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How often do health insurers say no to patients? (2023)

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Re: How often do health insurers say no to patients? (2023)

#71

Post by noobhacker »

avalys wrote: post #63
kstrauser wrote: post #43

Earlier quoted context omitted.

The sheer amount of overhead induced by insurance is staggering. For example, the sum of the net profits of all insurers represents money extracted from the system without contributing to health. And the amount of time doctors spend documenting patient care over and above what’s medically necessary purely to make insurers happy is time not spent seeing patients. Clinic staff spending hours on the phone each day argui…

Have you actually checked any of these numbers? What do you imagine is the profit margin of a health insurance company? According to this report by the national association of state regulators, the profit margin of the health insurance industry in 2023 was 3%, or $25 billion. Compared to over $1T of premiums, and over $4T of total healthcare spending in the US, that doesn't seem "staggering" to me. https://content.na…

Profit margin is the wrong metric in this debate. The person you are replying to is saying that the insurance companies as a whole is a waste, including all the salaries paid to their employees.

Re: How often do health insurers say no to patients? (2023)

#72

Post by savanaly »

mattnewton wrote: post #27
arwhatever wrote: post #22

Earlier quoted context omitted.

1. A properly competitive marketplace 2. Socialized medicine 3. What we have now I would like to see #1 tried but at this point I’ll gladly accept #2

I just don't think #1 is possible, how can you have a functioning marketplace for a good when the demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive. I'd say the US really tried and the incentives just aren't there for a stable system.

>demand is hard to forecast for an individual, almost completely inelastic and often extremely time sensitive

These don't preclude a free market working well. For instance, they're all apt descriptors of me when I find myself needing an Uber home. I'm not completely inelastic, since I could take a series of long bus rides to get home, or walk, but accepting for the sake of argument those aren't life-threatening, the cab companies more or less have me over a barrel. Or do they? We all know what keeps them from charging me more they do, even given the time sensitivity, lack of prediction, or inelasticity. It's competition.

The USA system doesn't work well, and I'm not necessarily saying that free market is the right solution, just pushing back on the notion that just because a good meets those criterion we are forced to throw our hands up and say the free market could never provide that.

Re: How often do health insurers say no to patients? (2023)

#73

Post by arwhatever »

mattnewton wrote: post #52
arwhatever wrote: post #36

Earlier quoted context omitted.

When did the U.S. really try?

Isn’t this just a no true Scotsman? The US claims at least to have built a free market solution, and if nobody else has been able to make it work at scale, why isn’t that enough.

I don’t think so, although that seems like a fair question of you to ask.

I’ve tried on numerous occasions to get pricing quotes for healthcare both paying fully out of pocket, and for getting an estimate for what I’ll be left covering after insurance negotiates ads pays their part.

In every attempt I get absolutely nowhere price estimate-wise and wind get this or that procedure done just hoping and praying that the ultimate bill will be remotely reasonable

We’re so far off the mark for having a healthy marketplace for healthcare pricing that I just can’t see considering it dysfunctional to itself be an appeal to some purity.

Perhaps one might argue that a formerly functional healthcare pricing system will inevitably degenerate into this robber Baron situation that we’ve got currently, but otherwise I don’t see the no true Scotsman.

Re: How often do health insurers say no to patients? (2023)

#74

Post by arwhatever »

kstrauser wrote: post #62
eviks wrote: post #58

Earlier quoted context omitted.

You're not a mechanic, how can you evaluate the services be certain that they didn't oil your breaks instead of your engine? > can’t search for my preferred cardiologist when I’m having a heart attack. You can't search for your preferred mechanics when your breaks failed on a highway. Yet somehow that didn't kill the competitive marketplace.

That’s a bad analogy. If my brakes fail, once I come to a stop there’s no urgency in getting them fixed. I can abandon the care if it’s a lemon. I can have it towed home. I can use Yelp to find a reasonable mechanic. I can rent another car until this one’s fixed. It’s the opposite of “every second counts”. Meanwhile, this is the only heart I have, and if it’s in danger of stopping, I have approximately seconds to cal…

It could be said that you’re over-generalizing here.

Arguing against any attempt at competitive healthcare pricing because medical emergencies exist is a bit throwing the baby out with the bath water.

