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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)

#71

Post by dqv »

anon291 wrote: post #59
dgellow wrote: post #38

Earlier quoted context omitted.

Depends on the urgency and the specialist, but generally yes, I can get an appointment in a week. Mental health is the only specialty where I’ve seen multiple months wait times. For a specialist you generally first go through a generalist who gives you a voucher for your insurance. But you can also go directly and pay yourself if you want to skip that step. Even if you have slightly more wait time, the cost is still…

I'm not familiar with the german system... is it private or public insurance? As for US employers paying for everything... yes it's common. It used to be that they'd just cover everything via a 'PPO' plan with minimal 'co-pays'. Usually you'd pay $5-15 for a GP, ~$50 for urgent care, and ~$100 for an ER visit. These days, many have switched to a 'High Deductible' plan, where the insurance comes with a 'max out-of-poc…

> As for US employers paying for everything... yes it's common.

Hmm, I think it's better to use a percentage than a fuzzy word like "common":

https://www.kff.org/health-costs/health-policy-101-employer-...

Figure 8

12% of covered single workers and 3% for families have the employer cover their premiums in full

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

#72

Post by dgellow »

anon291 wrote: post #59
dgellow wrote: post #38

Earlier quoted context omitted.

Depends on the urgency and the specialist, but generally yes, I can get an appointment in a week. Mental health is the only specialty where I’ve seen multiple months wait times. For a specialist you generally first go through a generalist who gives you a voucher for your insurance. But you can also go directly and pay yourself if you want to skip that step. Even if you have slightly more wait time, the cost is still…

I'm not familiar with the german system... is it private or public insurance? As for US employers paying for everything... yes it's common. It used to be that they'd just cover everything via a 'PPO' plan with minimal 'co-pays'. Usually you'd pay $5-15 for a GP, ~$50 for urgent care, and ~$100 for an ER visit. These days, many have switched to a 'High Deductible' plan, where the insurance comes with a 'max out-of-poc…

Germany has mandatory health insurances, with both a private and public system. By default you’re in the public system and can opt into private insurances if you have a high income (the threshold increases every year, moving more people to the public system over time).

When you have to pay a co-pay it is 5€ per prescription. You don’t pay for generalists, and do not pay for specialists if you get a recommendation from a generalist first.

There is no deductible.

Not everything is covered though, dental care often has limited coverage (only for the most basic services), so you end up paying yourself.

I never heard of a healthcare saving account, that’s an interesting and strange concept

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

#73

Post by tdb7893 »

pfannkuchen wrote: post #48
tdb7893 wrote: post #21

When arguing that health insurance isn't that inneficient he talks about "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.". 22.6% for a middleman is not insignificant! Also providers have to spend a lot dealing with insurance so it's certainly an undercount of their total cost. This makes the burden of insurance seem like a huge %…

I don’t like the current system at all, but is insurance really just a middleman? Like part of their function is being a middleman, but they also apply some kind of cost smoothing that is outside what a pure middleman would do.

I don't think it's odd for a middleman to have some functions in a market (as long as they aren't actually producing anything) but also the definition of a middleman is unimportant to me. I am just highlighting how he glides over a lot in this article (some of which are actually common progressive critiques of the insurance system) and I don't come away from it sympathetic to medical insurance companies at all.

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

#74

Post by gopher_space »

anon291 wrote: post #31
dgellow wrote: post #23

Earlier quoted context omitted.

Because you wanted to pay more? Or are you saying it is cheaper in the US? If the latter, could you be more specific? I pay the maximum possible in Germany for my health insurance and from what I understand I still pay less for healthcare than I would in the US.

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.

What kind of Northern Exposure bullshit is this?

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

#75

Post by clcaev »

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 failing to provide adequate treatment early in a disease course, further exacerbations and comorbidities can appear, and these can become their own chronic conditions requiring further ongoing treatment.

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

#76

Post by polski-g »

eli_gottlieb wrote: post #25
neilwilson wrote: post #5

It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. Healthcare needs to be provided as a matter of course, and “competition” won’t improve it or control it because there is always a supply side shortag…

> “competition” won’t improve it or control it because there is always a supply side shortage of provision. Why is there always a supply-side shortage?

Because human labor is supply side constrained.

There's only so many doctors, only so many MRI machines, so many valve stents, so many syringes.

Everything on earth is supply constrained.

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

#77

Post by akramachamarei »

zephen wrote: post #70
akramachamarei wrote: post #55

Earlier quoted context omitted.

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, an…

I am deeply offended by your allegation. Not everyone who disagrees with you is a shill. I would not make the same accusations about you, nor would I act as if I can estimate the probability that you are. HN's commentary guidelines address this.

You can consider my mistake to be in conceptualizing the cost of "medical services" too narrowly, as just the medicine, and not the providers' surrounding administration. To that end I take your point. In theory, at least. Do you know how much this has? In particular, you refer to the back-and forth negotiation of claims--on what do you base this claim?

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

#78

Post by polski-g »

tdb7893 wrote: post #21

When arguing that health insurance isn't that inneficient he talks about "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.". 22.6% for a middleman is not insignificant! Also providers have to spend a lot dealing with insurance so it's certainly an undercount of their total cost. This makes the burden of insurance seem like a huge %…

22% isn't bad to remove the need for me, personally, to negotiate prices for services. I wouldn't know where to begin on how to price a bone marrow transplant, but UNH does.

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

#79

Post by BrenBarn »

It is certainly true that providers charge more in the US. However, it's hard to disentangle this from the insurance issue because of the way that providers and insurers are intertwined in a gordian knot of insanity.

The article mentions one example of this, which is that part of "provider costs" is actually paying for the provider to wrangle with the insurer. But even apart from such direct costs, the care is distorted in various ways in order to comply with the insurer's whims. One you hear about a lot is doctors ordering tests that likely aren't really necessary, simply to avoid having the insurer deny something later because they didn't go through all the required motions.

Another reason that "profit margin" is grossly inadequate as a measure of cost or inefficiency is that it doesn't count the actual "work" done by the companies, even though a lot of it simply doesn't need to be done. There are thousands of people with jobs in insurance companies that simply do not need to exist because most of what the industry does simply doesn't need to be done. The leeching is not just a matter of shareholder returns or executive salaries. All the salaries of everyone working for insurance companies are a form of waste. (Okay, probably not all, since even with a saner system some bookkeeping would need to be done, so if you look at the net difference it's not a total waste. But it's more than just shareholders and executives.)

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

#80

Post by akramachamarei »

clcaev wrote: post #75
akramachamarei wrote: post #55

Earlier quoted context omitted.

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

By failing to provide adequate treatment early in a disease course, further exacerbations and comorbidities can appear, and these can become their own chronic conditions requiring further ongoing treatment.

This is a great answer.
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