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The American Healthcare Conundrum

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Re: The American Healthcare Conundrum

#111

Post by rayiner »

lotsofpulp wrote: post #47
dmitrygr wrote: post #36

Earlier quoted context omitted.

Ding Ding Ding. We have the correct answer. And this was a predicted consequence of that profit cap.

>So insurance companies spend more so they can collect higher premiums. That's how they make more money. > If this is correct, then how come there are so many complaints about insurance denying payment for healthcare or the hoops they make patients and doctors jump through for pre authorizations? If the path to more profit was spend more money, then there would be no reason to question a doctors’ orders? Nor threaten…

> If this is correct, then how come there are so many complaints about insurance denying payment for healthcare or the hoops they make patients and doctors jump through for pre authorizations?

Because those anecdotes get reader and viewer engagement. Charts comparing how much U.S. insurers pay on average for common procedures compared to, say, the UK NHS, don’t drive forward the narrative.

You should interrogate the media sources you consume and ask why you’re fed so many stories like that, and investigate what the real data is. A few years ago my friend got a continuous glucose monitor for Type 2 diabetes. I looked at the coverage polices for continuous glucose monitoring (for Type 2) for my insurer and some of the other big ones. Turns out that most US insurers, Medicare, and Medicaid in 45 states+DC cover continuous glucose monitors for people who have type 2 even those that don’t use insulin. At the time, most Canadian provincial systems didn’t cover the technology except for Type 1 or people who take insulin. UK NHS was worse, covering it only for Type 1, or Type 2 with certain conditions (such as you’d otherwise need to do 8 or more pin prick tests a day). https://www.diabetes.org.uk/about-diabetes/looking-after-dia...

Re: The American Healthcare Conundrum

#112

Post by mwwaters »

CWuestefeld wrote: post #58
Retric wrote: post #37

Earlier quoted context omitted.

> part of the healthcare system that is moderately competitive. That’s only half the story though insurance companies also try and reject way more claims, cover fewer people, and are just harder to get money from than Medicare. This means hospitals can’t afford to give them cheaper rates as they just require vastly more work from staff for the same procedure. The industry isn’t blind to this effect, but has little re…

This isn't even close to true. Keep in mind that Medicare, together with Medicaid (which operates under much of the same administrative rules), account for nearly half of medical spending. So basically, if a provider doesn't want to play by their rules, they MUST deal with Medicare. That is, the government is nearly a monopsony in this industry. There's a common, misleading, claim that Medicare is more efficient beca…

Medicare has overhead, but you’re not saying whether it is more than commercial insurance. The admin expense/profit portion of commercial insurers also don’t take into account provider admin costs (not to mention the huge amount of time patients can deal with denials, appeals, etc.)

Re: The American Healthcare Conundrum

#113

Post by [deleted] »

nostrebored wrote: post #28
raw_anon_1111 wrote: post #19

Earlier quoted context omitted.

So I happen to be in Costa Rica for the month. Just like every other 1st world country, it has managed to have universal health care that is better and cheaper without private insurance. Even if you do get private insurance for quicker access, it’s still much cheaper than the US. I just spoke to someone who flew down here to save $30K on dental work. The problem isn’t the ACA, it’s the ass backwards American health c…

ACA enshrined the worst parts of the American healthcare system for years to come. It is a politicized victory that is the best solution for no American citizens. Places I’ve been with fully privatized healthcare or single payer are both significantly better for consumers. Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come.

[deleted]

Re: The American Healthcare Conundrum

#114

Post by nradov »

CWuestefeld wrote: post #83
Retric wrote: post #78

Earlier quoted context omitted.

> nearly half of medical spending > something like 2 FTEs focusing just on the reimbursements from Medicare and Medicaid 2FTE’s vs what? The question isn’t is this free, the question is how large is the total staff including price negotiations, doctors, and IT time spent handling billing issues, and is Medicare more or less than 50% of the total. I am ware of one hospital and 2 medical clinics where the difference is…

2FTE’s vs what? versus nothing. Hospitals don't have to maintain a whole team for UnitedHealth, or for Anthem, etc. This is my point. Medicare cooks the books to look more efficient by offloading their administrative costs onto providers. Other payers can't do that because, even if huge, they don't operate at the same scale. Think about it: we often hear on the news about disputes about contracts when a local hospita…

Depending on the size of the health system it may not be a team of multiple FTEs but they absolutely do expend significant resources on managing differences between commercial payers. They all have different rules about covered services, step therapy, prior authorization, hospital admission, etc. Sometimes those differ significantly even between health plans offered by a single carrier.

