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Insurers rely on doctors whose judgments have been criticized by courts

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

#111

Post by travisgriggs »

cjbgkagh wrote: post #28
bgnn wrote: post #23

Earlier quoted context omitted.

not an American, but it seems to me that the reason is purely ideological. They like a small state, especially the federal government. This would give too much power to the government. The idea of federal government providing care for citizens is not acceptable to people. Now, weird thing is this doesn't work for the military somehow.

The US should not be used as an example of a small government. Some people in the US may profess to wanting a small government, but they definitely don’t have one. Haven’t run the numbers but I would suspect the US government is the largest government in human history.

I’m not sure how one would define “the size of government” but the ILO says differently at least:

https://worldpopulationreview.com/country-rankings/public-se...

(Wikipedia has a similar page, but not as navigable imo)

I scroll through a lot of European countries before getting to the US at 13.4%.

I think the healthcare (and other) systems suck because they are complex. There are two ways to hid information: lock it up (lack of transparency) OR dilute it amongst noise. The latter is what complex systems of whatever do. Complex systems create opportunity for those with enough resources to locate and exploit eddies of wealth in the system. While those without the time and resources to spend understanding the complex system just decry it because it is too difficult to understand.

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

#112

Post by apsec112 »

ceejayoz wrote: post #72
ernst_klim wrote: post #58

Earlier quoted context omitted.

Like where? UK system is collapsing under underfunding and misallocation, German system is crumbling under terrible lack of personell with raising (already high) costs with lowering quality and increasing waiting times (up to infinite where mamologs and psychiatrists simply take no new patients in many cities). Basically in all thirst world countries trend is negative unless and experience is frustrating unless you a…

> UK system is collapsing under underfunding and misallocation Fifteen years with the "let's privatize everything!" party will do that, yes.

The NHS structurally basically has to get worse no matter who is in charge:

- the cost of top healthcare will keep going up as new technology is invented

- the amount of care you need keeps going up as the population ages

- GDP can't grow because of various political constraints (Brexit, planning permission, Green Belt, environmental rules, etc)

- Tax revenue can't rise much because it's already ~40% of GDP

- NHS can't grow as a percentage of the budget because of competing commitments (pension triple lock must, in the long run, grow as a percentage of GDP)

I'm sure Labour and Starmer want to fix the NHS, but it's like trying to play chess when you're already mated.

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

#113

Post by jimmymcgee73 »

ceejayoz wrote: post #72
ernst_klim wrote: post #58

Earlier quoted context omitted.

Like where? UK system is collapsing under underfunding and misallocation, German system is crumbling under terrible lack of personell with raising (already high) costs with lowering quality and increasing waiting times (up to infinite where mamologs and psychiatrists simply take no new patients in many cities). Basically in all thirst world countries trend is negative unless and experience is frustrating unless you a…

> UK system is collapsing under underfunding and misallocation Fifteen years with the "let's privatize everything!" party will do that, yes.

[dead]

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

#114

Post by [deleted] »

thrillgore wrote: post #33
azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

[flagged]

[deleted]

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

#115

Post by s1artibartfast »

School-Cotton wrote: post #49
GiorgioG wrote: post #37

Earlier quoted context omitted.

As an American born to European immigrant parents I can assure you that the grass is not always greener on the other side. All systems have problems. I say this as the parent of a child with a chronic illness (t1d) who is extremely frustrated with our health(insurance)care system.

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…

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

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

#116

Post by SpicyLemonZest »

convolvatron wrote: post #103
Workaccount2 wrote: post #89

Earlier quoted context omitted.

The problem with the European system is that it is contingent on the American system keeping the status quo. Without high prices in the US, European governments can't negotiate for the same lower prices. The US is a goldmine for medical corporations, which the EU gets to ride on the coat tails of.

you're suggesting that the entire difference in cost/benefit between the US and EU model is due to research and development? that seems wildly unsubstantiated. the google blurb puts it at 6% of US spending, but its unclear how much of that is actual research and how much is product development and marketing.

Not “due to” in the sense that that’s where the money directly goes, but concerns about slowing medical innovation are one of the big arguments that are raised against reform proposals in the US. In Europe, my understanding is that this is broadly not a concern and few health systems take fully incentivizing new therapies as a design criterion.

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

#117

Post by kfarr »

afthonos wrote: post #21
azalemeth wrote: post #15

I'm not American and grew up (and work) in Western Europe. Everyone is born, and, at some point, will get sick and die. Why does each of these cost tens or hundreds of thousands of dollars? I've heard American doctors at conferences describing their system as "the worst imaginable". Every American I know hates their system. It costs a lot more, has worse outcomes and shovels money and privilege towards the rich. Why…

Everyone hates “the system”, including the people in it. But every party of the system is perfectly fair and reasonable for the people benefitting from it, even if they hate every other part. So every part of the system will have people fighting for it—and if you try to change the whole system, the entire system will fight you. It’s an equilibrium, even if it’s obviously far from optimal.

There's an old essay "Meditations on Moloch" which is an exploration of themes around why humans create systems with destructive outcomes even when no individual wants them: https://slatestarcodex.com/2014/07/30/meditations-on-moloch/

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

#118

Post by s1artibartfast »

convolvatron wrote: post #103
Workaccount2 wrote: post #89

Earlier quoted context omitted.

The problem with the European system is that it is contingent on the American system keeping the status quo. Without high prices in the US, European governments can't negotiate for the same lower prices. The US is a goldmine for medical corporations, which the EU gets to ride on the coat tails of.

you're suggesting that the entire difference in cost/benefit between the US and EU model is due to research and development? that seems wildly unsubstantiated. the google blurb puts it at 6% of US spending, but its unclear how much of that is actual research and how much is product development and marketing.

It is true for emerging technology such as drugs and devices, but doesnt figure in for most healthcare like getting a broken bone fixed or childbirth.

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

#119

Post by sdwr »

fetzu wrote: post #75
radlad wrote: post #68

Earlier quoted context omitted.

A huge amount of physician / provider time (cost) is dedicated to insurer billing, coding, and documentation.

That’s correct. And I still baffles me that no substantial improvements have been made in that problem space. My grocery shop has a LLM powered Robo-assistant, and doctors are still copy-pasting (or even worse, re-inputting them by hand) text between various pieces of software on a daily basis. I understand regulation plays a good role in that, but I can’t believe that it is the only reason..

Healthcare software is incredibly resilient against bottom-up replacement.

Huge feature lists, high standards for correctness, strict regulations, existing long-term contracts.

It's like the space industry before SpaceX. Everyone knows the incumbent is inefficient, but you can't compete without building the whole damn rocket.

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

#120

Post by patja »

rqtwteye wrote: post #108

Question for the techies here: Due to lack of political will and deep-seated corruption I believe a lot of issues in the US system are almost unfixable but I always wonder why it has to be so convoluted (besides being hyper-expensive). Why can't the insurers have an app where the patient (or the provider) can type in the procedure codes they are planning to use and then the insurer returns the co-pay, co-insurance an…

In my experience this behavior is due to the fact that they don't really know on the insurance side how the care provider is going to code something until they have actually done the procedure and have submitted it with the coding. And there is a very high wall between the insurance/patient billing side and the care providers, even in a case like Kaiser where they're all employees of the same company.
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