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The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of hea

• ThrustVectoring 8y ago
  >So then if it's supposedly more efficient, why do I waste multiple hours dealing with insurance bullshit literally every few months? It's friction costs for splitting up the decision-making process into multiple entities. For any bill, the insurance company pays $X, the patient pays $Y, and the provider has $Z in costs. The $X that the insurance company pays is what they optimize for, not $Y and certainly not $Z. This has the side effect of somewhat optimizing $Z, since $Y is limited by how much money people have and if $Z is consistently bigger than $X + $Y, the healthcare provider loses money and goes out of business. Honestly, the way to go is to treat the entire process as interaction with hostile bureaucracy. Document everything, and look like you'll generate a regulatory incident if you don't get what you're legally entitled to. Otherwise the insurance company will happily reduce their costs by offloading it onto you or the healthcare provider through pulling bullshit stunts.
• Skunkleton 8y ago
  Efficient? For who and what purpose? Its efficient for insurance companies, and for the purpose of making money. What do you expect? Any consumer friendliness comes from regulation.
• deleted 8y ago
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• InclinedPlane 8y ago
  Capitalism as it exists today in the US (and other parts of the world) is a paperclip optimizer. The pressure is for those with power to leverage that power toward their maximum short term financial benefit. One consequence of this is that health care has essentially been parasitized by profit seekers who extract money from the system as if it were a strip mine. You can easily see the impact of this in the gross statistics in the form of the extremely high spending on health care in the US vs. comparatively poor return on that spending in terms of overall health outcomes. This is a corrupt system which today produces health care only as a side effect of its main purpose of wealth extraction. That is a natural consequence of our culture, economic incentives, etc. combined with the vast power imbalances between health care "providers" (hospitals, drug makers, device makers, etc.), insurance companies, employers, and individuals. There's no such thing as a patients or insurance holder union, the imbalance is enormous and there's very very little to tip it back from being dominated by the interests of the powerful.
• analog31 8y ago
  >>> This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. In reality, it's less efficient.
• alexmingoia 8y ago
  Ask your employer to pay your benefits amount in salary. That way you don’t need to change insurance when changing jobs.
  • ebg13 8y ago
    I've always heard that your benefits amount at a large organization is almost certainly not enough to pay for the same benefits as an individual, because companies get group rates that you can't get.
    • lotsofpulp 8y ago
      It’s also not taxed as a medical benefit. Also, companies have to maintain certain enrollment proportions to avoid non discrimination testing, and so allowing people to take cash in lieu wouldn’t work out for employer.
• CloudFormation 8y ago
  Churning health insurance with a high deductible plan + HSA is an even bigger timesuck. Just yesterday I sent in the paperwork to roll over my HSA from one bank to another-- the punchline is, my insurance provider didn't change and my insurance login was the same (Premera ConnectYourCare), but it looked like the 15k in my HSA account inexplicably disappeared. Needless to say, this was concerning. A few phone calls later, and I come to find out that my 15k with Bank_0 was available on the backend, but since Bank_1 was preferred by my new employer, Premera shows Bank_1 on the frontend. Keep in mind, all interactions with your HSA bank account are abstracted away from you. So you must track down your Bank_0 and Bank_1 account numbers (I used my tax paperwork) and mail in honest to god physical signed forms authorizing the rollover. Then I come to find out that I should have done this anyway-- HSA accounts are laden with monthly account fees, paper billing fees and investment fees that my previous employer wasn't paying anymore, and these aren't covered by my current employer. HSA bank accounts are one hell of a moneymaking venture for the big banks-- 0 risk because employers send yearly contributions into the account; high likelihood that people will forget to roll it over and the account will drain via fees. HSAs have the hugely hidden cost of managing this separate account+tax entity, and I did not know this when I signed up for one. I'm not even sure that my hours of labor on it are worth the tax savings.
  • moonka 8y ago
    It's painful. After going through something similar (with UMB and ConnectYourCare/UMB), I ended up over at Lively. No fees, and you can invest with TD Ameritrade for free. I hear Fidelity is a good option as well.
• willio58 8y ago
  I’m about to graduate college and I just last week had to take an hour to learn insurance vocabulary to decide if I should go to a doctor for something. It’s disgusting how complicated it is now compared to how simple the concept of insurance initially was when it was created. The insurance companies profit massively from the confusion they have created.
