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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

#171

Post by dfxm12 »

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.

I think a lot of the "insanity" we see in both the US and UK and probably elsewhere can be traced back to lies from the consolidated & ubiquitous conservative media (specifically, guys like Rupert Murdoch).

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

#172

Post by nickff »

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?

Here's a link to a story where a Canadian woman waited three years: https://www.cbc.ca/news/canada/nova-scotia/halifax-woman-3-y...

Apparently the average in her province is about 14 months, about sixty times longer than you experienced.

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

#173

Post by DangitBobby »

HDThoreaun wrote: post #141
quasse wrote: post #47

Earlier quoted context omitted.

> 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.

We can use a designed system of allocation instead of defaulting to the class system.

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

#174

Post by like_any_other »

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.

I've heard this bunk before, that if it was not for extortionate pricing in the US, medical R&D would grind to a halt. Putting aside for the moment how inflated drug prices are only a small element of US health industry problems, let's re-examine the claim:

"If you don't pay my exorbitant fee, I will cut the part of my business that you need most.. but leave other parts alone?" - pharma spends more on marketing than R&D [1], but the propaganda never says "drug marketing is only possible thanks to high US prices", or "dividends", it's always "research".

How about this - drug R&D is only possible by high public spending on research, which is only possible because governments save money on healthcare: "Study: Public funding made up 97-99% of the R&D cost of Oxford Astra-Zeneca vaccine" - https://www.theguardian.com/science/2021/apr/15/oxfordastraz...

[1] https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

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

#175

Post by DangitBobby »

nickff wrote: post #172
alistairSH wrote: post #97

Earlier quoted context omitted.

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?

Here's a link to a story where a Canadian woman waited three years: https://www.cbc.ca/news/canada/nova-scotia/halifax-woman-3-y... Apparently the average in her province is about 14 months, about sixty times longer than you experienced.

We should probably not continue to wring our hands and allow our entire system to be the worst in the world based on FOMO anecdotes.

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

#176

Post by s1artibartfast »

Eumenes wrote: post #149
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

She's alive isn't she?

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

#177

Post by nradov »

maxerickson wrote: post #67
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 payment model probably isn't the biggest problem with the US system. My belief is that it's the relatively complicated regulation of capacity (federal and state regulations on facilities and providers), which pairs poorly with government programs that increase access to care with direct subsidies. We should train lots more providers and eliminate barriers to entry (so for instance, if someone wants to open an MRI…

I generally agree, but many states don't have certificate-of-need rules blocking new imaging centers and those states don't seem to have significantly lower healthcare costs.

The most immediate bottleneck on producing more physicians is lack of federal government funding for residency programs. Every year there are students who graduate from medical school with an MD but are unable to practice medicine because they don't get matched to a residency program (some do get matched the following year). At one point the AMA lobbied Congress to limit the supply of doctors but some years back they reversed that position. So far Congress hasn't acted.

https://savegme.org/

The other thing we can do to increase the supply of providers is to rely more on physician assistants and nurse practitioners for primary care. There may be some reduction in care quality but it's good enough for routine treatments and patients will just have to accept that. Real physicians should be reserved for more complex cases.

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

#178

Post by vladgur »

xiphias2 wrote: post #160
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…

While you are right and you have to work(and pay) to find good food in the US, I would not use airport food as a signal of nutrition availability anywhere in the world

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

#179

Post by DangitBobby »

SoftTalker wrote: post #125
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.

These insurance doctors are not really evaluating case particulars. They are not second-guessing the diagnosis, they are looking at whether the proposed treatment is the "standard of care" for the diagnosis, and that customary less expensive/invasive treatments have been exhausted. Medicare and any other potential "single payer" government plan would do this also because sadly fraud by clinicians does exist. For exam…

This is all just semantics. Arguably, the arbiter of what is "medically necessary" is practicing medicine. They have chosen to intercede in your care, and they should be liable for the decisions that they make leading to your health outcomes.

The legal system could just as easily have seen that the determination of which procedures are "medically necessary" is indeed part of medicine itself. It's a miracle of delusion and corruption that it went the other way.

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

#180

Post by ssivark »

Aunche wrote: post #135
cool_dude85 wrote: post #57

Earlier quoted context omitted.

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 tha…

When judging a system using the ROC curve, you need to evaluate both the precision AND the recall. You are pointing out that the precision is low, and must be improved; the article is pointing out that recall ought to be improved. Both are true, and we cannot use just one of the two metrics to evaluate system performance.

https://en.wikipedia.org/wiki/Receiver_operating_characteris...

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