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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)

#111

Post by ch4s3 »

treis wrote: post #103
ch4s3 wrote: post #99

Earlier quoted context omitted.

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.

It can be a one way ratchet, which is my argument here. Regulations, medicare rates, and pricing power from drug companies set a floor for prices. Insurance companies already run pretty lean and have so-so margins. The 80-20 rule incentivizes a slow ratchet up on prices and the other factors prevent competition on price. The system is designed to have slow predictable price increases.

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

#112

Post by keernan »

What I haven't seen mentioned is the identification of "providers". The days of your doctor being the 'provider' are long gone. Providers are now large corporations and, interestingly, the largest "providers" are health insurance companies.

Point 4 of an article[1] about health delivery is quoted below:

>>Perhaps the most underappreciated transformation of the past 40 years is the corporate consolidation and financialization of medicine. Care delivery—once local and community-based—is now dominated by corporations.

>>Vertical consolidation is now a defining feature of American health care. UnitedHealth Group isn’t just the largest insurer; it’s also the largest employer of physicians and the largest operator of home health and hospice agencies. CVS Health, the largest pharmacy chain, also owns the biggest pharmacy benefit managers—and now giant insurer, Aetna. McKesson, a pharmaceutical distributor, now operates the nation’s largest chain of oncology practices and is rapidly expanding into other specialties. These combinations raise all the conflicts of interest you’d expect—higher prices, business steered away from independent providers and pharmacies, gaming regulations, and more.

[1] https://yourlocalepidemiologist.substack.com/p/aca-health-ca...

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

#113

Post by salawat »

treis wrote: post #94
ch4s3 wrote: post #68

Earlier quoted context omitted.

After the ACA passed it's really hard for insurers to differentiate on policies because so much is mandated. They're essentially all identical products that are going to have similar prices.

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

Stop thinking of insurers/providers as separate agents, and start thinking of them as building blocks for financial engineers.

Law binds individual fictions, but not compound ones. Until we start making financial engineering basically illegal, these types of "happy, profit juicing conjunctions" will be the norm.

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

#114

Post by readthenotes1 »

antasvara wrote: post #66
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

The insurance company that provides your ACA plans gets money from the government for doing so. How much money they get is tied to a few things (not an exhaustive list): 1. On average, how healthy is your group of ACA plan holders? If the group has a bunch of chronic conditions, they get more subsidy money to offset the increased care costs. Going to the PCP allows them to have official medical evidence of those cond…

I believe the more recent studies show that annual PCP visits actually reduce quality of health. Seems contrary, but a lot of doctors in the USA will overreact for fear of future litigation. Since most interventions have some possibility of negative consequences, it apparently adds up.

On your specific example, my understanding is that the odds are very low that a random PCP visit will detect an arrhythmia.

Of course, if you mentioned to doc that you're having fainty spells or heart palpitations, then maybe hen'll give you a holter monitor-- but then you've now increased your risk by waiting for the PCP visit instead of doing it when you first notice the symptoms.

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

#115

Post by esbranson »

anon291 wrote: post #29
eli_gottlieb wrote: post #25

Earlier quoted context omitted.

> “competition” won’t improve it or control it because there is always a supply side shortage of provision. Why is there always a supply-side shortage?

Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.

What does the AMA have to do with the Clinton-era cap on federal DGME and IME residency payments? New York spends billions every year, California spends none. These are choices that Congress and California make every year, not the AMA.

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

#116

Post by gatlin »

readthenotes1 wrote: post #114
antasvara wrote: post #66

Earlier quoted context omitted.

