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

141–150 of 262 posts

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

#141

Post by HDThoreaun »

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…

Incentives matter. If theres no downside to using a service people will use the service more. Single payer removes much of the downside to using medical care so people will look for medical care where they wouldnt before. To solve this single payer systems need ways to stop people from receiving care they dont need, and heuristics are imperfect so that will stop some people who actually do need care too.

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

#142

Post by HDThoreaun »

alistairSH wrote: post #97
_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…

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?

Where I live there are mri strip mall spots where you can just walk in. Same with dialysis.

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

#143

Post by s1artibartfast »

radlad wrote: post #68
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

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

Even vertically integrated hospitals, insurances and pharmacies still suffer from the cost issue, so I think a large portion of the problem is more fundamental.

I think a substantial part comes from low risk tolerance and opting for high quality low volume care

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

#144

Post by ClumsyPilot »

jack_h wrote: post #110
liontwist wrote: post #39

Earlier quoted context omitted.

> 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 s…

> if demand is greater than supply you must ration the supply somehow.

This is logic of post-2008 fail-capitalism instead of 1970’s and China’s aspirational, problem solving capitalism.

You don’t address shortages of healthcare, housing or food with an elegant and fair system to decide who starves and dies.

You expand supply to make sure no one has to. You examine supply chain and figure out the bottlenecks.

For example China has started mass producing MRI machines, that’s one way you adress a problem.

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

#145

Post by thayne »

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.

> Either private insurance companies aren't interested in lowering costs

They aren't. Since their profits are capped at 20%, reducing costs means reducing profit as well, so they are actually incentivised to keep costs high.

> their claims process is so arduous that providers demand higher rates to deal with the high rate of denials and ever changing minutiae.

I think this is also the case

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

#146

Post by JusticeJuice »

giantg2 wrote: post #100
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.

I can't speak for Denmark, but I can speak for New Zealand, which has similar spend, and similar results (compared to the US). I wrote a thesis about healthcare software in uni, but as part of that I interviewed a bunch of people across the NZ healthcare industry, and learnt a lot about it.

A big efficency for NZ is 'pharmac', which is essentially a country-wide medicine subsidizer, and supplier. It's a government entity which figures out how much of a certain drug the entire country will need for say a month, then goes and buys it, in bulk on the international market. Making such a large purchase gives them really good bargining power, and they'll buy generic versions. Not all drugs are pharmac covered, but most are. It means there's not much profit margin for drug supply in the system.

The system is setup into 'district health boards'. Their job is to manage the health of everyone in a geographic area, and this means both in hospitals, and in primary care (your local doctors office). Because of this, they see the cost of their entire system, and are incentivised to optimise the care overall, as opposed to say a private hospital, and a private doctors office optimising their individual businesses.

One way this manifests, is putting a big focus on getting people to go to primary care, instead of hospitals. Hospitals are the most expensive thing in the system turns out, so they'd much perfer people get to a primary care doctor sooner, before something becomes an issue that requires hospitalization. So they're incentivised to keep doctors visits cheap, and accessible. This comes into play quite a lot with elderly care, they make up a huge amount of primary care visits - but if they don't become hospital visits, that's great.

You mentioned drug use. That's an interesting one as that's a government-wide issue, not just a healthcare issue. It affects poverty, education, emergency housing, the economy as a whole. There's been a big focus on public education, and actually ad campaigns about tabacco and alcahol, trying to make them seem really un-cool. And it's sort of been working, smoking rates are down, I'm not sure about vaping rates though. Meth is a big issue in NZ, but opiate/painkiller abuse is uncommon (compared to the US).

One general point though, is there's not much profit oppertunity for companies in the system. As the majority of money comes from the government, the funding is very standardized. Running a doctors clinic or say a pharmacy is just like running a small business, with the same oppertunities. There just isn't huge 'startup' oppertunities to find a killer product and turn a huge profit. Profit isn't taken at every point of the supply chain in care.

NZ's system has flaws, but overall I'm really pleased with it, and glad that we have it.

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

#147

Post by blactuary »

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?

Most people know the overall system sucks, but they also think their insurance is mostly fine because they haven't had to use it very much (which is simply definitional, 80% of costs come from 20% of people). And so people fear the unknown. They would like something better but fear giving up what they have right now for something they haven't experienced. It is also a deeply personal issue, and has so many entrenched interests. Health care spending is 1/3 of our economy.

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

#148

Post by HDThoreaun »

fetzu wrote: post #75
radlad wrote: post #68

Earlier quoted context omitted.

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

That’s correct. And I still baffles me that no substantial improvements have been made in that problem space. My grocery shop has a LLM powered Robo-assistant, and doctors are still copy-pasting (or even worse, re-inputting them by hand) text between various pieces of software on a daily basis. I understand regulation plays a good role in that, but I can’t believe that it is the only reason..

LLMs are absolutely being used in medical transcribing. A doctor I know was just raving to me about Epic's new system. Now instead of staring at the computer during the whole appointment he has the epic LLM fill out the report from his notes and does brief editing which allows more face to face time.

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

#149

Post by Eumenes »

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 would I trust what Denmark does? This was Denmark's Minister of Health, a severely obese woman: https://en.wikipedia.org/wiki/Maggie_De_Block

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

#150

Post by Aunche »

ceejayoz wrote: post #98
throw10920 wrote: post #44

Earlier quoted context omitted.

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 lowe…

To be clear, I'm not blaming the ACA for increased healthcare costs. Most people get insurance that is self-funded by their employer where the mandated loss ratio doesn't apply. The incentive for insurers to overpay for care has always existed, but the loss ratio mandate makes it easier to illustrate.
Post reply on HN