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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

#151

Post by WarOnPrivacy »

afthonos wrote: post #21
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…

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

> every party of the system is perfectly fair and reasonable for the people benefitting from it

This observation has value. However, if we hold it exclusively in mind we might lose focus of how prioritizing consumers strongly benefits society.

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

#152

Post by DangitBobby »

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…

We already are doing rationing, it's just the rations are distributed according to our class system instead of any reasonable metric.

Everyone already pays for heavily for it, much more than necessary due to the grift.

These things are conceptually simple and much easier for a bureaucracy to handle than the current dumpster fire. It's actually only impossibly hard for us to solve because entrenched power and corruption mean few politicians are actually particularly interested in making the changes necessary to fix it, and those who are are excluded from the democratic process by gatekeepers.

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

#153

Post by cjbgkagh »

travisgriggs wrote: post #111
cjbgkagh wrote: post #28

Earlier quoted context omitted.

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.

I’m not sure how one would define “the size of government” but the ILO says differently at least: https://worldpopulationreview.com/country-rankings/public-se... (Wikipedia has a similar page, but not as navigable imo) I scroll through a lot of European countries before getting to the US at 13.4%. I think the healthcare (and other) systems suck because they are complex. There are two ways to hid information: lock it…

Well clearly absolute staffing numbers would work, but I would go by absolute money spent.

I think it's ironically reductive to simplify a complex problem to a general problem of complexity.

I'm not sure what your point is, we appear to agree that the system is corrupted and that there is regulatory capture. My point is that the US government shouldn't be used as an example of a small government in general and for healthcare specifically. Even if I was to agree that the US should adopt an European healthcare system I don't see how to uncorrupt the existing system to enable that to happen. This notion that a government takeover will take the money out of the system and diminish opportunity for greed is fanciful.

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

#154

Post by gmerc »

GiorgioG wrote: post #37
School-Cotton wrote: post #25

Earlier quoted context omitted.

> Why don’t you change it? Who do you think should change it, exactly? You’re making the classic mistake of assuming the US works like the average European country: a functioning democracy where if something makes sense, politicians will promise it in their manifestos, and then implement it once they get elected. In reality the US works completely differently and is not a functioning democracy. Making any major refor…

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.

Classic diversion. Healthcare is better in Europe. That's the topic.

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

#155

Post by giantg2 »

JusticeJuice wrote: post #146
giantg2 wrote: post #100

Earlier quoted context omitted.

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 en…

Thanks for the detailed response!

In the US, Medicare is doing negotiation for meds for those in the program. There is talk about expanding that bargaining.

The ACA was trying to get people into primary care early. I'm not sure how big of an impact that made. At least in my experience, the primary care is hard to get on short notice in my area - takes 1-4 weeks depending on different things. One big seems to be that the offices Tru to increase throughput and keep their schedule booked solid to make money based on what the insurance will pay per visit (eg maximize visits). I wonder how NZ deals with the availability part if prices are set. I would think the incentive would be similar.

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

#156

Post by hallway_monitor »

kfarr wrote: post #117
afthonos wrote: post #21

Earlier quoted context omitted.

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

There's an old essay "Meditations on Moloch" which is an exploration of themes around why humans create systems with destructive outcomes even when no individual wants them: https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

This is a really good read. It talks about all kinds of systems which become their own entity. Nobody likes them. They make things worse for everybody. But somehow we get trapped in these downward spirals and there’s seemingly no way out.

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

#157

Post by DangitBobby »

joe_guy wrote: post #107
ceejayoz wrote: post #72

Earlier quoted context omitted.

> 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.

It's not so much about agreeing as their paychecks being dependent on the current solution.

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

#158

Post by namuol »

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?

Bribery is legal.

https://en.m.wikipedia.org/wiki/Citizens_United_v._FEC

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

#159

Post by NickC25 »

Der_Einzige wrote: post #62
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

[flagged]

Luigi went back to the drawing board, and seems to have found a way to get health "insurance" executives quite freaked out to the point where some of their proposed changes for 2025 were quietly walked back.

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

#160

Post by xiphias2 »

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…

Healthcare is incredibly complex because currently all technologies we have just make living longer exponentially more expensive with every added year.

But one thing is clear: it's easy to improve the nutrients that people in the USA take.

Whenever I travel in to USA, in the airports I can't even find a simple salad or any real food, even though I can see lots of pictures of salads, which drives me crazy.

Last year I went through Atlanta airport, I bought a hamburger because they didn't have literally any other food at 10pm, and I thought I would just throw away the buns and eat the salad + maybe the meat (depending of the ingredients). Then I looked at the ingredients and it was like 50 things that I didn't even know what they mean. It didn't smell or taste like food at all, so at the end I found 1 year old nuts in my bag that my mom packed a year earlier, and I ate that.

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