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Insurers rely on doctors whose judgments have been criticized by courts

propublica.org

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

#251

Post by londons_explore »

lotsofpulp wrote: post #126
londons_explore wrote: post #17

Earlier quoted context omitted.

> incentivized to overpay for care to maximize the size of their 20% slice. This. You see it anytime you mandate some profit cap or limit as a percentage of revenue. Companies will just manipulate the other variable to get more profits. Or they'll buy other related companies so they can do sneaky internal pricing shenanigans.

Only if no competitors exist, or all the competitors are colluding.

I feel like nearly every industry is colluding, at least a little, with a "we wont screw you over if you don't screw us over" approach.

Competition focuses on trying to expand the market, rather than screwing a competitor and stealing all their clients.

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

#252

Post by [deleted] »

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.

[deleted]

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

#253

Post by n4r9 »

kfarr wrote: post #211
n4r9 wrote: post #190

Earlier quoted context omitted.

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.

I think this is related to fundamental attribution error. The system is messed up and therefore attracts messed up people in leadership positions, not the other around.

I guess I miscommunicated the thrust of my argument. It seems to me that the paradox presented in the linked article hinges on an assumption that "nobody wants" there to be suffering. This seems flawed to me. There are plenty of people - some of whom are in positions of great power - who are content to generate a large degree of suffering in order to advance personal goals. This is currently very clear in Ukraine and Gaza. But it applies equally well to people that drive shady mergers and acquisitions at the cost of the consumer, or people that push drugs at the cost of addicts' health and relationships.

It's not "nobody wants this", but "sufficiently many people are sufficiently apathetic to continue this state of affairs".

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

#254

Post by lotsofpulp »

londons_explore wrote: post #251
lotsofpulp wrote: post #126

Earlier quoted context omitted.

Only if no competitors exist, or all the competitors are colluding.

I feel like nearly every industry is colluding, at least a little, with a "we wont screw you over if you don't screw us over" approach. Competition focuses on trying to expand the market, rather than screwing a competitor and stealing all their clients.

That is a unnecessarily narrow definition of competition, and businesses don’t steal clients (absent illegal methods), they provide better products or services at a preferable utility to price ratio such that customers choose them over another business.

Just like a person performing better in a job interview isn’t stealing from other applicants who performed worse.

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

#255

Post by nradov »

s1artibartfast wrote: post #250
nradov wrote: post #247

Earlier quoted context omitted.

You have misunderstood the problem and misinterpreted the papers you read. Hospitals bill for everything they do (although some bills are written off as bad debt or charity care). They don't fix broken arms for free. The bill might have an attending physician's name on it rather than the resident who actually performed the procedure but it still gets billed. The problem is that employing a resident incurs a lot of ov…

What I said especially holds true if you are billing in the name of the attending. If you have residents doing real work and the attending checks it out, that shows up as $0 on the books for the resident, and potentially millions of billable services for the attending. When the hospital says, "we lose money on residents", of course they do! They way they bill ensures exactly that. That's why I say that step 1 is dete…

You're just hand waving and haven't proposed any sort of viable specific solution. Customers aren't willing to pay higher bills for the sake of training residents. Those who have a choice will go to a cheaper, non-teaching hospital. Hence the free rider problem.

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

#256

Post by evanelias »

ceejayoz wrote: post #121
s1artibartfast wrote: post #115

Earlier quoted context omitted.

Ironically, Switzerland has a similar healthcare system to the US. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland

Health insurance in the US isn't practically compulsory since SCOTUS struck down the individual mandate's fines for not having it in 2012. (It was then removed entirely from the law in 2017.)

That's not quite right. SCOTUS upheld the individual mandate fines. They didn't strike it down. [1]

Congress then set the fine to $0 in legislation passed in 2017, which went into effect in 2019. [2]

[1] https://en.wikipedia.org/wiki/National_Federation_of_Indepen...

[2] https://en.wikipedia.org/wiki/Affordable_Care_Act

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

#257

Post by mindslight »

nradov wrote: post #255
s1artibartfast wrote: post #250

Earlier quoted context omitted.

What I said especially holds true if you are billing in the name of the attending. If you have residents doing real work and the attending checks it out, that shows up as $0 on the books for the resident, and potentially millions of billable services for the attending. When the hospital says, "we lose money on residents", of course they do! They way they bill ensures exactly that. That's why I say that step 1 is dete…

You're just hand waving and haven't proposed any sort of viable specific solution. Customers aren't willing to pay higher bills for the sake of training residents. Those who have a choice will go to a cheaper, non-teaching hospital. Hence the free rider problem.

When the holiday rush comes around, does UPS pay to train new employees or do they just throw up their hands and say that it will now take a month to deliver a package? And how does UPS avoid its customers being not "willing to pay higher bills" for the sake of training new employees? And what stops Fedex from being a free rider that poaches the new UPS employees right after they're trained?

Your whole argument is just beating down criticism by taking the current broken incentives as if they're set in stone. Yes, we know the incentives of the current system are terrible. In fact that's exactly why the whole system needs to be overhauled with sweeping reforms, rather than waiting for it to get better on its own.

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

#258

Post by DangitBobby »

SoftTalker wrote: post #227
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…

Unfortunately there are many examples of fraud on the part of practicing doctors. The insurance companies (whether private or government) can't just pay for whatever the doctors say they want to do.

That's fine if they have the same liability as doctors when they decide what gets done.

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

#259

Post by DangitBobby »

SoftTalker wrote: post #231
staticman2 wrote: post #222

Earlier quoted context omitted.

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.

And if their adjustment conflicts with the body shop, but it turns out the body shop was right and I die as a result? Who gets that liability? That's what I'm talking about. You can make adjustments, but you are practicing medicine when you do so.

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

#260

Post by DangitBobby »

liontwist wrote: post #217
DangitBobby wrote: post #152

Earlier quoted context omitted.

We already are doing rationing, it's just the rations are distributed according to our class system instead of any reasonable metric. Everyone already pays for heavily for it, much more than necessary due to the grift. These things are conceptually simple and much easier for a bureaucracy to handle than the current dumpster fire. It's actually only impossibly hard for us to solve because entrenched power and corrupti…

We are rationing. But not in the binary yes/no sense you will get from a bureaucracy designed flow chart. It’s economizing which allows substitution and sharing across supply and demand. At least you agree it’s a resource problem and we don’t have infinite healthcare. The point about rich folks being price insensitive is demonstrably false. One key here is that rich and reckless exists, but is a much rarer breed than…

> The US has unique demographic problems where the bottom quartile of health and well being demand most healthcare resources.

This is not a unique problem. The sickly and elderly always consume much more medical resources than the healthy.

> slightly worse for responsible people

You mean people with money.

And for all the problems the EU countries medical systems have, I've never heard a European say they'd prefer the American system.

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