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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

#191

Post by makeitdouble »

serjester wrote: post #168
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 am…

Even in Canada you can pay more to get better or faster care. You'll always have overpriced options that by definition won't be worth it for people who can wait, and you can shop around the world if it's not an super emergency and you're really willing to spend.

If that doesn't resonate, it's the same as schooling: you can have good and cheap public schools accessible to everyone, and private schools that will cost 5~20x more but provide a significantly different education.

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

#192

Post by GiorgioG »

gmerc wrote: post #154
GiorgioG wrote: post #37

Earlier quoted context omitted.

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.

Reading comprehension might not be your strong suit. The parent was arguing about the effectiveness of governments.

I wholeheartedly agree healthcare in Europe is better, but not everything is better there.

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

#193

Post by unyttigfjelltol »

lostlogin wrote: post #186
maxerickson wrote: post #67

Earlier quoted context omitted.

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?

Yes, Congress and the American Medical Association capped the number of new doctor trainees in 1997.[1] That is one cited reason why there is a serious shortage of medical doctors in the US.

[1] https://www.openhealthpolicy.com/p/medical-residency-slots-c...

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

#194

Post by unyttigfjelltol »

vladgur wrote: post #184
Yeul wrote: post #137

Earlier quoted context omitted.

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…

While technically true, hospital sticker prices actually are extreme because hospitals try to impress insurers with gigantic discounts off a fictitious base price, which no one pays except the unfortunate middle class person who finds themselves in an emergency without adequate health insurance.

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

#195

Post by mindslight »

nradov wrote: post #177
maxerickson wrote: post #67

Earlier quoted context omitted.

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 d…

> 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.

Every efficiency idea is ultimately just used as an excuse to make the system worse and worse. As it stands "real physicians" are already mostly phoning it in, because their attention has been sliced up into 10 minute slivers by "insurance" companies. I'm not saying that NPs or PAs are going to be worse than that (in fact individual NP/PAs can be more engaged than individual MDs!), but it's still galling to be on the receiving end of negative-sum cost optimization - "our next appointment with a doctor is in four months, or you can see a PA next month".

The sweeping reform we need is to drastically introduce actual market dynamics into the industry. This applies regardless of the payer structure - the entire industry needs to be moved from cost-externalizing negative-sum interactions towards cost-internalized positive-sum interactions. Imagine having actual supply and demand for doctors and hospitals funding their own residency programs rather than a set number of government funded residency slots.

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

#196

Post by Aloisius »

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…

> This means that insurers are actually incentivized to overpay for care to maximize the size of their 20% slice.

I'm confused. If that's the case, then why would they deny coverage? Wouldn't that be an easy way to overpay?

Heck, they could simply allow everything through and use rising costs as a justification to increase premiums.

This nefarious scheme of course requires insurers to have no competition. After all, if your competitors don't overpay, then they can lower rates and steal your customers.

The truth of the matter is that hospitals and doctors try to maximize their profits through excessive billing and care little about cost efficiency. They don't try this at the same rate with medicare/medicaid both because the government does not generally negotiate - reimbursement schedules are largely fixed and because defrauding the government is a criminal rather than civil offense.

There are some easy fixes here and there. We could, for instance, ban price discrimination by healthcare providers. Every payer would then pay the lowest accepted rate - which is usually medicaid or medicare's. This won't prevent billing for medically unnecessary or inefficient services, but it would eliminate the negotiation problem.

The problem is political. If you save a trillion dollars a year in healthcare costs, the GDP gets lowered by roughly the same amount. Healthcare providers would, of course, fight to prevent any reduction in reimbursements from happening - which they've been extremely effective at historically.

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

#197

Post by makeitdouble »

serjester wrote: post #168
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 am…

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

The taste I got of it (introduction bit)

https://youtu.be/QqrpFICtqpQ?si=iqrhOc6lvELGuzvV

A definition of insurance that doesn't seem to understand how randomness can be upon the group instead of the individual. A person in his situation can't be so grossly misunderstanding pooling risk over a population.

I've skipped here and there among the multiple videos to get a better feeling of the whole interview, but to be blunt that perfectly fit into the stereotype of a guy coming from McKinsey.

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

#198

Post by s1artibartfast »

NickC25 wrote: post #183
s1artibartfast wrote: post #139

Earlier quoted context omitted.

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...

Yes, insurers adds new costs, but they also check other costs.

Every health systems has and needs some mechanism to deny potentially lifesaving treatment.

My point is that even when you abolish private insurance, you still have someone in the hot seat saying who dies because that care is too expensive.

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

#199

Post by nradov »

like_any_other wrote: post #174
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.

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…

You're cherry picking a single vaccine and failing to understand how the "D" part of R&D works. The vast majority of drug development expense comes from large scale phase-3 human clinical trials. Those now cost ~$1B each (necessary to establish safety and effectiveness) and many fail. Outside of rare circumstances like a global pandemic there is little political appetite anywhere in the world for widespread public funding of phase-3 trials. It's just never going to happen, and even if it did there's no evidence that government bureaucrats would make good decisions about which trials to fund.

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

#200

Post by [deleted] »

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…

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