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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

#161

Post by dfxm12 »

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…

All of our systems are made by and for the rich. Not the doctors and certainly not the patients. This isn't limited to healthcare. When I say all systems, this includes government who make laws for lobbyists (who represent big business, like the insurance companies) and this also includes the media who ridicule the idea of socialized healthcare & the politicians who back it for all Americans as childish, impossible to pay for & socialist (as if that's a bad thing), among others. Even the political parties will withhold support from the few candidates who are realistically trying to make this happen.

Against these odds, our current healthcare system is very unpopular [0], and if you put it to a vote, we would probably get a more sane healthcare system, but again, realistically, it's not up to us, unless, over the course of ~6 years we constantly show up to both primary and general elections and vote for representatives who support it, and leave the corporate backed candidates in the dust.

0 - https://news.gallup.com/poll/4708/healthcare-system.aspx

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

#162

Post by DangitBobby »

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?

The US is not a democracy, it is an oligarchy.

> Multivariate analysis indicates that economic elites and organized groups representing business interests have substantial independent impacts on U.S. government policy, while average citizens and mass-based interest groups have little or no independent influence. The results provide substantial support for theories of Economic-Elite Domination and for theories of Biased Pluralism, but not for theories of Majoritarian Electoral Democracy or Majoritarian Pluralism.

1. https://www.cambridge.org/core/journals/perspectives-on-poli...

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

#163

Post by EliRivers »

derektank wrote: post #27
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…

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

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.

Why would they turn productivity improvements into lower costs, when they could instead turn them into higher profits? Big health insurers such as UHC practice "intercompany eliminations", as it's known; they own those providers you mention and use increasing charges there to get around the limits on how much of the insurance premiums they can keep for themselves. It's in their interests for the charges to go up, especially on anything that's actually cheap. Productivity improvements is just more profit to launder through the providers they own for the purpose of laundering those premiums.

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

#164

Post by ceejayoz »

staticman2 wrote: post #140
TheCoelacanth wrote: post #38

Earlier quoted context omitted.

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?

> Being an expert doesn't mean you are "practicing medicine".

Sure, but being paid by someone to make the final call if the patient should or should not receive their treatment team’s desired procedures should.

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

#165

Post by Sohcahtoa82 »

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…

> What are the reasons why moving to a single payer system is so bad?

Half the country (or at least, half the voters, which is only like 2/3rd of the country because so many don't vote) believes in rugged individualism and a Just World.

They see single payer as their tax dollars going to paying for someone else's health problems that they caused themselves. In other words, they'll complain about their dollars paying for a smoker's lung cancer treatment or an overeater's diabetic treatment. They think everyone's health problems are their own and don't want to pay for it.

The fact that when they pay for health insurance but don't make claims means their money goes to other people is completely lost on them.

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

#166

Post by EliRivers »

derektank wrote: post #95
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]

They get round this by what's called "intercompany eliminations".

UHC and chums simply buy the medical providers, and can then use them to launder people's premiums. UHC et al can only keep a maximum of 20% (? - I forget the exact figure) of the premiums; but if UHC simply own the hospitals, then money laundered through those hospitals via very high profit procedures etc become permitted profits for UHC.

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

#167

Post by DangitBobby »

blactuary wrote: post #147
ashoeafoot wrote: post #73

Earlier quoted context omitted.

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…

Any evidence that "most people" are given a voice into actual systemic change? I haven't been given an opportunity to vote for a candidate that actually wants to change our healthcare system, personally. Obama helped many people, but his moves did not really attempt to solve the problems of insurer inefficiency and grift, and instead codified their position as gatekeepers.

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

#168

Post by serjester »

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…

Any single payer system would significantly impact American's ability to choose their doctors, specific drugs, and procedures. Just look at the difference between dealing with an MRI for an injured knee in the US vs Canada - you're going to wait much longer in Canada.

Americans really value choice and access, so they resist anything that hints at “rationing.” As a result, costs keep climbing, and there’s an insane amount of money tied up in administrative overhead.

For anyone looking for a nuanced perspective on this, I highly recommend Peter Attia's interview with Saum Sutaria (McKinsey's formed healthcare lead).

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

#169

Post by liontwist »

ClumsyPilot wrote: post #144
jack_h wrote: post #110

Earlier quoted context omitted.

> 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 exam…

> who starves and dies.

It’s not a binary decision. Healthcare is a gradient of treatment options and outcomes. The concept you are missing is called economizing which includes substituting services, adjusting time preferences, sharing, expanding network of providers, etc.

> post-2008 fail-capitalism

You mean the one where government agencies were taking the risk of bad mortgages from sellers?

We don’t have anything close to a capitalist market in healthcare or finance.

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

#170

Post by DangitBobby »

dfxm12 wrote: post #161
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…

All of our systems are made by and for the rich. Not the doctors and certainly not the patients. This isn't limited to healthcare. When I say all systems, this includes government who make laws for lobbyists (who represent big business, like the insurance companies) and this also includes the media who ridicule the idea of socialized healthcare & the politicians who back it for all Americans as childish, impossible t…

Curious what drive-by down voters actually have to say about this. The entire block of text seems at least mostly true. I think it's fair to say the assumption that the USA is a functioning democracy is at the very least up for debate.
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