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Providers, not insurers, are responsible for excess U.S. health care cost (2024)

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Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#61

Post by Legend2440 »

pdxandi wrote: post #44
jugg1es wrote: post #15

I've worked in the healthcare space for a decade and I have asked some tough questions of my leadership and I got a response I'll never forget: "Everyone in healthcare is a little bit evil"

That's a an honestly upsetting statement. My wife is a pediatric critical care physician and there is not an evil bone in her body. She works her tail off, is (in my opinion) underpaid (like most pediatricians), and her job takes huge emotional toll. The same is true for all of her partners. Maybe I'm reading this wrong and you mean administrative or insurance or something else. But at least in my orbit, that stateme…

Is she really underpaid? The average pediatric critical care physician in the US makes $262K-$440K a year according to Glassdoor.

This is twice what the same role pays in most European countries. Unless she is well below that range for some reason, she is likely overpaid.

Everybody in healthcare, from the nurses to the hospital CEOs, makes far far more in the US than they would in a country with socialized medicine.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#62

Post by akramachamarei »

readthenotes1 wrote: post #20

"But when we look at United Health Group’s operating costs in the diagram above, they’re only 22.6% of the actual cost of medical care." A 22% decrease and a return to providers having to consider the cost implications to their patients would be a good thing. ("Return" I know a 95 year old doctor who said he still carries some guilt from keeping a poor guy in the hospital an extra night back in 1955 days because he c…

Of course, it wouldn't be a 22% decrease, it might be an 11% decrease if we assume optimistically that operating costs are cut in half. I don't know if administrative efficiency is exactly a strength of the government, either.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#63

Post by anon291 »

EvanAnderson wrote: post #40
anon291 wrote: post #29

Earlier quoted context omitted.

Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.

This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.

A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the AMA wants it or not. As Americans get richer, many are even just going to foreign countries to get treatment. I know several 'third world' countries have fairly good medical care available for very cheap.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#64

Post by anon291 »

dlev_pika wrote: post #52
anon291 wrote: post #31

Earlier quoted context omitted.

Are you paying for the same thing? I can see a doctor or specialist usually within a week. Less if it's urgent. I think wait times in these countries are never mentioned. Paying for a service tomorrow vs paying for one a few months from now are entirely different classes of goods.

> I can see a doctor or specialist usually within a week That might be true to your specific location and set up, but I have some experience and family in healthcare, both in the US and outside of it, and it is definitely not like that for much of the US.

That's true of any medical system? Still we can look at the data on Canadian v American health care wait times and the data tell the story.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#65

Post by akramachamarei »

insane_dreamer wrote: post #41

Many problems with this article, but no time to pick them apart; needless to say, Noah's argument is thin. I will say this: profit margin % is not the yardstick by which we should measure whether insurance companies are responsible for high health care costs in the US.

Seems like a pretty good yardstick to me. Ultimately, it shows (partially) how much money is going through an insurer vs to an insurer. The revenue flow graph is included for UnitedHealth Group, for example, and about 2/3 is going through the company to medical providers.

Any good hacker is familiar with Amdahl's Law, and the same principle applies here. You can optimize the insurance providers all you want and maybe recover about 1/6 the total cost of care. At the very least, the first place we should be looking is the biggest expense, which is also clearly not the insurance.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#66

Post by antasvara »

readthenotes1 wrote: post #22
tqi wrote: post #6

They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…

I'm on ACA. I get between $100 and $150 on a gift card to do my annual PCP visit even though my premium is $0/month. Why? Obvious if you know about the perverse incentive tqi mentions

The insurance company that provides your ACA plans gets money from the government for doing so. How much money they get is tied to a few things (not an exhaustive list):

1. On average, how healthy is your group of ACA plan holders? If the group has a bunch of chronic conditions, they get more subsidy money to offset the increased care costs. Going to the PCP allows them to have official medical evidence of those conditions.

2. The government gives these plans quality ratings to help people compare them to each other. These ratings are partially based on how often patients get their annual screenings and patient satisfaction. A gift card for a PCP visit accomplishes both aims.

There are also more practical concerns. Preventative care is cheaper than an acute incident for the company. You'd rather catch an arrhythmia at a PCP appointment than pay for the cost of a heart attack.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#67

Post by Legend2440 »

anon291 wrote: post #63
EvanAnderson wrote: post #40

Earlier quoted context omitted.

This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.

A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the…

Doctors salaries should be reduced, as should nurses and dentists. We pay them nearly twice as much in the US as in countries with socialized medicine.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#68

Post by ch4s3 »

treis wrote: post #57
tqi wrote: post #6

They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…

They can grow profits by capturing a larger share of the market.

After the ACA passed it's really hard for insurers to differentiate on policies because so much is mandated. They're essentially all identical products that are going to have similar prices.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#69

Post by gopher_space »

ngriffiths wrote: post #36

> It’s not hard to understand why people hate health insurers. When you interact with the U.S. health care system, the providers — the hospital staff, the doctor, the nurses, the technicians — all just take care of you . > Your interaction with the health insurer, on the other hand, feels like a struggle against an enemy who wants to destroy you. Exactly, the big factor driving healthcare costs is that people like ex…

> They like the fancy plan that covers their doctor

The fancy plan.

Re: Providers, not insurers, are responsible for excess U.S. health care cost (2024)

#70

Post by zephen »

akramachamarei wrote: post #55
zephen wrote: post #14

Earlier quoted context omitted.

> the only way for them grow profits is to increase cost. And, of course, things like spurious denials drive up costs for them and for the providers. More direct costs, more costs at the provider they have to cover... From the insurance company perspective, it's a win-win!

How would spurious denials drive up the cost of medical service?

By adding tons of paperwork and time and effort. When a denial happens, often the doctor himself has to communicate with the insurance company via phone, instead of, you know, doctoring.

This often proceeds over multiple rounds. And then either the company eventually pays, or the consumer has to pay and try to get reimbursed later.

You asked this question 30 minutes after even a casual reading of my other comment, and a little thinking about it, would have fully answered it.

I would like to assume good faith, but your other comments indicate a high probability that you are an insurance company shill.

And in response to your other question about collusion, no there doesn't have to be collusion. Insurance companies putting onerous bogus requirements on providers will automatically drive up the costs.

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