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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

#231

Post by SoftTalker »

staticman2 wrote: post #222
DangitBobby wrote: post #179

Earlier quoted context omitted.

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 delusio…

If you were designing a legal system you probably wouldn't want for profit insurance companies to decide who gets to determine if a patient needs treatment, due to the obvious conflict of interest. But that doesn't mean applying the same "malpractice" framework to the people deciding what's covered under the program is necessarily the right approach either.

We're fine with insurance companies sending adjusters out to inspect property damage or collision damage. We don't just expect them to pay for whatever the contractor or body shop says was necessary.

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

#232

Post by SoftTalker »

ceejayoz wrote: post #34
SoftTalker wrote: post #26

Earlier quoted context omitted.

Denying care is the default state. It's the basis of the Hippocratic Oath, "First, do no harm." I.e. the determination of whether a treatment is beneficial is made by comparing it to doing nothing.

That's more "think first, treat second" than "denying care is inherently good".

It's also how first responders deal with feeling responsible if someone dies on them. They did more than nothing, so their presence improved the odds even if the result was the same.

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

#233

Post by alistairSH »

HDThoreaun wrote: post #142
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?

Where I live there are mri strip mall spots where you can just walk in. Same with dialysis.

Not here, gotta get a CON, which the existing facilities will fight tooth and nail to prevent.

We seem to have the worst of all options. Not a free/open market. Not a socialized or single payer.

Instead it’s all rent seeking, regulatory capture, and the rich getting richer.

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

#234

Post by s1artibartfast »

nradov wrote: post #204
mindslight wrote: post #195

Earlier quoted context omitted.

> 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…

It is a billing problem. Simple as that. Residents provide a vast amount of care, both under the supervision of an attending physician, that currently goes uncharged.

Federal residency payments to hospitals forbids charging for it, and insurance refuses to pay for it. It is enough to cover the salary and cost of the residents.

You are right that the current state is a free-rider problem. Free rider problems have tons of solutions, in both through markets and public policy. A free rider problem doesn't mean we must throw up our hands and give up. Instead, it suggests the type of solutions which are applicable.

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

#235

Post by s1artibartfast »

ClumsyPilot wrote: post #228
jack_h wrote: post #219

Earlier quoted context omitted.

> This is logic of post-2008 fail-capitalism instead of 1970’s and China’s aspirational, problem solving capitalism. No, this is reality. It does not matter if you're working under capitalism, socialism, communism, mercantilism, or some as yet unknown system since economics is the “study of the allocation of scarce resources which have alternative uses.” You cannot deny resource scarcity anymore than you can deny nat…

> expanding supply of healthcare you are taking resources away from somewhere else This is totally wrong. It takes 5 years to get planning approval in UK, it takes 1 year in France. Tunnelling costs are 3x higher in Uk than in europe. Building a tram takes 3 times less. Lower Thames crossing has been in planning for 15 years and we have spent 300 million on lawyers, more than Norway has spent on building an actual to…

>If USA has expensive insulin and poor Bulgaria has cheap insulin and it works just as well, maybe you are doing something dumb.

The insulin example always drives me nuts. The type of insulin you get in Bulgaria is also cheap in the US. In the US, you can get a months supply of generic off patent insulin at Walmart for $40. You can also get extremely fancy insulins for $1000, and $10,000 insulin pumps.

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

#236

Post by bojangleslover »

unyttigfjelltol wrote: post #194
vladgur wrote: post #184

Earlier quoted context omitted.

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.

This is critical. I get these "Explanation of Benefits" from United, and they always show some enormous sticker price with a "discount." Something is clearly whack with these discounts.

It would be too much credit to call it "financial engineering". Do you know who mostly benefits from these (basically) fraudulent "discounts"?

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

#237

Post by feoren »

Someone1234 wrote: post #43
ShinyNewFeature wrote: post #31

In many jurisdictions in the US, there is a requirement for the casino and lottery operators to pay a certain percentage (typically 90+%) back as winnings. Do health insurance companies have to follow similar requirements? If so, individual cases of insurances denying insurance would be bad, but would indicate that the overall system is still working reasonably well.

Indeed, they do. The ACA set a 80% requirement. Unfortunately unintended consequences have resulted in that meaning it benefits health insurance companies to increase the cost of care so their 20% share is more.

Health insurance companies conspiring with each other and with providers to drive up costs is not an unintended consequence of the ACA, it is a predictable consequence of monopolistic collusion. Imagine saying "all the grocery stores are intentionally increasing the cost of eggs in order to increase their cut" -- that's just straightforward illegal behavior that should be a slam-dunk anti-trust suit. Don't blame the ACA for that.

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

#238

Post by bojangleslover »

apsec112 wrote: post #112
ceejayoz wrote: post #72

Earlier quoted context omitted.

> UK system is collapsing under underfunding and misallocation Fifteen years with the "let's privatize everything!" party will do that, yes.

The NHS structurally basically has to get worse no matter who is in charge: - the cost of top healthcare will keep going up as new technology is invented - the amount of care you need keeps going up as the population ages - GDP can't grow because of various political constraints (Brexit, planning permission, Green Belt, environmental rules, etc) - Tax revenue can't rise much because it's already ~40% of GDP - NHS can…

Best comment about the UK I've seen in a while. Focuses on the immutable facts — doesn't necessarily take "one side". So true.

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

#239

Post by giantg2 »

JusticeJuice wrote: post #221
giantg2 wrote: post #155

Earlier quoted context omitted.

Thanks for the detailed response! In the US, Medicare is doing negotiation for meds for those in the program. There is talk about expanding that bargaining. The ACA was trying to get people into primary care early. I'm not sure how big of an impact that made. At least in my experience, the primary care is hard to get on short notice in my area - takes 1-4 weeks depending on different things. One big seems to be that…

The funding for primary care comes from a bunch of places in NZ, but most of it comes from the government. Most people in NZ don't have private healthcare insurance, it's just not needed. The way it works is patients 'enroll' with a doctors office, and then the clinic gets funding based on that patient population (how many patients, what sort of patients, etc). GPs still set their own fees ontop of that, but it's usu…

Seems like they have as many or more here in the states, at least where I am. I see some stats that it's about 20 patients a day. I almost always end up at urgent care because they don't have enough availability at the primary in my area. The urgent care isn't covered by my insurance because they say there's enough covered providers in the area already. When I have a fever of 103F for 5 days and think it's time to investigate antibiotics, I want an appointment within 24 hours, not 5 business days from now. It seems the insurance payout and keeping the schedule booked solid drive the (under)staffing in my areas. Although it hasn't been like this in other areas I've been in, but that's more than 10 years ago now.

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

#240

Post by HDThoreaun »

alistairSH wrote: post #233
HDThoreaun wrote: post #142

Earlier quoted context omitted.

Where I live there are mri strip mall spots where you can just walk in. Same with dialysis.

Not here, gotta get a CON, which the existing facilities will fight tooth and nail to prevent. We seem to have the worst of all options. Not a free/open market. Not a socialized or single payer. Instead it’s all rent seeking, regulatory capture, and the rich getting richer.

Oof, CONs strike again. We really do have the absolute worst of both worlds, neither free market nor gov run. Just some fucking government locked in monopolies.
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