The insurance company that provides your ACA plans gets money from the government for doing so. How much money they get is tied to a few things (not an exhaustive list): 1. On average, how healthy is your group of ACA plan holders? If the group has a bunch of chronic conditions, they get more subsidy money to offset the increased care costs. Going to the PCP allows them to have official medical evidence of those cond…

I believe the more recent studies show that annual PCP visits actually reduce quality of health. Seems contrary, but a lot of doctors in the USA will overreact for fear of future litigation. Since most interventions have some possibility of negative consequences, it apparently adds up. On your specific example, my understanding is that the odds are very low that a random PCP visit will detect an arrhythmia. Of course…

I believe you but I'm interested in the studies mentioned in your first sentence.

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

#117

Post by colechristensen »

toast0 wrote: post #95
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.

Has he broken Medicare or VA health more than it already was? I'll acknowledge he's playing games with Medicaid eligibility, but is he messing with the administration of care?

VA:

"Senate Veterans’ Affairs Committee Ranking Member Richard Blumenthal (D-CT) today released a comprehensive report detailing the harm and impacts of the Trump Administration’s draconian directives and cuts on veterans. The report, Breaking the Pact: Impacts of Trump, DOGE, and Doug Collins’ Ongoing Assault on Veterans, was released ahead of the Committee’s oversight hearing with Department of Veterans Affairs (VA) Secretary Doug Collins next week.

Blumenthal’s report reveals historic staffing losses at the Department resulting in dire workforce shortages, increasing wait times for life-saving mental health care, and veterans’ care and benefits being put at risk as a direct result of the Trump Administration’s harmful policies. The Committee report—compiled from extensive reporting, firsthand accounts, and ongoing conversations with veterans and VA employees across the nation—details the Administration’s systemic assault on VA over the past year and the tangible impacts its cuts are having on veterans."

https://www.veterans.senate.gov/2026/1/cuts-cover-ups-chaos-...

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

#118

Post by 486sx33 »

peyton wrote: post #88
tqi wrote: post #82

Earlier quoted context omitted.

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.

[dead]

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

#119

Post by jasonlotito »

dgellow wrote: post #23
jasonlotito wrote: post #17

Earlier quoted context omitted.

> Yep, for-profit healthcare is a bad idea. It's the main reason our USA healthcare costs so much. And yet it still exists in the rest of the world. But people tend to think of it only as for rich people as opposed to covering things the rest of the world ignore. I'm not saying the US is perfect, but having lived under both kinds of healthcare, cost and quality are two reasons I'm in the US.

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.

> Because you wanted to pay more?

No. Canada was 4 figures a month with a wait time of at least a year for one service.

> Or are you saying it is cheaper in the US?

It was 100% free in the US. With no wait time. For all the services needed.

> If the latter, could you be more specific?

Autism care for children.

I want to be very clear: We received more care and assistance in the two weeks prior to moving to the US than the entire time we were seeking help for our children in Canada (they are Canadian, as is my wife). Canada was at best abusive to my children.

My wife was told by a member of the medical establishment to put one of our autistic children in a home and to forget about him.

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

#120

Post by jasonlotito »

FireBeyond wrote: post #37
jasonlotito wrote: post #17

Earlier quoted context omitted.

> Yep, for-profit healthcare is a bad idea. It's the main reason our USA healthcare costs so much. And yet it still exists in the rest of the world. But people tend to think of it only as for rich people as opposed to covering things the rest of the world ignore. I'm not saying the US is perfect, but having lived under both kinds of healthcare, cost and quality are two reasons I'm in the US.

I've lived for many years each in the UK, Australia and the US. I've worked as a healthcare provider for many years in the US. I would dearly love to know what "costs" of healthcare you are looking at when you say the US is preferable enough to actually move to/be in/stay in the US. Because when I can have higher end insurance from my employer, and still be out $9K for a kidney stone after insurance, I'm not seeing i…

> I would dearly love to know what "costs" of healthcare you are looking at when you say the US is preferable enough to actually move to/be in/stay in the US.

Autism care for children. I'm looking at $15-30k a year for a service such as speech therapy. Minimum of 6-month wait time.

US? Free. Wait time? Immediate (not hyperbole).

We routinely keep track of this. It has not improved at all.

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