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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

#131

Post by ClumsyPilot »

kstrauser wrote: post #91
School-Cotton wrote: post #49

Earlier quoted context omitted.

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.

Spot on.

I saw this as an immigrant to UK from a developing country, who only recently understood what he signed up for

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

#132

Post by s1artibartfast »

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…

Cost controls are a necessary part of the US system, and European single payer systems as well.

The primary difference is that the US system puts the patient in-between the doctor and payer.

Alternative systems usually sort this out by simply denying or allowing the treatment without the patient in the loop

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

#133

Post by HDThoreaun »

asdf6969 wrote: post #30
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? There is no general “you” with agency. The few people who have the ability to change it have no incentive to do that.

Dems in the last two elections before this one have had a single payer candidate. Both times the dem primary voters rejected him. If people want single payer they need to vote for it.

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

#135

Post by Aunche »

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…

Again, zeroing in on these denials is missing the forest for the trees. It's the entire claims process that is incentivized to dysfunctional. Insurers are paying for unnecessary chiropractic adjustments, name-brand prescriptions as a first resort, and the more expensive private rooms that hospitals like to build these days over shared ones. Occasionally, they'll fail to provide life saving care, but they can spin that into a win because that will give them an excuse to increase premiums even higher.

Psychiatric issues, which this Propublica article is about, are already being over-treated even though it may be under-treated in other aspects. Focusing only on these cases of denial may cause under-treatment to go down, but at a cost of much higher over-treatment, which comes out of everyones premiums. I don't think anything wrong with SSRIs or stimulants being used as medication, but clearly something wrong with the way we're prescribing them when despite being the largest consumers of them, Americans suffer more poor mental health outcomes.

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

#136

Post by ClumsyPilot »

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.

> Without high prices in the US, European governments can't negotiate for the same lower prices.

This sounds like total Copium. It is also remarkably anti-market, suggesting that negotiating well is actually bad.

I could invent similar argument for why it is people in the global south that deserve credit for democracy in the west. Or for anything really:

The problem with western democracy is that it is contingent on the Global south being totalitarian and penniless. Without cheap raw materials from the non-west, western governments can’t maintain the high standards of living required for a stable democracy.

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

#137

Post by Yeul »

rscho wrote: post #64
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.

This is the crux.

Rich people in Europe have "noblesse oblige". Yes you have to pay for your neighbour who is on welfare and a drug addict. Deal with it.

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

#138

Post by HDThoreaun »

cute_boi wrote: post #48
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.

The problem is that not everyone hates the current system. Doctors in the US are paid exceptionally well because the system limits their supply. They can admit the system is horrible while also benefitting themselves. Healthcare is 17% of US GDP so there are huge incentives to not change anything from the people collecting that money.

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

#139

Post by s1artibartfast »

Spivak wrote: post #18
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…

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.

Claim denial isnt about (mostly) fraud prevention. It is about cost control.

Doctors and patients have no incentive to control cost and select cheaper and inferior treatments.

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

#140

Post by staticman2 »

TheCoelacanth wrote: post #38
staticman2 wrote: post #14

Earlier quoted context omitted.

In many circumstances denying care is not malpractice. Even a doctor saying "I'm not taking on new patients" is technically denying care.

That's a very different scenario than a doctor who is being paid to provide an expert opinion on the medical necessity of care. That obviously should be considered practicing medicine with all the normal liability.

Being an expert doesn't mean you are "practicing medicine". Suppose the medical standard is "you must examine the patient in person when creating a treatment plan."

We're going to apply that to some insurance job function operating outside standard medical practice how exactly?

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