Re: How often do health insurers say no to patients? (2023)

#75

Post by bestouff »

Eddy_Viscosity2 wrote: post #44
firesteelrain wrote: post #41

Earlier quoted context omitted.

How would it all be paid for if not by increasing premiums (like what happened with ACA)?

Health insurance companies do not provide any medical services. They are the middle man between patients and the places/people that actual do provide medical services. So when they deny coverage, they just keep all the premiums paid by the patient. That money is sucked up by the middle man. So you don't need to raise premiums, you need to lower profits at health insurance companies. Every billion they make in profit…

The waste is not "every billion they make in profit". It's every billion they make.

Re: How often do health insurers say no to patients? (2023)

#76

Post by mrcommentwriter »

azemetre wrote: post #20
kstrauser wrote: post #14

All the time. I have a UnitedHealthcare “platinum” plan, and it may as well not include pharmacy benefits because it never covers anything. Generic thyroid meds went from $2/month with Aetna to $70 with UHC. ADHD meds went from $10 to $300. The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. I was raised a die-hard ca…

These are completely human systems that can be changed any time for any reasons. The current system is achieving exactly what it was designed for: wealth extraction. There’s no reason why this system has to exist. We can make it better any time we want.

First they sell you the problem, then they sell you the solution.

There is no emphasis on long term planning or prevention.

Everyone is grabbing with both hands.

Re: How often do health insurers say no to patients? (2023)

#77

Post by firesteelrain »

Eddy_Viscosity2 wrote: post #44
firesteelrain wrote: post #41

Earlier quoted context omitted.

How would it all be paid for if not by increasing premiums (like what happened with ACA)?

Health insurance companies do not provide any medical services. They are the middle man between patients and the places/people that actual do provide medical services. So when they deny coverage, they just keep all the premiums paid by the patient. That money is sucked up by the middle man. So you don't need to raise premiums, you need to lower profits at health insurance companies. Every billion they make in profit…

> They are the middle man between patients and the places/people that actual do provide medical services

This is the same way Medicaid/Medicare works too. Maybe they are the Neutral Good whereas insurance companies are the Neutral Evil.

Re: How often do health insurers say no to patients? (2023)

#78

Post by notmyjob »

kstrauser wrote: post #42
SpicyLemonZest wrote: post #38

Earlier quoted context omitted.

> The threatened “death panels” we heard about when ACA was being debated are actually employees of insurers who decide what they’re not going to pay for. The key insight, though, is that this is fundamentally unavoidable. Someone, somewhere has to decide how a limited healthcare budget will be allocated among all the various healthcare it could go towards. You and I agree that it would be best to have a system where…

For context, I’ve co-owned a medical practice for about 25 years, and spent the previous decade working for a healthcare startup that processed insurance claims to do data science. The system is broken. It’s useless to extrapolate how things might work based on their current functionality. It doesn’t have to be like this. Everywhere else in the world manages it better than we do, and we’re not special snowflakes who…

“Everywhere else in the world manages it better than we do”

If that were true, why do people come to get health care in the US? (Because we have better healthcare and it’s free if you don’t have money or aren’t a citizen.)

Re: How often do health insurers say no to patients? (2023)

#79

Post by kstrauser »

NuclearPM wrote: post #70
refurb wrote: post #67

Earlier quoted context omitted.

Elected representatives should determine what healthcare I get? Really?

Yes. Indirectly.

Yeah. They should manage the organization that directly decides, like the current arrangement with CMS managing Medicare.

Re: How often do health insurers say no to patients? (2023)

#80

Post by kstrauser »

arwhatever wrote: post #74
kstrauser wrote: post #62

Earlier quoted context omitted.

That’s a bad analogy. If my brakes fail, once I come to a stop there’s no urgency in getting them fixed. I can abandon the care if it’s a lemon. I can have it towed home. I can use Yelp to find a reasonable mechanic. I can rent another car until this one’s fixed. It’s the opposite of “every second counts”. Meanwhile, this is the only heart I have, and if it’s in danger of stopping, I have approximately seconds to cal…

It could be said that you’re over-generalizing here. Arguing against any attempt at competitive healthcare pricing because medical emergencies exist is a bit throwing the baby out with the bath water.

I wasn’t arguing that. I was pointing out that this was a bad analogy.
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