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

noahpinion.blog

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

#101

Post by franktankbank »

akramachamarei wrote: post #65
insane_dreamer wrote: post #41

Many problems with this article, but no time to pick them apart; needless to say, Noah's argument is thin. I will say this: profit margin % is not the yardstick by which we should measure whether insurance companies are responsible for high health care costs in the US.

Seems like a pretty good yardstick to me. Ultimately, it shows (partially) how much money is going through an insurer vs to an insurer. The revenue flow graph is included for UnitedHealth Group, for example, and about 2/3 is going through the company to medical providers. Any good hacker is familiar with Amdahl's Law, and the same principle applies here. You can optimize the insurance providers all you want and maybe…

Does not consider global kickback schemes skimming money off the before profit revenue.

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

#102

Post by akramachamarei »

supertrope wrote: post #96
akramachamarei wrote: post #65

Earlier quoted context omitted.

Seems like a pretty good yardstick to me. Ultimately, it shows (partially) how much money is going through an insurer vs to an insurer. The revenue flow graph is included for UnitedHealth Group, for example, and about 2/3 is going through the company to medical providers. Any good hacker is familiar with Amdahl's Law, and the same principle applies here. You can optimize the insurance providers all you want and maybe…

The blog post is too simplistic an analysis. It ignores the second order effects of medical care financing reform. Imagine if car engine oil changes had to go through car insurance. In such an inefficient equilibrium you might remark that only that insurer overhead is only 20% of a $300 oil change. Sellers always capture easy money that flows in from insurance money, credit, or government subsidies. The fewer layers…

This all makes sense to me, and I agree. And at the same time it's consistent with the thesis of the post: "Insurers aren't the main villain of the U.S. health care system". So, I wouldn't say the post is too simplistic, because it's not claiming to be a complete analysis; on the contrary it's really just contributing to the discussion of one facet of the issue.

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

#103

Post by treis »

ch4s3 wrote: post #99
treis wrote: post #94

Earlier quoted context omitted.

That goes against the "insurers are intentionally raising prices" argument.

Not really. They're highly regulated in their offerings, and the government mandates how much they spend on care vs. overhead. They can't effectively compete so the only option is to negotiate slightly higher payments to providers and PBMs every year so they can take more profit in absolute terms.

Either prices are in their control and one company can gain market share by lowering them. Or they're not. I don't think you can have it both ways.

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

#104

Post by dlev_pika »

anon291 wrote: post #64
dlev_pika wrote: post #52

Earlier quoted context omitted.

> 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.

That's true of any medical system? Still we can look at the data on Canadian v American health care wait times and the data tell the story.

Possible in some cases, triaging and wait times are a thing in other places too, with the difference being that you don’t get a bill at the end. I have multiple anecdotes from people outside the US having little trouble getting primary care, or even psych care, much faster than what I’ve seen here.

When looking at comparative data, I think it’s worth breaking it down a bit by socio status, for example. In complex systems with a wide spread averages can be misleading. My impression is that we are not seeing the whole story.

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

#105

Post by zephen »

chongli wrote: post #100
zephen wrote: post #49

Earlier quoted context omitted.

Spurious denials. It's easy to find documentation of this. For example: https://pmc.ncbi.nlm.nih.gov/articles/PMC10391242/ https://phrma.org/blog/70-denied-how-insurance-denials-are-d... https://www.forbes.com/sites/joshuacohen/2026/05/04/independ... Anecdote is not the singular of data, but when my late wife was dying of cancer, the oncologist was attempting to follow standard care procedures. Preauthorizations were…

None of your links provides data on spurious denials. The third link does provide this statistic: "Over a six-year period between 2019 and 2025, almost half of a large set of denied health insurance claims in New York state were reversed when the cases reached independent review organizations, comprised of clinicians unaffiliated with insurers" But that doesn't get into the reasons why the claims were denied in the f…

> But that doesn't get into the reasons why the claims were denied in the first place.

The first link in that article does. It starts off by noting that this the third level review, so there were ample chances for the insurance company itself to fix things, and also says that "The report also showed that 47.1% of denials on the basis of medical necessity, 44% of denials based on care determined to be experimental or investigational, and 42.9% of formulary denials were overturned."

It's a pipe dream to assume that, by the time the appeals got to that point, it could be chalked up to administrative error.

> Insurance companies are concerned with adverse selection and moral hazard. A client who files a lot of claims shortly after getting insurance raises the suspicion that they were not honest about their health prior to applying. Similarly, a client who claims every drug a pharmacy carries raises other suspicions.

Yes, every Canadian gets 5 abortions a year, even the men. But seriously, the moral hazard goes the other way. It is so fucking difficult to get doctor appointments that the insurance companies should be doing everything in their power to help keep people healthy, rather than worrying about the 0.1% of the population that suffers from Munchausen syndrome.

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

#106

Post by pdxandi »

Legend2440 wrote: post #61
pdxandi wrote: post #44

Earlier quoted context omitted.

That's a an honestly upsetting statement. My wife is a pediatric critical care physician and there is not an evil bone in her body. She works her tail off, is (in my opinion) underpaid (like most pediatricians), and her job takes huge emotional toll. The same is true for all of her partners. Maybe I'm reading this wrong and you mean administrative or insurance or something else. But at least in my orbit, that stateme…

Is she really underpaid? The average pediatric critical care physician in the US makes $262K-$440K a year according to Glassdoor. This is twice what the same role pays in most European countries. Unless she is well below that range for some reason, she is likely overpaid. Everybody in healthcare, from the nurses to the hospital CEOs, makes far far more in the US than they would in a country with socialized medicine.

That was really not meant to be the focus of my comment, but that range definitely seems high, from all those that I know in the field. You have to also factor in the significant amount of debt they incur over the 14 years it takes to get through undergrad, medical school, residency training and then subspecialty fellowship training. Adult ICU doctors make twice as much as pediatric ICU doctors, that was really the thought behind the comment on being underpaid. That, and she works difficult hours (long shifts, nights, weekends, holidays, on-call, etc.) and the emotional toll of the work can't be understated.

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

#108

Post by sagarm »

anon291 wrote: post #63
EvanAnderson wrote: post #40

Earlier quoted context omitted.

This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.

A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the…

Foreign doctors have to go through residency in the US.

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

#110

Post by jugg1es »

pdxandi wrote: post #44
jugg1es wrote: post #15

I've worked in the healthcare space for a decade and I have asked some tough questions of my leadership and I got a response I'll never forget: "Everyone in healthcare is a little bit evil"

That's a an honestly upsetting statement. My wife is a pediatric critical care physician and there is not an evil bone in her body. She works her tail off, is (in my opinion) underpaid (like most pediatricians), and her job takes huge emotional toll. The same is true for all of her partners. Maybe I'm reading this wrong and you mean administrative or insurance or something else. But at least in my orbit, that stateme…

The statement was in reference to the players in the US healthcare system: payers, ACOs, MCOs, providers, suppliers, SNFs, third parties, etc... It was not in reference to individuals. Most individuals in the healthcare system are decidedly not evil.
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