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Rent seeking. Literally getting paid to have a pile of money and sometimes pay part of people's medical care while skimming fat profits.
by decoyworker 7y ago
Rent seeking.
Literally getting paid to have a pile of money and sometimes pay part of people's medical care while skimming fat profits.
- lotsofpulp 7y agoWho will double check a doctor’s orders? Voters clearly don’t want the government to do it. Do people have enough money to visit a second or third doctor to get opinions regarding decisions that costs tens of thousands of dollars?
- dv_dt 7y agoMedicare is strongly supported by the seniors who receive it - surviving against decades of attempted rollbacks. I don’t know how one ends up thinking people are unhappy with government administered billing and payments in healthcare.
- merpnderp 7y agoStrongly supported because they love it, or strongly supported because they have exactly zero other options?
- dv_dt 7y agoThey have Medicare Advantage private options. Anecdotally I think people vastly prefer the public Medicare over the more complex private versions.
- howard941 7y agoThe MA programs typically offer better benefits than 80/20 Medicare part B because they selectively market to groups of seniors in relatively good health but mostly because they get one hell of a taxpayer subsidy. To the surprise of no one the promised efficiencies never materialized.
- dragonwriter 7y ago> The MA programs typically offer better benefits than 80/20 Medicare part B ...because the coverage of Medicare Part A + Part B is the legal minimum for Medicare Advantage, so they are necessarily on average greater coverage.
- mikeash 7y agoSeniors vote in large numbers. A politician with a good plan for giving seniors a better option would have a huge advantage. That nobody had used this tactic to attain high office suggests that better options are hard to come up with.
- astura 7y agoCan't they get health insurance through the Obamacare marketplace now?
- deleted 7y ago[deleted]
- dragonwriter 7y agoNo, eligibility for marketplace plans ends when Medicare eligibility starts.
- fucking_tragedy 7y ago> strongly supported because they have exactly zero other options? Like all Americans, they're free to buy private health insurance.
- refurb 7y agoMedicare Part D (which covers all Medicare patients) and Medicare Advantage are run by private insurers.
- jtdev 7y agoWTF?! There’s literally no entity I want less involved in healthcare decisions than the private insurance industry. The conflict of interest is shocking... how we arrived at this place is bewildering.
- offshore1243 7y agoHave you been to the DMV? It's not very efficient.
- polytomous_ 7y agoWhether or not people want the government to do it implies nothing about whether the government would be good at doing it. And neither of those things imply anything about whether private insurers are good at checking doctor's orders. I would say that for any reasonable definition of "good", whether in skill or virtue, private insurers have shown they are definitely not good actors in our health system. Our health system might just be better off without them. As for your question, I for one would like _doctors_ to double-check doctors' orders. Not an actuary.
- alistairSH 7y agoAs for your question, I for one would like _doctors_ to double-check doctors' orders. Not an actuary. To be fair, with private insurers, it's usually BOTH a doctor and an actuary reviewing care. Which isn't to imply I like insurance - I'd much prefer an NHS-style system where my taxes fund the majority of care and I can buy a private policy if I want a "Cadillac" plan.
- decebalus1 7y ago> Who will double check a doctor’s orders? Voters clearly don’t want the government to do it. Which voters? Do you have any numbers to back up the 'clearly' statement?
- cryoshon 7y ago>Who will double check a doctor’s orders? last i checked, insurance companies do not do this to any extent that is beneficial to the patient. in fact, my experience with this is that the insurance companies get in the way of the doctor doing their job and the patient getting the care they need close to 100% of the time. they only check to make sure the doctor isn't trying to use medical resources which are "too" expensive or similar. i would be fine with getting the government to do it -- provided that the insurance companies were forced out of business in the process. at this point, i don't see a future where american life expectancy improves with insurance companies still existing in any form.
- deleted 7y ago[deleted]
- riffic 7y ago>Who will double check a doctor’s orders? medical licensing boards perhaps?