Re: The American Healthcare Conundrum

#115

Post by tonymet »

profsummergig wrote: post #81

The end goal of AI + Robotics has to be robots doing surgery on humans, for a little more than the price of electricity.

2/3 of the costs are already wasted. Even if your robot is cheaper, the provider will hire more lawyers, admins, facilities staff, etc to keep the budget growing. Prices have been going up 15% yoy for 20 years do you think that will stop?

Re: The American Healthcare Conundrum

#116

Post by AnthonyMouse »

da_chicken wrote: post #105
nradov wrote: post #49

Earlier quoted context omitted.

That's true to an extent, and those minimal controls are why Medicare also wastes billions on paying fraudulent claims. https://relentlesshealthvalue.com/episode/ep502-how-some-pre...

They waste billions on fraudulent claims because they don't fund the program well enough to have compliance enforcement or auditing. Also, I'm not going to trust a podcast owned and operated by Stacey Richter, who also just so happens to be the co-president of Aventria Health Group and QC-Health.

> They waste billions on fraudulent claims because they don't fund the program well enough to have compliance enforcement or auditing.

These are synonyms for having higher overhead, right? If you pay a billion dollars in claims with ten million dollars in administrative costs then your "administrative overhead" is 1%, even if half the claims are fraud. If you increase "administrative costs" to a hundred million to get rid of the fraud, in practice you just saved 410 million dollars but now your "administrative overhead" is up to 20%.

Re: The American Healthcare Conundrum

#117

Post by nradov »

lotsofpulp wrote: post #47
dmitrygr wrote: post #36

Earlier quoted context omitted.

Ding Ding Ding. We have the correct answer. And this was a predicted consequence of that profit cap.

>So insurance companies spend more so they can collect higher premiums. That's how they make more money. > If this is correct, then how come there are so many complaints about insurance denying payment for healthcare or the hoops they make patients and doctors jump through for pre authorizations? If the path to more profit was spend more money, then there would be no reason to question a doctors’ orders? Nor threaten…

Complaints about denied claims or prior authorization requirements should generally be directed at employer HR departments. Most HN users in the USA probably have employer-sponsored group health plans, and often those are self-funded where the insurance company doesn't actually bear any risk but just administers the plan. Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with zero denials. It would be less work for them. But naturally employers don't want to pay for that, so the HR departments have the insurance carriers impose more restrictive coverage rules to hold down medical expenses.

Re: The American Healthcare Conundrum

#118

Post by hermanzegerman »

legitster wrote: post #88
hermanzegerman wrote: post #65

Earlier quoted context omitted.

We in Germany copied a lot of the stupid stuff from America (including the stupid billing system for inpatient stays), so it's not that surprising that our system is also bad value for money. PS: Outcomes here are not worse than those of rich people in the US, because I know some idiots will claim this to cope https://jamanetwork.com/journals/jamainternalmedicine/fullar...

Germany didn't copy the US - they just happen to share similar roots. Both historically had private hospital systems, and just so happen to implement pension/employer-based insurance programs very early on. German's just evolved in one direction and the US evolved in the other.

We copied the DRG reimbursement System from the US.

And no, we didn't had a historically significant share of private hospital systems, those came with the introduction of the DRG System, which forced many city/church owned hospitals into privatisation.

Before that, they had a "Fixed Price per Night" System, which also was a bit stupid, before that they got reimbursed their cost.

Re: The American Healthcare Conundrum

#120

Post by nradov »

graemep wrote: post #60

> The US spends ~$14,570 per person on healthcare. Japan spends ~$5,790 and has the highest life expectancy in the OECD. That gap is roughly $3 trillion per year. The difference in life expectancy will be influenced by multiple factors and may have more to do with diet and lifestyle than with healthcare. Japan also spends less per capita than the UK, France or Germany. The US spends a lot more than any of those so th…

Japan also has the "Metabo Law" (aka fat tax). Do you think Americans would go for that?
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