Torrent of Hate for Health Insurance Industry Follows CEO's Killing • Hacker News Board

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#231

Post by s1artibartfast » Fri, Dec 06, 2024, 4:40 AM UTC

justinclift wrote: post #227

s1artibartfast wrote: post #226

Earlier quoted context omitted.

There are laws enacted by our elected government (Democrats under Obama) that say exactly how much overhead is acceptable for a health insurance company, and all business expenses and CEO pay comes out of that portion. If they collect too much in premiums to and their profits exceed that percent, they have to refund the insurance members. Health insurance has a fixed profit margin on claims paid. Denying claims costs…

Not sure how this is relevant?

Because they arent murdering or killing people to make money. The less they pay out, the less they make.

Because there is a clear legal understanding of how much profit is acceptable.

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#232

Post by tptacek » Fri, Dec 06, 2024, 4:41 AM UTC

paulryanrogers wrote: post #225

tptacek wrote: post #103

Earlier quoted context omitted.

The people in those states do not want it, which is why state single payer referenda fail.

Romneycare and the ACA were a pretty big step in the single payer direction. Popular enough to overcome vetos and attempts to roll them back.

I like the ACA. I think the Swiss system makes a lot of sense. Community rating, guaranteed issue, mandate, subsidy, then universal single payer at retirement, where costs are concentrated. It's a sane system. The problem isn't the system structure.

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#233

Post by tptacek » Fri, Dec 06, 2024, 4:46 AM UTC

CamperBob2 wrote: post #223

tptacek wrote: post #219

Earlier quoted context omitted.

If what I was backing with "pie charts" was "everyone else is being unreasonable", sure, but that's not what I said. Go look it up. Zero out all insurer costs. What percentage of health care costs do we save?

There's a lot more than just "Insurer costs" and "Doctors' BMW payments" in the pie chart. Again, relatively little of it has to do with actually treating injuries and illnesses. And that's not even getting into the massive market distortions associated with forcing the concept of "insurance" into a market where virtually every single customer will eventually need to file multiple claims. You usually come up with bet…

I've lost track of what you're saying. I'm saying that if you zero out the insurance companies, you don't significantly impact total health costs, because the insurers aren't where those costs are; that's the claim I made upthread you found "... novel", but it's not novel, and it's easy to go verify.

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#234

Post by s1artibartfast » Fri, Dec 06, 2024, 4:52 AM UTC

tptacek wrote: post #200

hirvi74 wrote: post #197

Earlier quoted context omitted.

This could be an opportunity for me to learn something new... I thought the American Medical Association were the ones who artificially constrain the supply of physicians. Is that not true, or is the AMA constraint transitively related to the Medicare caps in some manner?

The AMA is just a lobbying group. The actual cap on the number of new physicians is residency slots, which are funded by Medicare.

Which I think itself is a bit of a red herring. Medicare subsidized residency slots are not the only way training doctors could be funded, and largely an artifact of our billing procedures and criteria.

It is just one aspect of how incredibly constrained the supply of healthcare is in the US. Medications that are over the counter in many countries requires someone with 12 years of training.

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#235

Post by justinclift » Fri, Dec 06, 2024, 4:52 AM UTC

s1artibartfast wrote: post #231

justinclift wrote: post #227

Earlier quoted context omitted.

Not sure how this is relevant?

Because they arent murdering or killing people to make money. The less they pay out, the less they make. Because there is a clear legal understanding of how much profit is acceptable.

> Because they arent murdering or killing people to make money.

Ahhh. I guess you're not aware of stuff like this?

https://www.newsweek.com/hospitals-are-reporting-more-insura...

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#236

Post by justinclift » Fri, Dec 06, 2024, 4:53 AM UTC

tptacek wrote: post #230

justinclift wrote: post #229

Earlier quoted context omitted.

> By that logic, every health system in the entire world is murdering people constantly. Not at all. The US "health care" system has the extremely bad reputation it has for a reason. This guy seems to (for all we know) have only killed a single person (so far). The person he shot has likely killed far more. I'm not sure why you're ok with that, or am I misunderstanding?