- logfromblammo 7y agoA person needs to be at least a nurse, veterinarian, or pharmacist to meaningfully double-check a physician's orders. Accountants and actuaries can provide helpful inputs, but they lack both the training and patient familiarity to make those decisions medically that they are currently effecting through the back door, by controlling the payments. As a society, we trust the government to employ lawyers as circuit judges, appellate judges, and supreme court judges. It would be little difference for it to employ double-check nurses to review diagnoses and treatment plans against published standards and procedures, triple-check physicians to review contested or flagged cases, and quadruple-check physicians to ensure that the patients involved in difficult cases are receiving the best available standard of care, and to establish or modify standards for future cases that may be similar. A lot of people don't even have enough money to visit a first doctor. And aside from that, families may have enough money to send one member to one doctor, and everyone else with perceived-to-be-lesser medical problems then has to forego treatment altogether. The diabetic gets improved insulin, while the asthmatic has to make do with too-frequent use of rescue inhalers, because the maintenance inhalers are too expensive, and the beesting-allergic person panics every time something flies nearby, because then there's no money left over for epinephrine autoinjectors. The system does not currently consider whole-family finances as a medical consideration. It attempts to maximize profit on a per-patient basis, ignoring that at some point, that strategy may force a parent to choose which one of their children gets to survive. That's something that not only influences votes, but also creates activists. The voters might not want the government to do it, specifically, but they are clearly not satisfied with the status quo.
- mywittyname 7y agoThe government already does this via Medicare/caid. They are considered the gold standard of reimbursement for insurance companies and hospitals. Medicare/caid's guidelines on what they will and will not pay for are very clear and they stand by their rulings. Insurance companies, on the other hand, will break their own agreements left and right. One major health insurance company in the US has an internal policy of blanket denials of claims. Meaning, if you have them as an insurance provider, it's about as effective as having no insurance. Unfortunately I can't name names.
- raspasov 7y agoWhy not?
- mywittyname 7y agoI can't provide proof without potentially going to jail and/or pissing off a billion dollar company. The chances may be small, but the risks are really high. But perhaps some fellow HNers have anecdotes of an insurance company how's denied every claim they've made.
- newen 7y agoWay too cautious, I think. Because the FBI is not going to ask HN for your IP address on behalf on an insurance company's complaint about somebody lying.
- mywittyname 7y agoProviding proof surely would. But I will say this company is more concerned with shielding themselves than their clients.
- howard941 7y agoGRIC?
- reallydude 7y ago
- JMTQp8lwXL 7y agoWould you also describe auto insurance and home insurance as rent seeking? Because it sounds like the same thing.
- eviltandem 7y agoThey could be. I'd argue the real problem is competition. A person buys their car insurance. The purchaser is the customer, there are lots of competing companies, and prices are good as a result. In health care typically your employer is the customer. The doctor and/or hospital also are customers. The insurance company is itself a customer. Unlike - say - car repair you don't get a good estimate up front so it's hard to shop. Many times there aren't many good alternatives anyway. If you don't like a choice one of the actual customers made it doesn't matter because you have no real purchasing power anywhere in the system.
- dsfyu404ed 7y agoFor almost all non-emergency care you can get a good cost estimate up front though. Even for much "emergency" care it wouldn't be hard to provide an estimate and then stick withing a certain % of that. Stuff like stitches, pulling fish hooks out of people and all sorts of other "routine" things that are uncommon individually but are common from the perspective of the emergency room can also be estimated accurately. Chronic illnesses and long term care are what's really expensive.
- learc83 7y agoHealth insurance isn't actually insurance though (at least not only insurance), it's more like prepaid medical care.
- athenot 7y agoYes, it IS insurance. Its value is not to reimburse you for routine visits or minor procedures, it's to prevent you from going bankrupt if you get cancer or any similarly expensive condition to treat. A useful way to look at it is the cost to treat each condition multiplied by your odds of getting that condition. That's also why pre-ACA, insurers would discriminate against patients with pre-existing conditions: the cost to them was nearly guaranteed to happen as the odds were close to 1. If you were to start a health insurance company and only have a small pool of customers, you'd essentially be gambling as the variance is too unpredictable. (In reality, you'd be re-insured but that's a different story.) That is why a large pool of patients makes the most sense, and ideally, if the { pool of patients } = { country population } then you can rely on Public Health stats for risk modeling. And if you're not beholden to shareholders demanding a profit/dividends, there are some efficiencies that can be gained.
- m0zg 7y agoIIRC insurer's "fat profits" are now limited by ACA to some small percentage of premiums. They were previously not. Ironically this seems to be having the opposite of the intended effect and prices are only growing faster.
- pochamago 7y agoBecause insurance companies are now incentivized to work with the hospitals to raise overall prices so that their percentage is worth more.