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Providers, not insurers, are responsible for excess U.S. health care cost (2024)

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Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#51

Post by calvinmorrison »

rickydroll wrote: post #33
colechristensen wrote: post #16

Earlier quoted context omitted.

The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss fo…

Before we go pushing money into private insurance, we need to define why. We need to understand why the public ones are inadequate and who/what drove those decisions. A public health care system should be independent of politics. Unfortunately, as the latest administration has shown, even if you designed it to be independent, such as the CFPB, it doesn't matter with an autocrat in charge. On the other hand, private i…

hard to take you seriously when you think we have an autocratic system.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#52

Post by dlev_pika »

anon291 wrote: post #31
dgellow wrote: post #23

Earlier quoted context omitted.

Because you wanted to pay more? Or are you saying it is cheaper in the US? If the latter, could you be more specific? I pay the maximum possible in Germany for my health insurance and from what I understand I still pay less for healthcare than I would in the US.

Are you paying for the same thing? I can see a doctor or specialist usually within a week. Less if it's urgent. I think wait times in these countries are never mentioned. Paying for a service tomorrow vs paying for one a few months from now are entirely different classes of goods.

> I can see a doctor or specialist usually within a week

That might be true to your specific location and set up, but I have some experience and family in healthcare, both in the US and outside of it, and it is definitely not like that for much of the US.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#53

Post by collingreen »

colechristensen wrote: post #16
neilwilson wrote: post #5

It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. Healthcare needs to be provided as a matter of course, and “competition” won’t improve it or control it because there is always a supply side shortag…

The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss fo…

There are so many more options than a 4 year administration being hostile to the people it's supposed to represent. Corruption will undermine any collective action amongst honest collaborators regardless of what color their party flag is.

Also, having a baseline of public care and then private as an option on top doesn't sound like the boogeyman this is pitching it as to me. That seems like a great way to reduce the scope of what the state needs to be in charge of.

If the take is that government cannot possibly work for the people no matter what then yeah, all policy is bad.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#54

Post by colechristensen »

toast0 wrote: post #46
colechristensen wrote: post #16

Earlier quoted context omitted.

The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss fo…

Public healthcare in the US can work. Most seniors on traditional Medicare like it. Make that available to more people, and bob's your uncle. I propose allowing buy into medicare at 5 years before regular eligibility. And a long phase in of lowering the eligibility age. Drop it by 6 months every year for 10 years, then 1 year every year for 10 years, then 2 years every year until everyone with work credits is eligibl…

Again, you're disconnected from reality.

Do you want Donald Trump to be in charge of public healthcare? Please stop suggesting we make all of those changes unless you're willing to say you want him to be in charge of it.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#55

Post by akramachamarei »

zephen wrote: post #14
tqi wrote: post #6

They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…

> the only way for them grow profits is to increase cost. And, of course, things like spurious denials drive up costs for them and for the providers. More direct costs, more costs at the provider they have to cover... From the insurance company perspective, it's a win-win!

How would spurious denials drive up the cost of medical service?

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#56

Post by ecshafer »

I am not sure providers are entirely blameless. My daughter had an annual checkup, when we were asked if there were other issues, we asked about a bug bite. They charged us for a second emergency visit, what the hell is the point of an annual visit if we can't ask about issues? Insurance company okayed it. So they are both at fault for this insanity.

The most efficient medical experiences I have had have both been ones where there were no insurance involved:

1. A USCIS surgeon, that was like 80 years old, running his own office, everything via check, on paper. Guy put more patients through per day then the big hospital systems special immigrant medical services did.

2. A specialized Eye Surgeon who did my wife's ICL eye surgery (which insurance wont cover). Ended up being the most efficient practice I've seen, every follow up and pre-surgery meeting was not separately billed. Just the surgery was. Eye Doctors / Surgeon spent a ton of time with you. And they had massive amounts of flexibility. But even the out of pocket surgery was probably less than an insurance covered surgery at a hospital.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#57

Post by treis »

tqi wrote: post #6

They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…

They can grow profits by capturing a larger share of the market.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#58

Post by akramachamarei »

tqi wrote: post #6

They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…

What you wrote seems fully consistent with the blogpost. Unless you are suggesting that health insurance companies collude with providers to raise the cost of medical service?

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#59

Post by anon291 »

dgellow wrote: post #38
anon291 wrote: post #31

Earlier quoted context omitted.

Are you paying for the same thing? I can see a doctor or specialist usually within a week. Less if it's urgent. I think wait times in these countries are never mentioned. Paying for a service tomorrow vs paying for one a few months from now are entirely different classes of goods.

Depends on the urgency and the specialist, but generally yes, I can get an appointment in a week. Mental health is the only specialty where I’ve seen multiple months wait times. For a specialist you generally first go through a generalist who gives you a voucher for your insurance. But you can also go directly and pay yourself if you want to skip that step. Even if you have slightly more wait time, the cost is still…

I'm not familiar with the german system... is it private or public insurance?

As for US employers paying for everything... yes it's common. It used to be that they'd just cover everything via a 'PPO' plan with minimal 'co-pays'. Usually you'd pay $5-15 for a GP, ~$50 for urgent care, and ~$100 for an ER visit.

These days, many have switched to a 'High Deductible' plan, where the insurance comes with a 'max out-of-pocket'. After you've paid that amount, then everything is fully covered, but nothing is covered until you hit the deductible.

My current company has this plan, but puts the entire 'max out of pocket' value in what's called an 'HSA' (healthcare savings account). This money grows tax free and will eventually turn into a retirement account. So, if you have no health issues, then this becomes a free income stream. If you do have health issues, then you just spend this money every year and then insurance takes over and pays for the rest. This is common in the tech world these days... not sure about other industries TBH.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#60

Post by ryandrake »

colechristensen wrote: post #47
ryandrake wrote: post #27

Earlier quoted context omitted.

The fact that a single person is "in charge" of the government, with the other two branches largely deferring all power to that one person, is a recent aberration from the norm in the USA. I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader.

>I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader And I want to win the lottery, marry a princess, and for my childhood dog to come back to life. We all want things. When we're advocating for government changes we need to be realistic and make good choices. Right now thr…

At least elected governments are in theory accountable to the public through voting. Insurance companies and healthcare providers are not in any way accountable to the public, and the public has zero power (outside of regulation) to affect their actions. Just because public [X] is currently a bad choice doesn't make private, corporate [X] always a better choice.
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