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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

#121

Post by ceejayoz »

s1artibartfast wrote: post #115
School-Cotton wrote: post #49

Earlier quoted context omitted.

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

Health insurance in the US isn't practically compulsory since SCOTUS struck down the individual mandate's fines for not having it in 2012. (It was then removed entirely from the law in 2017.)

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

#122

Post by geodel »

paxys wrote: post #85

What do you call someone who graduates bottom of their class from the lowest ranked med school in the country? Doctor.

True. This makes me think long list nothing burger achievements that IT/ Software/Agilist folks put on Linkedin seems inspired by medical field where everyone is hero and saving lives.

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

#123

Post by mystified5016 »

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…

A couple of things. We've spent the last three generations systematically deconstructing our public education system while certain billionaires raid our journalism and social media businesses. Fully half of America actually and fully believe any lie put in front of them by someone with enough power (money) and who says it scary enough.

Americans don't want universal healthcare because then "bad" (read: not-white) people will have it. That's it. Giving something to the benefit of everyone is untenable evil because it's "communism". If you weren't lucky enough to be born into a social class that already has socioeconomic benefits, you simply don't ever deserve to have those things.

This country has spent the last half century pillaging the commons and masterfully convincing just enough of the population that it's a good thing, actually.

Why don't we just change things? Because we no longer own the government. Several billionaires own the government. Democratic change is next to impossible because the game has been rigged so well for so long and nobody with any power has any interest in fixing it. The US government no longer exists to serve the needs of the people, it exists solely to funnel the maximum possible amount of money from the working class to the ultra elite

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

#124

Post by s1artibartfast »

ceejayoz wrote: post #121
s1artibartfast wrote: post #115

Earlier quoted context omitted.

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

Health insurance in the US isn't practically compulsory since SCOTUS struck down the individual mandate's fines for not having it in 2012. (It was then removed entirely from the law in 2017.)

Agreed, I think private healthcare is the stronger similarity.

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

#125

Post by SoftTalker »

TheCoelacanth wrote: post #38
staticman2 wrote: post #14

Earlier quoted context omitted.

In many circumstances denying care is not malpractice. Even a doctor saying "I'm not taking on new patients" is technically denying care.

That's a very different scenario than a doctor who is being paid to provide an expert opinion on the medical necessity of care. That obviously should be considered practicing medicine with all the normal liability.

These insurance doctors are not really evaluating case particulars. They are not second-guessing the diagnosis, they are looking at whether the proposed treatment is the "standard of care" for the diagnosis, and that customary less expensive/invasive treatments have been exhausted. Medicare and any other potential "single payer" government plan would do this also because sadly fraud by clinicians does exist.

For example when I had an injury I had to do 6 weeks of physical therapy (without improvement) before they would authorize an MRI scan and then surgery.

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

#126

Post by lotsofpulp »

londons_explore wrote: post #17
Aunche wrote: post #12

Ironically, I think that the increased attention to the denial of claims plays straight into insurer's hands. Healthcare isn't expensive because insurers don't pay enough to healthcare providers. In fact, it's the opposite. The ACA mandates that at least 80% of premiums must go towards medical expenses. This means that insurers are actually incentivized to overpay for care to maximize the size of their 20% slice. If…

> incentivized to overpay for care to maximize the size of their 20% slice. This. You see it anytime you mandate some profit cap or limit as a percentage of revenue. Companies will just manipulate the other variable to get more profits. Or they'll buy other related companies so they can do sneaky internal pricing shenanigans.

Only if no competitors exist, or all the competitors are colluding.

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

#127

Post by ClumsyPilot »

cool_dude85 wrote: post #57
Aunche wrote: post #12

Ironically, I think that the increased attention to the denial of claims plays straight into insurer's hands. Healthcare isn't expensive because insurers don't pay enough to healthcare providers. In fact, it's the opposite. The ACA mandates that at least 80% of premiums must go towards medical expenses. This means that insurers are actually incentivized to overpay for care to maximize the size of their 20% slice. If…

Nobody, not this article or any other reasonable person, thinks that claim denial is the reason healthcare is expensive. Rather, they think it is fundamentally fraudulent that someone can pay their premiums, etc. and then when they need treatment, be arbitrarily denied by an in-house doctor employed by their insurer to deny treatment. This is a story of the fraud in the health insurance industry, not the racket part…

> is fundamentally fraudulent that someone can pay their premiums, etc. and then when they need treatment, be arbitrarily denied

This -somehow the insurance industry does whatever it wants. If I get paid but refuse to provide service, multiple times, I will be a wanted man.

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

#128

Post by mystified5016 »

ashoeafoot wrote: post #73
asdf6969 wrote: post #30

Earlier quoted context omitted.

> Why don't you change it? There is no general “you” with agency. The few people who have the ability to change it have no incentive to do that.

80% majority in a democracy can not change whatever they want? Or.. the ideology people inhalate is so strong ,it hacks democracy itself?

Your core mistake is assuming that America is a democracy.

It is not. It has been very efficiently designed to strip as many people of their political voice as possible. Our major elections are literally engineered to give insane advantages to whichever party is currently in power

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

#129

Post by blactuary »

clcaev wrote: post #24
Aunche wrote: post #12

Ironically, I think that the increased attention to the denial of claims plays straight into insurer's hands. Healthcare isn't expensive because insurers don't pay enough to healthcare providers. In fact, it's the opposite. The ACA mandates that at least 80% of premiums must go towards medical expenses. This means that insurers are actually incentivized to overpay for care to maximize the size of their 20% slice. If…

> The ACA mandates that at least 80% of premiums must go towards medical expenses. This is not precisely accurate. The medical loss ratio (80% for individual plans) can also be spent on quality improvement. There is a blurry line between administrative costs and QI initiatives. For example, a plan-provided coordinator could be QI rather than administrative.

This is correct, but I can tell you from experience that that stuff is a tiny amount of what goes into the claims in the numerator

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

#130

Post by jimmymcgee73 »

ceejayoz wrote: post #98
throw10920 wrote: post #44

Earlier quoted context omitted.

This is one of the drivers of cost disease[1] in healthcare, which is a huge problem that won't completely go away even if insurance is radically reworked. [1] https://slatestarcodex.com/2017/02/09/considerations-on-cost... ?

> This is one of the drivers of cost disease... The ACA (with this new 80/20 provision) passed in 2010. Costs have been on a steady upward march (yes, adjusted for inflation) since the 1970s. https://www.healthsystemtracker.org/chart-collection/u-s-spe... The "Average annual growth rate of GDP per capita and total national health spending per capita, 1970-2023" chart even shows the 2020s as the first decade with lowe…

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