return they get.

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

#95

Post by derektank »

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

[flagged]

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

#96

Post by costcopizza »

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

I wonder why this is getting downvoted as I've had this exact same thought.

A most efficient insurance program would be a closed loop.

Any leftover money not spent on care would be used to reduce premiums the following year and/or be saved for higher claim years.

I wonder how that could exist in the US? Perhaps these health sharing ministries are as close as we'll get: https://www.medishare.com/

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

#97

Post by alistairSH »

_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…

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)

Not true today in the US. It took me ~7 days to get an MRI of my hip. And have you tried getting into see an endocrinologist lately?

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

#98

Post by ceejayoz »

throw10920 wrote: post #44
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... ?

> This is one of the drivers of cost disease...

The ACA (with this new 80/20 provision) passed in 2010.

Costs have been on a steady upward march (yes, adjusted for inflation) since the 1970s. https://www.healthsystemtracker.org/chart-collection/u-s-spe...

The "Average annual growth rate of GDP per capita and total national health spending per capita, 1970-2023" chart even shows the 2020s as the first decade with lower increases in healthcare spending than corresponding GDP growth.

This theory seems... unlikely as a result. (Cost disease itself is certainly an issue; I merely very much doubt its attribution to this particular provision. Obama didn't have a time machine.)

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

#99

Post by JusticeJuice »

throw10920 wrote: post #44
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... ?

That was a really interesting read, thanks for linking.

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

#100

Post by giantg2 »

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 questions that I like to ask first when comparing systems to the US is, what is Denmark doing to reduce/prevent obesity and drug use, and what does elder care look like? There are certainly things that could change in the system, and it would be great to see what practices other countries have for some of our biggest cost drivers.
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