• tanzbaer 8y ago
  The problem isn't the insurance, but the fact that your insurance is tied to your employer. There's reason health insurance should be treated like car, life, and home insurance. You shop for what you want and switch whenever you find something better. Unfortunately the current system is so ridiculous that most people think private insurance itself is the problem.
• conanbatt 8y ago
  You can fund private insurance via taxes as well. That's not a limit to private market insurances. But I tell you one thing that really affects why insurance sucks: that you get sweet tax exemptions if you get it through an employer, and to be an insurance that works through an employer you need to overcome massive regulatory hurdles. Welcome to the world of regulatory capture.
  • smileysteve 8y ago
    I wonder if the increases in the gig economy (ride sharing, charging, food delivery) will lead to more people eligible to file these incomes as sole proprietorships, allowing them to deduct health insurance.
    • conanbatt 8y ago
      Even M4A includes removing the tax exemption. But it will not be popular when workers get a Marginal tax rate jump on their entire income. That subsidy should die and healthcare should be finally decoupled from the employer. That would unleash massive market forces.
• conanbatt 8y ago
  > Etc cetera. There's no end to the nuisance. If I could choose to just pay more in taxes (hell I'll pay way more than my current premiums) and never deal with insurance again, I would do it in a heartbeat. If you have a high deductible, you already chose to pay less. Revealed preferences and all that.
  • helen___keller 8y ago
    I'm not sure I follow your logic.
    • conanbatt 8y ago
      You can choose to have less insurance hassle by choosing a more expensive insurance plan where you don't haggle for the deductible.
      • helen___keller 8y ago
        Sorry what do you mean haggle? This is just one of the 3 plans offered by my employer where the deductible is much bigger and the premium is lower. I did need to open a savings account but I figured that would make things easier to pay, idk haven't used it. Otherwise my behavior as a consumer has been identical. maybe I'm missing something
        • conanbatt 8y ago
          If your employer has a low deductible plan with a higher premium your insurance coverage issues will be a lot lower (as you could eat the copay cost instead of negotiating).
          • helen___keller 8y ago
            what negotiation are you talking about?
• jimmy1 8y ago
  I think your phenomena might be due to startups? Obviously this is a startup focused board so I am not saying this to mean go one way or another, but I ditched the startup, job hopping life a little while ago, and had to deal with "insurance bs" roughly two times in 7 years. I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenue producing organization, but I don't seem to encounter what seems to be the well-represented insurance pains documented here (probably a little bit of both, in my guess).
  • Glyptodon 8y ago
    I'm not at a startup and have better than average insurance, however it's still a clown show. For example, I recently got prescribed a medical device, but was then told that if I didn't have a follow up appointment between certain dates I'd be billed out of pocket for the device. The prescribing physician, of course, has no open appointments until a couple months after the given follow up interval, despite knowing the potential issue and prescheduling the followup. And of course the device provider, the physician, and the insurance company all tell me completely different things about the situation. The current "solution" is "just see your primary care instead," not sure how it'll go.
  • helen___keller 8y ago
    Not due to startups necessarily so much as changing insurance a lot. I'm on my 6th insurance plan in 4 years (Job 1, not a startup, lasted 9 months. Job 2, a startup, changed insurance 2 months after I started then again the next year for a total of 3 plans over 2.5~ years on the job. Job 3, a startup, had better than average insurance (with a weird/awesome reimbursement plan so I pay 0 deductible and 0 premium and get to cover my wife for free too!). Then one month after I started we got acquired and so in 2019 I now have a normal (still good) corporate insurance policy. On top of that insurance frustrates my wife so before we were married when she was on PhD student insurance I generally managed that too, plus her transition to my insurance after marriage. So I'm definitely out-of-norm on this. If anything I like to think that means I'm more qualified to call out how bullshit the world of insurance is, atleast in terms of end-user UX, but obviously that's just my opinion.
  • 8y ago
• jvagner 8y ago
  We have a high-deductible health plan and live in Reno. When my gf recently had the need for a CAT scan, the first choice was here in Reno, and it was priced at over $800. She cancelled her appointment, called over in Carson City (20 minutes south of Reno), and got one done, by someone in our network, for $400. The doctor's office who referred her said, "$800? Really!?" The Reno specialist made her a follow-up appointment in June. The Carson City specialist saw her in 4 days. Etc, etc. We're our own LLC, and we got our own group health plan, as a function of being self-employed and having experienced the employment-related gaps in health insurance coverage. None of this is interesting, but it's stupid and risky. This system has to be changed.
