261–270 of 301 posts
IDK. What puzzles me here is that a NYPost article can be trending on HN.
Many online papers have pay walls. There are similar articles criticizing health care denials from other sources, feel free to post them. They're not all discussion material nor even readable.
And if the writer did a poor job, poke a hole in the argument.
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Otoh some medical providers like to over bill and over treat.
Stop speciously muddying the waters by either intentionally or accidentally making spurious arguments for these unethical sociopaths. I’ve seen this argument made on this website a lot, and it always conveniently omits the vertical integration of these insurers wherein they are the providers too. The DOJ is literally, actively, suing to block a merger between united healthcare and a provider. https://www.justice.gov/…
Both the payer and provider sides of the healthcare industry have been consolidating for years. Insurers merged to gain more negotiating power with providers and drive down costs. Providers responded by merging (or selling to private equity funds) to gain more negotiating power with insurers and maintain high rates. Government mandates on back office technology also incentivized provider consolidation due to economies of scale. In some areas now a few major provider organizations effectively control the market and payers are essentially forced to pay high rates in order to maintain sufficient networks. So, the logical next step is for payers to mimic KP by building their own captive health systems. Every major payer is pursuing this strategy to varying levels; it's not just UHC.
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One issue is that if denying medical care is murder then every healthcare system is guilty. In the US it’s insurance companies (or the government through Medicare or Medicaid) but in the UK it’s NICE, in Canada it’s CADTH and the provincial health authorities. Since there are finite resources spent on healthcare, trade offs are made all the time. If spending $10M on treatment A saved 10,000 lives and $10M on treatmen…
The difference is that patients in the US are being denied by people lining their own pockets with the savings. In sane countries, there’s at least some basis of trying to do the most good with the resources at hand, which sometimes means denying care for person A because those resources would be better spent on person B. With private insurers in the US, it means denying care for person A because they think they can…
https://www.cms.gov/marketplace/private-health-insurance/med...
If employers wanted it, insurers would be happy to offer health plans that fully paid every claim with zero denials. This would be enormously profitable for the insurers because they could run those health plans with minimal work. But instead, most employers are constantly looking for ways to cut employee health benefit costs. This means incentives aren't aligned.
There's an easy solution to this that the Federal Employee Program (aka FEP) [0] uses -- regular, external accuracy audits. The relevant metric to customers isn't "What percentage of claims are denied?" given the substantial amounts of medical claim fraud. It's "What percentage of claims are denied... that should have been approved ?" So you regularly audit a random sampling of denials, publish the results of that au…
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The other side of that is that some expensive services and drugs are simply unavailable in other countries, or are very tightly rationed. The USA has higher 5-year survival rates for most types of cancer than France, Germany, and Japan. I'm not saying that the US system is better overall, but it does do some things extremely well. We should make sure that any reforms don't sacrifice our unique advantages. https://doi…
This obviously goes without saying. In fact, I'm not sure how implementing a system like Germany or Japan has would impact this at all.
So no, it obviously doesn't go without saying. If we want to cut overall health system costs or improve access then we might have to accept some reduction in service quality, at least for the most expensive stuff.
There's an easy solution to this that the Federal Employee Program (aka FEP) [0] uses -- regular, external accuracy audits. The relevant metric to customers isn't "What percentage of claims are denied?" given the substantial amounts of medical claim fraud. It's "What percentage of claims are denied... that should have been approved ?" So you regularly audit a random sampling of denials, publish the results of that au…
The auditors would either be captured or rendered powerless in short order. There is a great deal of money that can be used for effective lobbying.
There's an easy solution to this that the Federal Employee Program (aka FEP) [0] uses -- regular, external accuracy audits. The relevant metric to customers isn't "What percentage of claims are denied?" given the substantial amounts of medical claim fraud. It's "What percentage of claims are denied... that should have been approved ?" So you regularly audit a random sampling of denials, publish the results of that au…
And now, we also pay to audit insurance? It's too much money burning.
This shouldn't be done by the private sector, period. The reason our costs are so insanely high is because of insurance the sheer inefficiency it brings to care.
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It seems to me that should then be handled by the legal system or perhaps the licensing boards. That is to say, the insurance companies should be forbidden from denying coverage and if they believe that something is going on then they can alert the police or take the doctor to court.
Will never happen. Doctors have strong lobbying of their own and they really like their second vacation homes and Porsches.
Care is expensive because of insurance. Hospitals needs hundreds of administrators and billing specialists. Very little of that money goes to the doctor.
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What’s the source of limited supply of doctors meme? Is there a good rundown somewhere? Because anecdotally, among my friends, I’ve never known someone to not make it through the system to practicing medicine who wanted to, but I do know several who persevered despite being real idiots. I don’t see how opening the pool wider would lead to better care.
1. There is a cap on the number of doctors that the US can churn out since Medicare funds most of their training. That number is 140,000. This inherently limits supply. This is the biggest issue.[0] 2. There are limited spots in certain residency programs due to how competitive they are. Ergo those specialties are artificially more lucrative. Dermatology is a good example. 3. Becoming a doctor is temporally arduous:…
https://students-residents.aamc.org/medical-school-admission...
We can also expand access to affordable primary care by shifting routine services to physician assistants and nurse practitioners. Physicians should be reserved for more complex or higher risk cases.
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Otoh some medical providers like to over bill and over treat.
Yes, insurance companies deny claims, but this is mostly because they don't have the money to pay for things most of their money is spent on care in the first place: they're forced to optimize and people get hurt in the process. Providers do far more damage. UHCs profit margins are only 6%, their operating costs are extremely low[0], and if you look across G7 insurers in the US pay more than the government does in ev…
1. This is true sometimes, but still privatization and insurance's fault. Hospitals have a motive to charge insurance more money. Public healthcare doesn't have this problem.
2. Administration and billing is ludicrously expensive because of insurance. Thousands of insurers with their own processes breeds the most inefficient and broken system you could possibly imagine. The solution is removing the market, i.e. having a single payer. Boom, administration costs disappear.
3. Preventative care is rarely paid for by insurance. In addition, many patients simply don't do it. It's easy for a smoker to get treatment for COPD, it hard for a smoker to stop smoking. That's just how it is.
No matter how you slice the healthcare problem in America, it undebatable that private insurance must go. The inefficiency it creates is absurd and it's why our healthcare costs are through the roof.
Not only do we pay much, much, MUCH more per citizen for care, but our care is also lower quality as compared to the rest of the west.