A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims • Hacker News Board

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#171

Post by komali2 » Mon, Mar 26, 2018, 10:10 AM UTC

shard972 wrote: post #166

komali2 wrote: post #130

Earlier quoted context omitted.

>pressure on hospitals to reduce prices Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company. The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you wan…

> The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. I'm sure they said that in soviet Russia too. It's all good to say X,Y or Z is a right until you actually cash in on that right. I mean you don't even have to look to the soviet union, what is goinig on with the VA? Obama was working to fix that smaller universal healthcare system from actually just waiting…

On Reddit, to responses like this ("America is incapable of universal healthcare because... Reasons") I like to link to the Wikipedia pages of the multitude of other countries with far lower GDPs solving the problem.

I can probably predict the response but on the chance I'll be surprised - why can't America solve the problem when Taiwan, Switzerland, Sweden, France, Germany, the UK, Canada, Finland, Norway, etc etc etc have or nearly have?

(I have received healthcare in several of these countries and an readily prepared with counterpoints to the inaccurate "healthcare isn't good / lines are long in those countries" arguments, fair warning)

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#172

Post by komali2 » Mon, Mar 26, 2018, 10:12 AM UTC

whatshisface wrote: post #152

AFNobody wrote: post #148

Earlier quoted context omitted.

I'm not sure its fair to argue that universal healthcare is a human right despite the fact it makes economic sense. Humanity survived just fine without real healthcare and healthcare is not essential to a fair balance of power b/t the government and its citizenry. Universal healthcare needs to be argued on the economics of the issue because that is the only practical way to make it sustainable. The "feel good" stuff…

You also have to watch out that asserting positive rights that are sometimes impossible to provide (like healthcare) will confuse people when governments attempt to claim that other, deeper rights are "impossible to give." (For example, they might try to argue that they can't afford to not torture, comparing it to how their impoverished country can't give everyone free internet.)

Why is that? If a country tries to claim it cannot afford not to torture, can't we simply point to all the countries that manage without it, as I do for the healthcare debate?

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#173

Post by cmurf » Mon, Mar 26, 2018, 10:12 AM UTC

shard972 wrote: post #166

komali2 wrote: post #130

Earlier quoted context omitted.

>pressure on hospitals to reduce prices Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company. The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you wan…

> The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. I'm sure they said that in soviet Russia too. It's all good to say X,Y or Z is a right until you actually cash in on that right. I mean you don't even have to look to the soviet union, what is goinig on with the VA? Obama was working to fix that smaller universal healthcare system from actually just waiting…

Americans pay double in health care costs per capital than any industrialized nation. And we don't have better outcomes. All of those countries have universal healthcare. Citation, OECD.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#174

Post by b1daly » Mon, Mar 26, 2018, 10:15 AM UTC

curun1r wrote: post #115

maxxxxx wrote: post #7

Earlier quoted context omitted.

"The whole idea of Obamacare is...the people who are healthy pay for the...sick" This is the whole point of health insurance! What a stupid idiot (I am overly nice to Paul Ryan. His budget plan was the most ridiculous thing I have ever read).

I'm sick of people making this comment because it's flat out wrong. Insurance is about lowering variance, not about subsidizing high risk. The ACA tries to make insurance affordable for everyone, and in the process, some people pay less than their actuarial cost and others pay more. That is not just insurance, it's forcing people with a lower actuarial risk to subsidize those with a higher risk. Insurance is about ta…

You seem to be making an argument based on “semantics” here?

The idea of extending an insurance program into a mechanism for subsidizing those who can’t pay the premium does not mean it magically transforms the program into a totally different thing.

In the limited definition, it is still the case that the healthy pay the cost of sick.

The extension of the concept of insurance fits semantically, because it is based on the idea that there is an element of chance inherent in who gets sick; getting sick includes many factors that are outside the source of an individual’s contol (as well as factors that are within an individual’s control).

The ACA included a “tax,” among other methods to socialize the cost of covering the “premiums” for those that couldn’t cover them on their own.

The whole system relied on the same actuarial principles as the previous system to smooth out variance in costs to individuals.

Paul Ryan sounds like an idiot here, because he is a mealy mouthed politician, who doesn’t have the courage of his convictions.

Ryan is libertarian minded tool, whose real opposition to the ACA is not that the healthy pay for the costs of the sick. His opposition is to the elements of the program that force wealthier members of society to cover the medical costs of the poorer members.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#175

Post by b1daly » Mon, Mar 26, 2018, 10:40 AM UTC

curun1r wrote: post #119

ModernMech wrote: post #50

Earlier quoted context omitted.

And by what mechanism does insurance linearize individual risk? The fact that if I get cancer, it's less likely to bankrupt me. But if it's not bankrupting me, someone else is paying for it. Who's paying for it? Someone who didn't get caner. So how is this not "less risky people subsidizing more risky people"?