  • ummonk 8y ago
    That actually sounds like the high deductible plan is functioning as it should though. Causing consumers to price-shop and avoid price-gouging providers.
    • sorokod 8y ago
      People in poor health are not consumers and getting medical help is not shopping.
    • munk-a 8y ago
      Sure, in the case of a scan that isn't urgent. If you were in a car accident and have a piece of metal embedded in your kidney are you in a level, clear-minded state to price shop about which emergency room won't gouge you? Health care is an inelastic good, we need it. So this is a market (much like having a military) that really benefits from the government stepping in and making things sane.
      • krapht 8y ago
        Not that I disagree, but the majority of health care expenses are not time-critical emergencies. I saw a statistic somewhere where it's around 15%?
• pavel_lishin 8y ago
  Isn't it pretty cost-effective and efficient to keep you on the phone for three hours in the hopes that you just give up and don't undergo a medical procedure?
  • craftinator 8y ago
    This is exactly what I was thinking during the whole read. It's what Comcast did in the early 2000s when they were scamming people by adding random charges. Just keep them sandbagged long enough to give up, and it's basically free income.
• imgabe 8y ago
  If private insurance is going to work, then every healthcare provider has to accept payment from every insurance. This clusterfuck we have where you have in-network providers with one price and out-of-network providers with a different price just has to stop. Oh you went to an in-network hospital, but this one doctor walked into the room for five minutes and she was out-of-network, so now your bill is 10x higher than it otherwise would be, etc. etc. It's ridiculous.
  • paulddraper 8y ago
    The reason this doesn't work is because not all doctors are equal. Insurance companies want to contract with the healthcare providers with the highest quality outcomes that don't have overprescription, relapses, and readmissions. Search terms: "narrow networks"
  • conanbatt 8y ago
    1) Pass law providers require to support all insurances 2) Make insurance company that reimburses 1$ per visit 3) Profit
  • u801e 8y ago
    I've always wanted to add a clause to those consent forms stating that my consent is conditional to the provider being in-network for the insurance information I provided the hospital. It is their responsibility to make that determination before they start treatment. If they provide treatment and find that they're not in network, then they forgo the right to bill for that service.
    • ThrustVectoring 8y ago
      A great alternative strategy is to structure your finances so that it's impossible for creditors to seize your assets - that way, your practical liability is limited to the up-front costs. Which, by being up-front, you can actually reason about and make informed decisions on. This is less difficult than it sounds. Move to Texas, and keep all your assets in retirement accounts, home equity in your primary residence, and possibly annuities if you've made too much money for that all to hold everything. Note that this should be done before possibly incurring debts.
• travisoneill1 8y ago
  > which should in theory make it more efficient for the sake of maximizing profit There are multiple reasons why this doesn't work for healthcare even in theory. - Emergency care can't be substituted without massive cost. Providers compete on distance not on price. - Emergency care can't be denied (or at least we don't want this) on the basis of price. - Health is not insurable like cars, etc. You can't predict in advance when you are going to get in a car wreck so you better buy insurance when you get the car. If you could, the price of the insurance would be the price of the car, and therefore worthless. But you could just wait until you feel sick to get health insurance. This is why the ACA has to be paired with the individual mandate to work properly.
  • conanbatt 8y ago
    Emergency care being expensive is not a problem of insurance. Public hospitals are also expensive. Its related to other things.
    • rtkwe 8y ago
      It's not the expense that's the problem the expense is a symptom and the problem is the attempt to treat healthcare like a market when consumers a) have very little ability to discover the price, b) have little option in substitution (if my appendix is ruptured my substitution to getting surgery is dying!) and c) many purchases are made under emergency situation with no time to price shop (or often the ability, no one can comparison shop unconscious in the back of an ambulance).
      • conanbatt 8y ago
        > to treat healthcare like a market when consumers a) have very little ability to discover the price There is HUGE price discoverability capacity in healthcare. But the US is not a free market: every single player has some sort of regulatory capture to mess it up, including workers, that get tax benefits and are blind to price through employer provided insurance. Price sensitivity does work for high deductible plans, pointing to the basic economic principal-agency problem of the current system: if you have low copays and you cant choose insurances because your employer pays for it, you are a price insensitive patient. My favorite example is OneMedical: one of the biggest complains patients have is "why do I have to pay 150 a year", while their healthcare plan is thousands A MONTH and a single doctor visit costs 300 U$S! > have little option in substitution (if my appendix is ruptured my substitution to getting surgery is dying!) Emergency healthcare is a small fraction of overall healthcare spending, and it is NOT expensive because of insurance, its expensive because hospitals are expensive. It doesn't make sense to complain to an auto-insurance company that fixing cars is expensive, its completley out of their hands, and they actually work in your favor to reduce costs if they can. And medicine has PLENTY of substitutes. From cheaper drugs, to less accessible and lower quality healthcare. It's called the Iron Triangle of Healthcare: cost-quality-access. You can find your place in the triangle.
