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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

#201

Post by AnnikaL »

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

Maggie De Block is a Belgian government official, not Danish.

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

#202

Post by AngryData »

School-Cotton wrote: post #53
brookst wrote: post #45

Earlier quoted context omitted.

The only hope for reform in the US is to position it as furthering the transfer of wealth to the ultra-rich. Then, you might get some traction. But it’s hard to frame a legitimately good policy in these terms.

It’s a nice soundbite, but not really accurate to describe US economic history as a process of wealth transfer to the ultra-rich. Everyone has gotten wealthier over time, it’s just that the wealth of the rich has increased even faster than everyone else’s.

Richer how, and relative to who and when? Because you could say the same thing for nearly every country on earth purely through technological advancements. Wealth is always measured in relative terms, and relative to the top of society much of the US hasn't gotten any richer. The average American only gained wealth relative to the past through technological means. Home ownership isn't really going up for the average American, education standards have been falling behind many other parts of the world, and while we have recently had a little bit of wage increases, it doesn't really make up for the decades of wage stagnation and only really came with an accompanying large increase in inflation for nearly every other consumer good.

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

#203

Post by xiphias2 »

vladgur wrote: post #178
xiphias2 wrote: post #160

Earlier quoted context omitted.

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

I think airports are great reflections of culture of a country, because that's the first thing a visitor from another country sees, but I had other experiences in USA, where I felt that some of the reataurants just shouldn't be allowed to exist.

I'm from Hungary, a country with 4x smaller average salary, and you can be sure that nowhere would the thing that they sold me without shame in the airport would be considered food, do it's clearly not a money problem.

I believe RFK Junior understands how seriously USA food culture is behind compare to the available money and hope he does something about it.

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

#204

Post by nradov »

mindslight wrote: post #195
nradov wrote: post #177

Earlier quoted context omitted.

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 b…

How exactly would doctors fund their own residency programs? They already graduate from medical school $500k in debt. There's no more room to squeeze them further. And teaching hospitals have no real incentive to fund more residency program slots. Their customers aren't willing to pay more for it. In game theory terms this is essentially a free rider problem: many entities in the healthcare system would benefit from a larger supply of physicians but they all want someone else to pay for education.

There have been some attempts to introduce market dynamics such as high-deductible health plans (HDHP) with HSAs. Those can work fairly well for a minority of engaged and intelligent consumers but overall aren't an effective solution to systemic problems.

Classical supply and demand economics don't function very well in healthcare. Demand is effectively infinite: sick people want all the healthcare they can get (even if it doesn't really help them much or causes iatrogenic harm) and they think someone else should pay for it. Thus the only way to constrain total system costs is by artificially limiting supply and imposing some sort of rationing. So the real argument ends up being about how we do the rationing.

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

#205

Post by AngryData »

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?

Having the majority of the population supporting something doesn't really mean too much in the US. I mean marijuana legalization was supported by near 70% of the population even 2 decades ago. Many states now have legalized recreational marijuana, and yet it is still federally illegal and the federal government could at any time shut down all the state approved marijuana sales. I think that by itself makes it pretty clear that the US is barely democratic and the will of the people is easily and regularly ignored by politicians.

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

#206

Post by nradov »

costcopizza wrote: post #96
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

I wonder why this is getting downvoted as I've had this exact same thought. A most efficient insurance program would be a closed loop. Any leftover money not spent on care would be used to reduce premiums the following year and/or be saved for higher claim years. I wonder how that could exist in the US? Perhaps these health sharing ministries are as close as we'll get: https://www.medishare.com/

Healthcare cost sharing ministries can work for some consumers but there are loopholes which allow them to deny coverage for services that commercial insurers do cover. This can leave consumers with huge surprise bills.

https://www.nbcnews.com/health/health-care/health-care-cost-...

Commercial insurers are already required to rebate premiums if their medical loss ratio is below the limit.

https://www.cms.gov/marketplace/private-health-insurance/med...

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

#207

Post by AngryData »

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…

Americans don't have to wait, if they can pay enough money to make other people wait, usually through having superior insurance. And this is anecdotal but my own father had to spend 3 months in 24/7 heart afib as he waited for his thyroid to be removed. And that is with every doctor knowing for a fact that having afib is both damaging to the heart and may result in a deadly heart attack at literally any moment. But because his insurance isn't as great as other people's insurance, he has to wait in line with all the poor saps while people with money get treatment within hours or days.

The idea that American's get better and more immediate healthcare is only true for people with money.

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

#208

Post by rscho »

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…

I think US has a much larger need for welfare than Denmark, or actually maybe all Western nations. So, welfare and care for the homeless is super pricey. IMO, this a byproduct of the extreme form of capitalism practiced in the US.

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

#209

Post by AngryData »

quasse wrote: post #47
_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…

> 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…

What he said is true, if you have a lot of money, which is the part people always seem to miss. But people get sucked into the propaganda because they personally haven't had to deal with it, or themselves or their family have the money to bypass such problems. Every time someone complains, people with money will dispute it because they themselves have not had or seen that experience and deny there is a problem at all because they personally don't have that problem.

And HN itself is full of people doing way better financially than the average American with better insurance than the majority of people, so even here many people will have a much better impression of and access to the US healthcare system than the average person in the US actually does.

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

#210

Post by nradov »

rqtwteye wrote: post #108

Question for the techies here: Due to lack of political will and deep-seated corruption I believe a lot of issues in the US system are almost unfixable but I always wonder why it has to be so convoluted (besides being hyper-expensive). Why can't the insurers have an app where the patient (or the provider) can type in the procedure codes they are planning to use and then the insurer returns the co-pay, co-insurance an…

Insurers have an app where the patient (member) can type in a procedure code and see prices for local network providers. It's literally right there in every member web portal! Every health plan has sent out multiple notifications to their members! How are people still not aware of this?

https://www.cms.gov/healthplan-price-transparency/consumers

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