Let's say your odds of getting that cancer are 5% and you know that ahead of time. So, knowing that it would bankrupt you, you gather 20 other people who are also at a 5% risk of getting cancer to form a group where you all chip in no matter who gets sick. You've now spread the risk out across a pool of people and, yet, everyone is still paying their fair share because no one knows who will be the unfortunate cancer…

I’m repeating myself, but you are wrong in at least two ways.

Health insurance in the US is not conducted in any way like the over simplified, text book example you provide. There exists no real world example of health insurance that functions as you describe.

There is the obvious problem that there is nowhere near that level of precision in anticipating the given level of risk for any individual getting a certain disease, especially as most populations are fairly heterogeneous when it comes to health risk profile.

The insurance companies use statistical tools to estimate the average risk of insuring a pool of people with some element of similarity, like a pre existing conditions. This is a far cry from being able to evaluate the risk profile of a given individual.

The complaints people have about being rejected for coverage based on a pre-exsisting condition, when they think that condition doesn’t really make them that risky reflect the imprecision of the actual tools.

This is also illustrated by these blanket denials: insurance companies are rejecting populations that the feel cannot be adequately evaluated for risk.

There is another aspect of such complaints (about blanket denial of coverage) which come from the issue that some people simply do have a health condition that they cannot cover the expected cost of.

This is a societal issue, and different socities deal with it differently. It inevitably involves some sharp elbows between the various interests involved.

In the US, for historical reasons, a big method of covering the costs of those who can’t afford the full premium was through the patchwork system of employee health plans, complementing government run plans like social security, Medicare, Medicade, local government programs, and charitable programs.

As imperfect as the system is, it remains the case that the health care coverage of high risk individuals, meaning those who can’t cover the full cost of a risk based premium, relies on what is known as “health insurance.”

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#176

Post by [deleted] » Mon, Mar 26, 2018, 11:04 AM UTC

candiodari wrote: post #163

intended wrote: post #155

Earlier quoted context omitted.

Healthcare is not hard. American healthcare is. Frankly a single payer system is simpler and faster. But this is an area where American politics and market rhetoric just lead to terrible outcomes.

In law school we were always taught that there are no rights. Rights, in practice are nothing but duties, and should be looked at like that. You have no right to "life, liberty and the pursuit of happiness", you have a duty to not interfere with other people's life, liberty or their pursuit of their happiness. But even that is a negative duty. Positive duties, like paying tax, are more like the right to healthcare. S…

[deleted]

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#177

Post by lotsofpulp » Mon, Mar 26, 2018, 12:01 PM UTC

zaroth wrote: post #118

tptacek wrote: post #32

Earlier quoted context omitted.

The rate of increase for health insurance prices went down after the ACA was enacted. The motivation for enacting the ACA was, in large part, the untenable increase in insurance prices in the 10 years leading up to it. People have a bad habit of blaming the ACA for insurance prices. The ACA failed at its goal of making individual health insurance affordable, that is true. But it didn't cause that problem, and it did…

Years ago I purchased private insurance for my family in CA. As I recall I was able to get a plan for my wife with no maternity benefits since we were done having children at that point which was significantly cheaper than the alternative. We were paying something like $400/mo total for a family of 4 with an HSA and $4k deductibles. Later, after some health issues first child diagnosed with T1D we were grandfathered…

Yes, ACA is bad if you don’t care about your others in your country getting healthcare. If you do, then you need to figure out how to spread the costs, and ACA is the best we could get with the legislature we had.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#178

Post by lotsofpulp » Mon, Mar 26, 2018, 12:37 PM UTC

aaavl2821 wrote: post #132

hippich wrote: post #109

Earlier quoted context omitted.

Note that you never mentioned person who actually receives service. IMHO problem is exactly that - none of players you mentioned truly interested in long term cost control. Some might just care about short term budgets, but otherwise all of them will pass it down to the consumer. And consumer being on their own, with little to no competition and information asymmetry has very little leverage..

I agree. The current players in the healthcare system view people as numbers, and that is terrible. Doctors are the most natural patient advocates, but unfortunately physicians' ability to influence healthcare, on a system or patient level, has decreased significantly in recent years. I would love to see (and am hoping to build) solutions that give more power back to doctors and patients, and focus on patient experie…

Allocating healthcare resources is numbers, and there is nothing wrong with that. If you want to decrease costs, then increase the supply of healthcare. Healthcare = doctors + medicines + equipment, so all you need to do is increase that supply. However, you’ll find that the doctors don’t want to increase their supply and they’re very effective. Drug manufacturers also don’t want to increase supply, and they’re also very effective.

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#179

Post by candiodari » Mon, Mar 26, 2018, 1:07 PM UTC

hestefisk wrote: post #169

candiodari wrote: post #163

Earlier quoted context omitted.

