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> The middleman role of insurance companies in American healthcare seems completely useless. It depends on where you are. There are areas of the country where

> The middleman role of insurance companies in American healthcare seems completely useless. It depends on where you are. There are areas of the country where insurance companies are fighting a cost war on behalf of patients against increasingly conglomerated and monopolistic hospitals. This American Life had a great episode on this a while back. I went in thinking, "This problem's simple, it's all the fault of x." (For a few values of x.) I left the episode thinking, "Wow, who knew health care could be so complicated?" I have moved towards a Marxist philosophy on healthcare. Well, Groucho Marxist: I no longer trust any solutions to healthcare that non-experts like me could understand. https://www.thisamericanlife.org/radio-archives/episode/391/More-Is-Less https://www.thisamericanlife.org/radio-archives/episode/391/...

killjoywashere 9y ago
Without clicking the link: is the hospital conglomerate HCA?
pavlov 9y ago
There are areas of the country where insurance companies are fighting a cost war on behalf of patients against increasingly conglomerated and monopolistic hospitals. This seems like an unnecessary war. Are patients really being helped by a structure where multiple corporate entities -- the hospital and the insurance companies -- are battling each other to extract the maximum value from both the patient and the government actor paying for some part of the care? If the hospital were not a regular for-profit corporation, they wouldn't turn into a monopolistic conglomerate... But of course it's practically impossible to undo these corporate structures and replace them with something with a whiff of socialism. It might even mean a pay cut for doctors, and then you'd have to restructure their education costs too... It's a very deep problem.
- brownbat 9y ago
  > This seems like an unnecessary war. Especially insofar as it's a war, yes. In general, I like two strongly motivated and opposing advisors on my healthcare decisions, one advocating for the best possible care, and one team of actuaries arguing about what's least likely to be a waste of money.[0] Anyway, that's just the ideal case where insurance and hospitals oppose each other, possibly motivated by financial incentives, and I benefit. Admittedly, things usually aren't ideal. You might be able to restructure things where hospital incentives are tied to outcomes. Making them responsible for hospital-acquired infections was a step towards that. But it's hard to pin them to long term outcomes, and weight that towards cost of procedures, which is apparently what we really care about judging by the outcomes / cost headlines. You could assign people to a specific hospital for long periods of time to track long term health outcomes, make them responsible for your health full stop. But occasionally some hospitals face systemic challenges and become institutional failures over time.[1] It'd be horrible to chain people to a failing institution, especially the sole institution responsible for their health. > It's a very deep problem. Agreed 100%. -- [0] Even if I'm not paying full costs directly, I don't want society to simply waste money on me. I've heard of plans that give you a weekly back massage from a chiropractor at a $10 copay. I'd feel terrible doing that, like I was stealing money from babies with cancer. [1] e.g., https://en.wikipedia.org/wiki/St._Joseph_Medical_Center_(Houston,_Texas)#Recent_history https://en.wikipedia.org/wiki/St._Joseph_Medical_Center_(Hou...

killjoywashere 9y ago

Without clicking the link: is the hospital conglomerate HCA?

pavlov 9y ago

There are areas of the country where insurance companies are fighting a cost war on behalf of patients against increasingly conglomerated and monopolistic hospitals. This seems like an unnecessary war. Are patients really being helped by a structure where multiple corporate entities -- the hospital and the insurance companies -- are battling each other to extract the maximum value from both the patient and the government actor paying for some part of the care? If the hospital were not a regular for-profit corporation, they wouldn't turn into a monopolistic conglomerate... But of course it's practically impossible to undo these corporate structures and replace them with something with a whiff of socialism. It might even mean a pay cut for doctors, and then you'd have to restructure their education costs too... It's a very deep problem.

brownbat 9y ago
> This seems like an unnecessary war. Especially insofar as it's a war, yes. In general, I like two strongly motivated and opposing advisors on my healthcare decisions, one advocating for the best possible care, and one team of actuaries arguing about what's least likely to be a waste of money.[0] Anyway, that's just the ideal case where insurance and hospitals oppose each other, possibly motivated by financial incentives, and I benefit. Admittedly, things usually aren't ideal. You might be able to restructure things where hospital incentives are tied to outcomes. Making them responsible for hospital-acquired infections was a step towards that. But it's hard to pin them to long term outcomes, and weight that towards cost of procedures, which is apparently what we really care about judging by the outcomes / cost headlines. You could assign people to a specific hospital for long periods of time to track long term health outcomes, make them responsible for your health full stop. But occasionally some hospitals face systemic challenges and become institutional failures over time.[1] It'd be horrible to chain people to a failing institution, especially the sole institution responsible for their health. > It's a very deep problem. Agreed 100%. -- [0] Even if I'm not paying full costs directly, I don't want society to simply waste money on me. I've heard of plans that give you a weekly back massage from a chiropractor at a $10 copay. I'd feel terrible doing that, like I was stealing money from babies with cancer. [1] e.g., https://en.wikipedia.org/wiki/St._Joseph_Medical_Center_(Houston,_Texas)#Recent_history https://en.wikipedia.org/wiki/St._Joseph_Medical_Center_(Hou...