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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

#181

Post by DangitBobby »

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

Anecdotal. Maybe I should compile a list of terrible US healthcare anecdotes so I can share 10 for every 1 I see here.

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

#182

Post by staticman2 »

ceejayoz wrote: post #164
staticman2 wrote: post #140

Earlier quoted context omitted.

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.

It's not that I'm defending our medical system, it's just that applying "medical malpractice" concepts to the practice of financing of procedures seems to me to be a bit of a stretch.

A doctor at an insurance company isn't deciding the "final call" on anything. The patient can pay for it without insurance, insurance company management could say "ignore the doctor and pay for it", the patient's medical team could say "You can't afford the procedure and insurance won't pay for it, that's okay we'll do it for free!"

It's not that I'm arguing against some way of holding insurance companies accountable, I just don't think what doctors are doing there is practicing medicine.

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

#183

Post by NickC25 »

s1artibartfast wrote: post #139
Spivak wrote: post #18

Earlier quoted context omitted.

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.

Cost control? Think about an insurance company for a moment.

They could pay their CEO less.

They could not engage in needless advertising.

They could refrain from paying dividends to shareholders.

The list goes on...

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

#184

Post by vladgur »

Yeul wrote: post #137
rscho wrote: post #64

Earlier quoted context omitted.

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.

The problem is that in the US we also pay for our neighbors who are on welfare and drug addicts.

Welfare -- my 30%+ federal income taxes

Medicare -- my income is taxed for it.

MediCal(California only) - my 10%+ state income taxes.

Uninsured/homeless goes to emergency room and hospital writes it off -- my 30%+ federail income taxes and my 10%+ state income taxes

City spends millions on homeless -- my 10% state income taxes and probably a bit of my property taxes.

On top of it, thousands per year of monthly medical insurance premiums for family of 3, thousands per year of "deductibles" before insurance kicks in.

This cannot be better than just paying high taxes and receiving high benefits for it.

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

#185

Post by geodel »

ClumsyPilot wrote: post #136
Workaccount2 wrote: post #89

Earlier quoted context omitted.

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…

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

And you seem very right to me. It is much better than bullshit that some propagate like "we can all be college educated, doing a high paying IT jobs, living in nice house in nice neighborhoods and so on.."

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

#186

Post by lostlogin »

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…

> We should train lots more providers and eliminate barriers to entry (so for instance, if someone wants to open an MRI suite, let them).

Is there something blocking them now?

Presumably you would still require qualified staff, safe and maintained equipment?

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

#187

Post by lostlogin »

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’d say it’s a family disorder we inherited.

A pre-existing condition? You’re not covered.

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

#188

Post by ceejayoz »

staticman2 wrote: post #182
ceejayoz wrote: post #164

Earlier quoted context omitted.

> 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.

It's not that I'm defending our medical system, it's just that applying "medical malpractice" concepts to the practice of financing of procedures seems to me to be a bit of a stretch. A doctor at an insurance company isn't deciding the "final call" on anything. The patient can pay for it without insurance, insurance company management could say "ignore the doctor and pay for it", the patient's medical team could say…

For a vast majority of people, and especially so with the sort of things that a) save lives and b) make the bean counters cringe, “won’t pay” is the same as “won’t get”.

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

#189

Post by DangitBobby »

staticman2 wrote: post #182
ceejayoz wrote: post #164

Earlier quoted context omitted.

> 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.

It's not that I'm defending our medical system, it's just that applying "medical malpractice" concepts to the practice of financing of procedures seems to me to be a bit of a stretch. A doctor at an insurance company isn't deciding the "final call" on anything. The patient can pay for it without insurance, insurance company management could say "ignore the doctor and pay for it", the patient's medical team could say…

If I hired a Hitman, if that fact were discovered I'd be prosecuted for murder or attempted murder, despite not pulling the trigger, despite not knowing if the intended target actually dies.

I don't think I can accept that people knowing or almost certainly knowing the outcome of their actions and taking those actions regardless should not responsible for the outcome under our legal system.

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

#190

Post by n4r9 »

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/

Surely some people do actually want suffering, or at the very least are indifferent to causing suffering to advance their goals? I don't feel like there's some weird paradox, but rather that the system makes it too easy for sociopathic types to rise to the top.
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