In law school we were always taught that there are no rights. Rights, in practice are nothing but duties, and should be looked at like that. You have no right to "life, liberty and the pursuit of happiness", you have a duty to not interfere with other people's life, liberty or their pursuit of their happiness. But even that is a negative duty. Positive duties, like paying tax, are more like the right to healthcare. S…

http://jeffsachs.org/2017/06/jeffrey-sachs-america-can-save-...

I must say, I've read through his points on the CNN website, and I find 2 of them very wrong (capitation, and the shifting of money away from trained doctors into untrained "workers" "aided by computers"). Most others ... perhaps, but I can't see them making a large difference except the ones about medicine.

Capitation brings the insurance industry's incentives (ie. only work with healthy people) away from insurance companies and onto doctors. What is a diabetic to do when doctors just directly refuse to treat them directly (or delay, or ...). And before you say it won't happen because of hippocratic oath, we both know this rule will force doctors to do that for 90% of their time.

For such doctors and facilities getting people with longstanding illnesses that are just going to come in time after time after time and need expensive drugs and treatment, like MS patients (multiple sclerose), is going to be financially debilitating. That's not reasonable and absolutely not what we want.

As for replacing doctors with "workers" (presumably he means not even nurses), I feel like shouting at him. Doctor's salaries are high, but don't represent a decent fraction of expenses. You could give everyone in medicine a 100% raise and the cost would be in the low single digit percentages (2-3%). Let's face it, this is not what we need to save on. And if we are to save on it, let's PLEASE do it the right way: by subsidizing the training of more doctors, not by replacing doctors with idots.

What I keep hearing about US medicine is that 2 things are necessary:

1) legal changes limiting legal liability of doctors (doctors pay 5 digits per month in insurance in some places, money that is paid by patients but is definitely not going to better care). Something like the European system where a doctor can only be sued before a judge if he's found by the local ethics/hospital/national medical/... board (staffed with exclusively other doctors) to have gone overboard.

2) limit the cost of medicine and increase choices (e.g. mandatory licensing, importing of generic drugs, or just outright force the use of a generic alternative if available like a lot of European countries are doing)

This is the only point I agree with Mr. Sachs.

and for a bonus (just for bringing sanity into the system):

3) Outlaw any and all advertising for anything medicinal (something like if it requires a prescription, advertising it = jail time)

Re: A Glimpse into the Bureaucratic Hell of Denying Health Insurance Claims

#180

Post by dragonwriter » Mon, Mar 26, 2018, 1:15 PM UTC

AFNobody wrote: post #148

komali2 wrote: post #130

Earlier quoted context omitted.

>pressure on hospitals to reduce prices Elsewhere it has been said: choosing between bankruptcy for your family or cancer care for your child isn't an actual choice, it's two loaded guns pointed at your skull. One held by the hospital, the other by the insurance company. The reason first world countries choose universal healthcare is that healthcare is a human right. Full stop. It is not an economic issue. If you wan…

I'm not sure its fair to argue that universal healthcare is a human right despite the fact it makes economic sense. Humanity survived just fine without real healthcare and healthcare is not essential to a fair balance of power b/t the government and its citizenry. Universal healthcare needs to be argued on the economics of the issue because that is the only practical way to make it sustainable. The "feel good" stuff…

> I'm not sure its fair to argue that universal healthcare is a human right despite the fact it makes economic sense.

“Universal right” is simply that which people feel all people ought to have.

> Humanity survived just fine without real healthcare and healthcare

“Universal healthcare” as a right is simply the right to a certain minimal level which is dependent on technology and resources. The fact that their have in the course of human history been times when no real healthcare by the standards of the early 21st century isn't material to that one way or the other.

> healthcare is not essential to a fair balance of power b/t the government and its citizenry.

That's quite arguably not the case; “government” is an a abstraction than the ultimately boils down to the subset of the citizenry with the most power in allocating resources, and it's quite arguable that that floors for allocation of resources in several domains, including healthcare, are essential for fair balance of power between that subset and the rest of the body of the citizenry.

Further, your implicit argument that a “universal human right” must either be something that prehistoric humans could not survive without or relate to balance of power between people and government is simply a statement of your political values, not a boundary on the what “makes sense” as a universal right.

> Universal healthcare needs to be argued on the economics of the issue because that is the only practical way to make it sustainable.

The actual concrete floor at any given time must be, but then again since every OECD country which guarantees universal healthcare, regardlesa of the details of the system, does it for less total (measured by absolute expenditures, per capita, or per GDP) than the US does spends on healthcare (and some don it for less by all three measures than the US spends in the. smaller public portion of its system alone, let alone the private expenditures), the economics aren't really an issue when you are talking about the US system.