We'll never know, but: I wonder what would happen if we moved the "medically necessary" requirement burden of proof from the doctor/patient to the insurer. So the insurer would be required to pay out a claim regardless of whether the insurer thought it was medically necessary, but their recourse could be to try to claw it back post-payment.
What would happen is that costs to self-funded employers would increase so much that many of them would simply stop offering health insurance benefits and choose to pay the tax penalty instead. The only way the current system sort of works is with health plans maintaining strict utilization management.
(In general society would be better off if access to healthcare wasn't tied to employment but that's a separate issue.)
>Everything about American healthcare is bad. Except the part where you are cared for by a competent clinician?
Are clinicians any more competent than in other countries with similar levels of training? In Europe, UK, or here in Australia for example, the quality of public care seems to be competitive with the US, and the quality of private care here seems often even better. I've heard this "US healthcare is expensive but at least it's good" thing a few times, but never with any particular evidence, and from the few numbers I…
I didn't know American health care is known to be good. According to random lists I find it ranks pretty average.
You're welcome to come up with an alternative system of aligning interests, so far all of the other ones have failed horrifically.
> so far all of the other ones have failed horrifically. Have they? i live in neither country but i know i'd rather have cancer in the UK than the US. That Breaking Bad meme about Walter getting lung cancer in the UK comes to mind.
The US has higher 5-year survival rates for most types of cancer than the UK. In general the US is the world leader in cancer care.
I had a tick bite that was irritated (but not a bullseye rash that I could see) - phoned GP practise, doctor phoned me back a couple of hours later and discussed the situation, ruled out blood tests because they said they were inconclusive at best and arranged for a 3 week course of antibiotics. My wife picked them sup from a pharmacy later that afternoon as she was in town anyway. No direct costs, no mention of mone…
You are getting snagged on the surface level discussion about tick bites, rather than the real discussion about the complexity of medicine.
Note the last sentence of what I said.
Edit: Discussions of US healthcare all seem insanely complex to me - but it all seems to be about insurance and money - which are the last things I want to think about if I am ill or injured.
Hmm sure, but there must similarly be things that are denied right? I lived in both systems. In a single payer system, the state essentially decide what is allowed and what is not. And with the state as a single payer, they also go back and forth on price with the hospitals. It still is a better system overall but there is no places where you can just spend as much as you want on healthcare without some type of centr…
In Britain the national health service is a single payer and there are some things it won't fund, but you are still free to take out health insurance or be a self pay customer and go to a private doctor or private hospital.
In my experience, its not so much what the NHS won't fund but getting access to what it does fund in a timely fashion.
Of course there is dentistry, which is a complete nightmare... people trying to do their own extractions with a pair of pliers is the sort of thing you used to associated with the US but I've actually met some people who have tried that due to how poor NHS dental services are and how expensive private treatments are.
>So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's unlikely someone else will if they have to pay on your behalf. Ok, hear me out for a minute. What if I wanted to pool with several people, so that if any of us had unexpected medical needs, it wouldn't bankrupt any of us. Knowing that mo…
There's nothing stopping you from starting your own non-profit health insurance company. If greedy health insurance companies are really the root of the problem, you should be able to out-compete them fairly easily.
You are correct that health insurance companies aren't the problem here. But there are a lot of things stopping you from starting your own non-profit health insurance company. Medical insurance is heavily regulated at the state and federal levels. Launching a new one takes years of work just to get through the paperwork and legal compliance issues.
> Sure wish there was a system that just did that, without trying to also generate insane profits off it. Health insurance companies in the US must pay 80% of premiums to providers. All their overhead (e.g. their accountants and actuaries and so on) comes out of the remaining 20%. What's left is their profit. People have this fantasy that all the money we spend on healthcare is secretly going to greedy insurance comp…
Their overhead (e.g. their accountants and actuaries and so on) spend a lot of time inserting paperwork and delays in between hospitals and patients, fighting hospital invoices and fighting patient claims, doing marketing, and any profit the insurance company makes is money customers "spent on healthcare" which didn't end up being spent on anyone's healthcare. > " Health insurance companies in the US must pay 80% of…
The actual minimum medical loss ratio is 85% for most large health plans. In practice most of the large payers are at a higher ratio due to competitive pressures. As to how that figure was decided upon, when Congress passed the Affordable Care Act (Obamacare) they just picked a number that seemed reasonable — it wasn't based on a quantitative economic analysis or anything like that.
People get annoyed at insurers who will deny treatment but most of the time you can just pay it yourself. The government has decided that everyone should pay for health insurance but you'll never be denied care if you pay for it yourself. So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's…
The problem is that patients are usually not in a position to determine if the care the doctor says is needed is really needed or not. This is the same as taking your out-of-warranty car to the mechanic. How do you know if the mechanic is telling the truth? Still, this would be better than the current system. Even when you don't know if the doctor is telling the truth you can go by their reputation for telling the tr…
Reputation is pretty much worthless. Patient reviews are largely based on how nice the doctor seems (bedside manner) and have no correlation with actual clinical outcomes.
People get annoyed at insurers who will deny treatment but most of the time you can just pay it yourself. The government has decided that everyone should pay for health insurance but you'll never be denied care if you pay for it yourself. So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's…
yup. So if you decide you want to have a child, you just get ready to fork out 40-80K for the birth. Because anyone can afford that, right? Oh, and by the way, if you are in Texas abortion is illegal. In case you didn't actually __decide__ to get (yourself, your partner) pregnant. So it's either 40-80K or 40 years. Easy choice.
No one with health insurance pays $40K for a birth. Even for high-deductible health plans the current family out of pocket annual maximum is $21K.
Pharmtech: "With your current insurance we can't sell you this medicine at any price. We're under an agreement." Me: "Okay, what if we don't go through insurance?" Pharmtech: "$45 for the prescription." Me: "That's a bit higher than last time." Pharmtech: performs some sort of incantation "Okay, $12." Me: "How did we go from not at any price to $12?" for those of you keeping score at home, the medicine was generic co…
There's an XKCD where the person who did the file download dialog for Windows visits some friends, https://xkcd.com/612/ . "I'm just outside town, so I should be there in fifteen minutes...actually, it's looking more like six days...No, wait, thirty seconds" Sounds like that guy got a job setting prices for prescription medicine.
this is actually what it's like getting pants hemmed at men's wearhouse once the salespeople realize you won't be paying their rent today with the commission on a big purchase. I needed them in a week. Dude quoted me 3 weeks, then 10 days, then 8 days, then said he could get it done in 15 minutes. I get that under the hood capitalism is about charging the most you can get away with and offering the least the other guy will expect, and he's supposed to do the same and y'all strike a middle ground that makes nobody happy but is acceptable to everyone. But you're not supposed to flat out look at me and go "What's the worst you'll accept from me right now?"