That's an appeal to popular culture, but every health system makes decisions that deprive some people of necessary care. Resources are finite.

The US "Health Care" system seems to be taking the piss though:

https://www.theregister.com/2023/11/15/unitedhealthcare_ai_m...

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#237

Post by tptacek » Fri, Dec 06, 2024, 4:58 AM UTC

justinclift wrote: post #235

s1artibartfast wrote: post #231

Earlier quoted context omitted.

Because they arent murdering or killing people to make money. The less they pay out, the less they make. Because there is a clear legal understanding of how much profit is acceptable.

> Because they arent murdering or killing people to make money. Ahhh. I guess you're not aware of stuff like this? https://www.newsweek.com/hospitals-are-reporting-more-insura...

This is the second time on this thread you've pasted this Newsweek link as a rebuttal. I don't understand why you think it rebuts either argument.

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#238

Post by tptacek » Fri, Dec 06, 2024, 4:58 AM UTC

s1artibartfast wrote: post #234

tptacek wrote: post #200

Earlier quoted context omitted.

The AMA is just a lobbying group. The actual cap on the number of new physicians is residency slots, which are funded by Medicare.

Which I think itself is a bit of a red herring. Medicare subsidized residency slots are not the only way training doctors could be funded, and largely an artifact of our billing procedures and criteria. It is just one aspect of how incredibly constrained the supply of healthcare is in the US. Medications that are over the counter in many countries requires someone with 12 years of training.

It's not the only way they could be funded, but it is the only way they are funded.

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#239

Post by justinclift » Fri, Dec 06, 2024, 5:13 AM UTC

tptacek wrote: post #237

justinclift wrote: post #235

Earlier quoted context omitted.

> Because they arent murdering or killing people to make money. Ahhh. I guess you're not aware of stuff like this? https://www.newsweek.com/hospitals-are-reporting-more-insura...

This is the second time on this thread you've pasted this Newsweek link as a rebuttal. I don't understand why you think it rebuts either argument.

Does this one help illustrate the problem?

https://www.theregister.com/2023/11/15/unitedhealthcare_ai_m...

Re: Torrent of Hate for Health Insurance Industry Follows CEO's Killing

#240

Post by vundercind » Fri, Dec 06, 2024, 5:14 AM UTC

s1artibartfast wrote: post #226

vundercind wrote: post #198

Earlier quoted context omitted.

I can’t begin to relate to seeing someone with a median income failing to donate to some particular go-fund-me as the same as choosing to head an organization that makes more money when people don’t get the health care they need, and overseeing operations that did that even more recklessly than the industry standard. One has taken on a business relationship already and is taking people’s money then screwing them, at…

There are laws enacted by our elected government (Democrats under Obama) that say exactly how much overhead is acceptable for a health insurance company, and all business expenses and CEO pay comes out of that portion. If they collect too much in premiums to and their profits exceed that percent, they have to refund the insurance members. Health insurance has a fixed profit margin on claims paid. Denying claims costs…

There’s some nuance to this.

The ACA’s loss ratio rules don’t apply to self-funded plans (many large employers use these) even if they’re administered (and possibly re-insured) by a health insurance company, which is usually the case. Just doesn’t apply at all.

Certain plans also allow much lower loss ratios, like 60/40 for expat plans.

A provider that manages to have a lot of new plans in a given state in a given year is immune from loss ratios rules in that state, for that year. I don’t know how gameable this is but my WAG would be it’s only state insurance commissions preventing this from being the case in every state, every year, for every provider, and keeping it to only some states in some years for some providers (I bet the biggies manage to rotate their state[s] and have at least one most years)

So a company the only business of which is health insurance can easily spend far less than 80 or 85% of income on payouts, and only need maintain that ratio on some subset—possibly small—of the premiums it’s collecting.

I don’t know how the game of this affects decisions for insurers that also own providers, but I bet there’s something beneficial there and that’s why they’ve been snapping up provider offices for the last several years.