Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Insurers rely on doctors whose judgments have been criticized by courts

propublica.org

Post reply on HN
Print view View original

101–110 of 262 posts

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

#101

Post by mightyham »

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…

Our healthcare system is complicated by the fact America has much larger wealth disparities and more complex regulations stemming from a republican government with disparate laws among the states. Also the baumol effect: America has a significantly more developed tech and finance sectors compared to Europe which inflates the cost of less productive service based industries like healthcare.

The system can't be "just changed" because it's a very complex issue with a lot of entrenched interests. There has to be sufficient political will at the top levels of government that simply doesn't currently exist (in either the Democrats or Republicans).

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

#102

Post by thanksgiving »

costcopizza wrote: post #96
asdf6969 wrote: post #36

Earlier quoted context omitted.

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/

I like the wording leftover money. My index fund has an "expense ratio" of 0.06% or something like that. Any money that doesn't go toward a patient directly, including everything from CEO bonus to call center expenses should be added as an expense that does not go directly to the patient and this expense ratio should be advertised front and center everywhere.

However, I don't think the problem is truly fixable without Medicare for all or similar single payer scheme. There is just a huge gap in not just bargaining power but just knowledge of the market information between the seller (hospitals and health care providers) and the buyers (sick people) that a free market solution can't even work in theory. Even if you ignore the fact that I can't exactly shop around when I have an emergency any more than I can shop around when my house is on fire. The only viable solution is single payer and the sooner we get there, the better for everyone.

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

#103

Post by convolvatron »

Workaccount2 wrote: post #89
kaikai wrote: post #61

Earlier quoted context omitted.

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.

you're suggesting that the entire difference in cost/benefit between the US and EU model is due to research and development? that seems wildly unsubstantiated. the google blurb puts it at 6% of US spending, but its unclear how much of that is actual research and how much is product development and marketing.

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

#104

Post by kevinob11 »

Workaccount2 wrote: post #60
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.

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.

Tragedy?

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

#105

Post by derektank »

inferiorhuman wrote: post #51
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

The conversion factors for private insurance are 2–3x those of Medicare. There's plenty of room to lower costs. Either private insurance companies aren't interested in lowering costs or their claims process is so arduous that providers demand higher rates to deal with the high rate of denials and ever changing minutiae. Providers are not the problem here.

Pharmaceutical companies and hospitals both have much higher profit margins than insurance companies and represent a much larger share of the total cost of healthcare than insurance companies so while I don't think they're the entire problem, they are at least part of it. You and another commenter make a good point regarding inefficiencies in claims processing but I'd be curious to know how substantial that is relative to the entire cost of care.

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

#107

Post by joe_guy »

ceejayoz wrote: post #72
ernst_klim wrote: post #58

Earlier quoted context omitted.

Like where? UK system is collapsing under underfunding and misallocation, German system is crumbling under terrible lack of personell with raising (already high) costs with lowering quality and increasing waiting times (up to infinite where mamologs and psychiatrists simply take no new patients in many cities). Basically in all thirst world countries trend is negative unless and experience is frustrating unless you a…

> UK system is collapsing under underfunding and misallocation Fifteen years with the "let's privatize everything!" party will do that, yes.

This goes back to what a parent commenter said

> I suspect because nobody can agree on what the new replacement system should look like.

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

#108

Post by rqtwteye »

Question for the techies here: Due to lack of political will and deep-seated corruption I believe a lot of issues in the US system are almost unfixable but I always wonder why it has to be so convoluted (besides being hyper-expensive).

Why can't the insurers have an app where the patient (or the provider) can type in the procedure codes they are planning to use and then the insurer returns the co-pay, co-insurance and other cost based on the plan the person is in? The insurer must have these systems already internally so why not mandate to give access to the calculations to patient? I had several occasions where I tried to figure out how much something would cost and the answer was "we can only tell you after the procedure was done".

This seems to be totally doable to me.

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

#109

Post by geodel »

ernst_klim wrote: post #58
Ylpertnodi wrote: post #35

Earlier quoted context omitted.

There are several functioning examples in Europe, 'they' could take a look at.

Like where? UK system is collapsing under underfunding and misallocation, German system is crumbling under terrible lack of personell with raising (already high) costs with lowering quality and increasing waiting times (up to infinite where mamologs and psychiatrists simply take no new patients in many cities). Basically in all thirst world countries trend is negative unless and experience is frustrating unless you a…

It is same with housing where US housing market is supposedly worse compared to Asia, Europe, Australia or anywhere. Despite clear evidence that housing is increasingly more expensive all over the world. In places where people don't earn half or one-third of US, homes are sometimes more expensive than US. And there is no NIMBYism or bad regulations there to cause high prices.

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

#110

Post by jack_h »

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…

> Because money is just a tool for allocating resources. > often devolves into rationing

Just to expand upon what you're saying a bit; most people don't view things in such terms which I think is unfortunate. You often see discussions about waiting times in single payer healthcare systems and cost in more free-market systems. The fact of the matter is that if demand is greater than supply you must ration the supply somehow. Prices are one way but not the only way. Waiting lines, by need, randomly, etc... are all valid rationing mechanisms as well.

What I've noticed is that when people don't view this is a resource allocation problem they are able to always see the greener grass somewhere else. They see the lack of treatment of a person or group of persons as a failing of their system where those people would have received treatment in a different system that uses a different rationing mechanism. The issue is that in a different system there would still be people who don't receive treatment, they would just be different people.

By not viewing it as a resource allocation problem I think it gives the appearance that there is a perfect solution and that its just political will halting its implementation.

Post reply on HN