• Gibbon1 8y ago
  > If I could choose to just pay more in taxes One of the fallacies in play is buying insurance is put in one category. Whereas paying taxes for insurance is another. The first is 'good' because it's 'free market' and the second is 'bad' because it's the government taking your money's.
  • conanbatt 8y ago
    What I don't get is why do you think paying 2k to a private insurance is any worse than 2k to the state.
    • Can_Not 8y ago
      Because the private insurance company is incentivized to optimize for profits and the state is incentivized to optimize for a healthy population.
      • conanbatt 8y ago
        > the state is incentivized to optimize for a healthy population. The state is incentivized to be a political boon for politicians, not to give "healthy outcomes".
  • helen___keller 8y ago
    >One of the fallacies in play is buying insurance is put in one category. Whereas paying taxes for insurance is another. The first is 'good' because it's 'free market' and the second is 'bad' because it's the government taking your money's. Well, I'm in favor of socialized healthcare and generally receptive to increased taxation, so that's definitely not the implication I was going for. But it is true that there doesn't need to be a categorical consideration at all. A more sound statement would be "I as a consumer am willing to pay dollars equal to twice my current premiums to get healthcare coverage while avoiding hassles while receiving routine healthcare" In truth I'm not making a blanket argument for any government-run healthcare system because alleviating my pain points necessarily depends on said system being efficient and well implemented. But I KNOW that the free market isn't suddenly going to start improving on these pain points without introduction of regulations to manage issues like competing doctor networks, confusing healthcare coding and opaque pricing, etc, and I have no trust that the free market types in congress have any interest in regulations of any kind, so I personally err on the side of socialized healthcare on this one.
• coldtea 8y ago
  >This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. Imagine there's a single, private, insurance company, A. Wouldn't the natural interest of A be to maximize health costs (i.e. make paying for health coverage expensive, as thus their insurance more desirable and more expensive in return)? And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition (so, having us end up with an even larger company)? And if there were several equally large insurance companies aside A (say, B, C, D), wouldn't it make sense for them to collude and keep prices and profits high? And since A (a single large) or A+B+C+D (several large) companies surely have considerable clout (money gives you that) isn't it their natural interest to spend on buying politicians, media, etc, to make sure things get even more in their favor? All those seem inevitable (and profitable) in a market economy. How would insurance being a private market make it "make it more efficient for the sake of maximizing profit"?
  • nybble41 8y ago
    > Imagine there's a single, private, insurance company, A. ... Wouldn't the natural interest of A be to maximize health costs ... ? Sure, but as an insurer they don't have any control over health care costs. They could bid prices up, I suppose, but that eats into their profits; such a strategy would cost them more than they could possibly gain. > And if there were more smaller insurance companies competing with A, wouldn't it make sense for A to just eat them up to eliminate competition ... ? The smaller companies would have to agree to that. Some of them could be co-ops or other organizations structured to represent their members and not interested in being bought out by a company which doesn't share the same principles. > ... wouldn't it make sense for them to collude and keep prices and profits high? Cartels are notoriously unstable. Every member has an incentive to cheat on the cartel to gain market share. And then you have the aforementioned co-ops and others who wouldn't be interested in joining the cartel. > ... isn't it their natural interest to spend on buying politicians ... ? And here we come to the real issue. Not that companies are interested in buying politicians—that's only to be expected, under the circumstances—but rather that (a) there exist politicians with the power to forcibly interfere in the market without being branded as criminals, and that (b) these politicians are willing to be bought and to support laws actively harmful to their nominal constituents. In order to have a private market for either health care or health insurance you must first get the politicians out of the market.
• arcbyte 8y ago
  Ironically, indirect government interference. The market is doing its job perfectly well maximizing the value defined by government constraints and influence (since govt is the largest payor).
• jjeaff 8y ago
  So you think if we paid more in taxes and turned all of it over to the government, the current level of beurocracy would decrease?