Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

I write about America’s health care system, and I got caught up in it

nakedcapitalism.com

Post reply on HN
Print view View original

81–90 of 143 posts

Re: I write about America’s health care system, and I got caught up in it

#81

Post by cascom »

lotsofpulp wrote: post #57
lil_dispaches wrote: post #54

Health Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise. The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't…

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

The parent is referring to known condition vs an unknown emergency event.

As an analogy in the case above the car owner is having their insurance company pay for their gasoline - where you are referring to an insurer paying for a car accident.

Re: I write about America’s health care system, and I got caught up in it

#82

Post by beerandt »

lotsofpulp wrote: post #13
civilized wrote: post #4

Aside from someone being denied life-saving medication, the most awful thing for me in these stories is the relentless Kafkaesque quality. We never get any answers to our basic sense-making questions about the bureaucratic process: - What did the insurer expect to happen, in order for this person to keep getting their medicine? - Why did those things not happen? - Whose job was it to make sure those things happened?…

I find the article written in a circuitous way, that does not clearly lay out the timeline. This statement about what a prior authorization is is also incorrect: > They’re essentially requirements that a physician get approval from an insurance company before prescribing a treatment. Doctors need no approval from anyone to prescribe. A prior authorization is approval from the insurance company that they agree with th…

>Technically, you can pin this on undersupply

Well said overall, but the supply of doctors isn't the issue here (regardless of if it's a separate, bigger problem).

1) This case is what mid-levels are ideally suited for. Routine and can be seen within a day or two. Would have moved the whole timetable forward.

2) It's the supply of doctors participating in any given insurance plan or govt reimbursement scheme, not overall supply.

It's pretty easy to find a doctor to see same-day if you pay cash (either straight cash or front cash and submit your own reimbursement).

Which is itself more an issue about regulation being so burdensome and costly that doctors can't afford it without joining a large group or hospital owned practice. Especially the cost of required electronic records.

Which is why it seems like all the small private practices are being bought out by hospitals. Because they either are, or their docs are retiring, or they are opting out of all insurance and govt plans and going concierge/prepaid/membership/cash-only.

What I'm curious about is #1: why couldn't this person get in to see a mid-level sooner? They rarely book more than a few days out.

It's exactly the type of issue that they are meant to help with to reduce demand on the doctors and get patients seen quicker. A routine refill without any nontypical complexities or changes to report.

Did approval specifically require a physician? That would be more of a system problem that needs resolving.

Re: I write about America’s health care system, and I got caught up in it

#83

Post by agumonkey »

nine_zeros wrote: post #66
agumonkey wrote: post #60

Earlier quoted context omitted.

Some countries have been jumping so far ahead. IIRC Slovakia, Iceland have ultra lean administrative processes in lots of places. Minutes instead of days or more, and non hassle. UK has some of that too. France is starting. Someone in the US should get funding for this. It's a 300M people's "market".

I highly recommend healthcare in Asia. In most asian countries, healthcare is pure market driven. Aka, most people are uninsured so there is no insurance bureaucracy. No contracts, no lawsuits. The reputation of service and doctors matters. Appointments for this afternoon? No problem, you got it. American healthcare is what I would wish on my enemies.

All asian countries ? china ? japan ? india ?

Any book about their systems ?

Re: I write about America’s health care system, and I got caught up in it

#84

Post by convolvatron »

throwaway6734 wrote: post #64
tragictrash wrote: post #39

Earlier quoted context omitted.

What twisted fucked up naive world view does this come from. These people are poor, vulnerable and sick. You should be ashamed of yourself. Why don't I throw you in a cage, and then you can try voting for someone to advocate for your release. The point is the seniors need help now, not being told to go organize. The healthcare system is broken, and until you get sucked into it, you don't understand the extent of it.…

This is an overly paternalistic point of view that robs these people of their agency. They've spent their lives participating and interacting within the current political framework. Blaming all problems at the feet of "morally bankrupt leaders" is hyperbolic populist rhetoric to absolve personal responsibility.

sounds they they should have had a better investment strategy when they were working. some people.

Re: I write about America’s health care system, and I got caught up in it

#85

Post by lotsofpulp »

civilized wrote: post #78
lotsofpulp wrote: post #77

Earlier quoted context omitted.

The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that: https://www.cms.gov/nosurprises https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule... For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.

Sort of. You get to initiate a fight with the insurer through an unaccountable arbiter. Insurer websites have lied to us in the past, claiming X was in network (zero cost!) and then sending us a denial resulting in a giant out of network bill for that exact X. Same service, same provider. Truly incompetent and evil system. Fills me with rage.

That is ridiculous. I have not had such blatant negligence / corruption happen to me yet.

Re: I write about America’s health care system, and I got caught up in it

#86

Post by mantas »

syki wrote: post #56
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

In all healthcare systems some form of rationing occurs since there aren’t enough resources to provide the best care to everyone. A system that rations care based on ability to pay or on wether or not your employer is generous is immoral. It is also immoral to profit off of denying someone care. Tough decisions have to be made and financially rewarding a company by denying care is despicable.

In countries with public healthcare it’s still based on ability to pay. You pay out of pocket and cut the queue, have decent time allotment with the doctor, get best medication available without money-saving algorithms etc.

Re: I write about America’s health care system, and I got caught up in it

#87

Post by cascom »

lotsofpulp wrote: post #57
lil_dispaches wrote: post #54

Health Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise. The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't…

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

To your last point I wonder what the effect of not allowing a provider to charge a different price for the same service/product would be.

Re: I write about America’s health care system, and I got caught up in it

#88

Post by coffeefirst »

nine_zeros wrote: post #37

Price aside, the biggest problem with American health care system is the administrative black hole at every stage. Wife was on some serious (and expensive) medical treatment. After many months, the medical provider was at the final stages of the treatment. As usual, the provider needs insurance approval for arcane codes that constitute that segment of the treatment. Get this, the medical provider applies for approval…

And to make matters worse, all this bureaucratic nonsense for coding, billing, authorization costs a stupidly large amount of money that gets baked back into the bills somewhere.

Re: I write about America’s health care system, and I got caught up in it

#89

Post by Auracle »

kemiller2002 wrote: post #38
refurb wrote: post #31

Earlier quoted context omitted.

Why is that broken? Even systems with universal healthcare have rules like this. Why use a $1000 per month branded drug unless you know the $5 per month generic drug doesn’t work?

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

It can also just be a matter of convenience. When I was first put on testosterone I was prescribed AndroGel, which is a gel you out on once daily. It costs $400 a month. Insurance gave a bit of hassle but with my test numbers they acquiesced.

They shouldn’t have, though. Injections (what I’m on now) work better. They’re easier to maintain the correct dose, you don’t have to worry about getting it on your partner/kids, you only take it once every week or two…and it’s maybe $20 a month.

That’s not just a few dollars saved. There are probably hundreds of thousands of men out there that take it. I see there’s a generic gel now but it still costs anywhere from $60-$150 a month.

Re: I write about America’s health care system, and I got caught up in it

#90

Post by lotsofpulp »

cascom wrote: post #81
lotsofpulp wrote: post #57

Earlier quoted context omitted.

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

The parent is referring to known condition vs an unknown emergency event. As an analogy in the case above the car owner is having their insurance company pay for their gasoline - where you are referring to an insurer paying for a car accident.

Yes, it is difficult to pin down an exact definition of insurance in cases where the cost is all but guaranteed.

I can see their point now, but at the time I was thinking relative to other taxpayer funded healthcare systems.

Post reply on HN