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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)

#81

Post by zephen »

akramachamarei wrote: post #77
zephen wrote: post #70

Earlier quoted context omitted.

By adding tons of paperwork and time and effort. When a denial happens, often the doctor himself has to communicate with the insurance company via phone, instead of, you know, doctoring. This often proceeds over multiple rounds. And then either the company eventually pays, or the consumer has to pay and try to get reimbursed later. You asked this question 30 minutes after even a casual reading of my other comment, an…

I am deeply offended by your allegation. Not everyone who disagrees with you is a shill. I would not make the same accusations about you, nor would I act as if I can estimate the probability that you are. HN's commentary guidelines address this. You can consider my mistake to be in conceptualizing the cost of "medical services" too narrowly, as just the medicine, and not the providers' surrounding administration. To…

> I am deeply offended by your allegation.

Be offended all you want. It's a free country, but, to be perfectly frank, you are still making it difficult to believe you are writing in good faith, as I will show.

> You can consider my mistake to be in conceptualizing the cost of "medical services" too narrowly, as just the medicine, and not the providers' surrounding administration.

Which is fine, except that my very first comment that you responded to explicitly explained "More direct costs, more costs at the provider they have to cover..."

So I already explained that which you said you missed, before your first comment questioning it.

> Do you know how much this has? In particular, you refer to the back-and forth negotiation of claims--on what do you base this claim?

When I wrote "You asked this question 30 minutes after even a casual reading of my other comment, and a little thinking about it, would have fully answered it." I was serious.

You still asking this question, instead of looking at that comment, indicates that at best you are completely unserious. For your edification, here is a link to that comment:

https://news.ycombinator.com/item?id=48480873

When you wrote your first comment in reply to mine, there were already two comments there -- that one and its very short parent.

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

#82

Post by tqi »

akramachamarei wrote: post #58
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?

It doesn't require collusion, just misaligned incentives.

"Perversely, with the MLR requirement capping profit margins and administrative costs, insurers are discouraged from containing health plans’ premium increases. Economists have noted that the MLR requirement effectively turns health insurers into “cost-plus” businesses: If insurers’ predicted premiums are less than the actual medical care spending on claims, it can lead to higher MLRs and less profits, within MLR restrictions. Professor Scott Harrington warned early on that MLR requirements could reduce insurers’ motivation to control premium increases. Prior research has found that the MLR requirement is associated with stronger financial performance for insurers, since they can raise premiums to cover higher claims and still comply with the MLR threshold."

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

#83

Post by ssl-3 »

colechristensen wrote: post #54
toast0 wrote: post #46

Earlier quoted context omitted.

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.

I'm thinking much longer-term than Donald Trump. I intend to outlive that orange cretin by a good number of years.

(You are, of course, free to be as myopic as you wish -- just as everyone else is.)

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

#84

Post by ngriffiths »

gopher_space wrote: post #69
ngriffiths wrote: post #36

> It’s not hard to understand why people hate health insurers. When you interact with the U.S. health care system, the providers — the hospital staff, the doctor, the nurses, the technicians — all just take care of you . > Your interaction with the health insurer, on the other hand, feels like a struggle against an enemy who wants to destroy you. Exactly, the big factor driving healthcare costs is that people like ex…

> They like the fancy plan that covers their doctor The fancy plan.

Yeah, because it covers all the doctors. It is literally the same as saying you will pay any price. It is a luxury good.

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

#85

Post by colechristensen »

ryandrake wrote: post #60
colechristensen wrote: post #47

Earlier quoted context omitted.

>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.

Who cares about theory when the reality is a corrupt insane government was elected. We're not dealing with theory. Healthcare is too important to propose major changes based on theory instead of reality.

You DO have healthcare choices now. Consider the healthcare option provided when accepting a job is on the table, provide feedback to your employer about their chosen provider (i.e. say NO to United Healthcare). Even though it involves big life choices with private healthcare there ARE options on the table instead of what the electorate chooses every 2/4/6 years.

And people are pretty misguided. The typical HN crowd person would STILL HAVE private health insurance on top of the public care in almost any country today that has the public option. The public option is bad, slow, and has a habit of denying care. You'd be rich, you'd still want better care than what was available for free.

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

#86

Post by colechristensen »

ssl-3 wrote: post #83
colechristensen wrote: post #54

Earlier quoted context omitted.

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.

I'm thinking much longer-term than Donald Trump. I intend to outlive that orange cretin by a good number of years. (You are, of course, free to be as myopic as you wish -- just as everyone else is.)

I'm also thinking longer term and am not so optimistic that he's just going to go away and the pattern he created won't be taken up by someone else (and the thing to be afraid of is someone else who isn't quite so stupid).

The dam may well be broken, Congress has proven to be full of cowards and the next aspirational autocrat might well win and do better.

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

#87

Post by ssl-3 »

colechristensen wrote: post #86
ssl-3 wrote: post #83

Earlier quoted context omitted.

I'm thinking much longer-term than Donald Trump. I intend to outlive that orange cretin by a good number of years. (You are, of course, free to be as myopic as you wish -- just as everyone else is.)

I'm also thinking longer term and am not so optimistic that he's just going to go away and the pattern he created won't be taken up by someone else (and the thing to be afraid of is someone else who isn't quite so stupid). The dam may well be broken, Congress has proven to be full of cowards and the next aspirational autocrat might well win and do better.

I intend to live longer than that potential outcome, too.

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

#88

Post by peyton »

tqi wrote: post #82
akramachamarei wrote: post #58

Earlier quoted context omitted.

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?

It doesn't require collusion, just misaligned incentives. "Perversely, with the MLR requirement capping profit margins and administrative costs, insurers are discouraged from containing health plans’ premium increases. Economists have noted that the MLR requirement effectively turns health insurers into “cost-plus” businesses: If insurers’ predicted premiums are less than the actual medical care spending on claims, i…

That’s an opinion from an economist along with prior behavior, not reality. I’ve talked to one of the guys who worked on the ACA, and his take was basically providers will do things like e.g. buy up all the cardiologists in an area, then jack up prices across the board. Employers need to provide a certain bundle of services under the ACA. That’s where people are taking advantage.

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

#89

Post by antasvara »

akramachamarei wrote: post #62
readthenotes1 wrote: post #20

"But when we look at United Health Group’s operating costs in the diagram above, they’re only 22.6% of the actual cost of medical care." A 22% decrease and a return to providers having to consider the cost implications to their patients would be a good thing. ("Return" I know a 95 year old doctor who said he still carries some guilt from keeping a poor guy in the hospital an extra night back in 1955 days because he c…

Of course, it wouldn't be a 22% decrease, it might be an 11% decrease if we assume optimistically that operating costs are cut in half. I don't know if administrative efficiency is exactly a strength of the government, either.

The main cost benefits are that you don't have to pay for marketing, underwriting, plan administration for a bunch of different plan types, negotiating with thousands of employers on the premium they'll pay, etc.

I think an 11% decrease is conservative if anything. None of our peer nations spend more than ~5% on administration as a share of overall healthcare spending.

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

#90

Post by dd8601fn »

FireBeyond wrote: post #30
readthenotes1 wrote: post #22

Earlier quoted context omitted.

I'm on ACA. I get between $100 and $150 on a gift card to do my annual PCP visit even though my premium is $0/month. Why? Obvious if you know about the perverse incentive tqi mentions

There are all sorts of perverse incentives in play. Many plans won't pay for weight loss drugs (obviously GLP-1s, but even beyond that) but will happily pay for gastric bypass, for one simple example.

A surgery happens once. Glp1s are forever.

$25k today or $15k/yr for 20 years?

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