4 ms·

Insurance companies actively work to not-deliver the thing they are paid to deliver.

by jvagner 7y ago

derg 7y ago
They are quite literally, the death panels republicans were screaming about during the effort to pass the ACA.
- tialaramex 7y ago
  To be fair: This role actually has to exist in some form. By definition healthcare will cost resources and so providing all conceivable care will cost infinite resources. You don't have infinite resources, so there will be rationing, your choice is _how_ to ration, not whether. In the UK for example we have NICE the National Institute for Clinical Excellence, which uses a methodology called Quality Adjusted Life Years (QALYs) to decide what a treatment is "worth". Resources are, as I said, finite, so we need to decide how many blind toddlers regaining their sight is worth one teenager who will otherwise die of brain cancer; how many hip replacements that let a nice little old lady walk to the shops without excruciating pain are worth a new treatment that prevents a newborn baby dying from exposure to the air? Politicians have to periodically re-learn that meddling with this is not in their interests. The UK had a period recently for example in which politicians overrode NICE to create a cancer fund. Cancer is sad you see, so a pile of money was put aside to buy people cancer drugs. Nothing else, only cancer drugs, because cancer is sad. But, wait, we just got done arguing about how many blind toddlers is worth one dead teenager - well, the cancer fund said the answer is Infinity. If we can save one cancer-struck teenager, with that fund we should, no matter how many toddlers are blind instead because blind toddlers don't get access to that fund. And eventually the voting populace realised this was bullshit and turned on the cancer fund and it went away again.
  - derg 7y ago
    Yes, that is entirely fair and I'm being somewhat flippant about it but there's a huge disconnect over private insurance and the fact that it's in their best interest to spend the least amount possible for maximum gain, whereas any government run system should have the interests of it's citizens in mind, and a healthy society is generally a more productive and happy society
- mywittyname 7y ago
  Well no, "death panels" where the political term used to describe mandating doctors discuss end-of-life treatment for patients. Effectively, they would have a conversation with the patient and their family over what treatment will look like and when treatment should cease when the patient is terminal. The bulk of the costs of care comes during the last few months of life. Medical staff are required to keep a person alive without considering their quality of life. So a person may not want to live out their life intubated, catheterized, and bedridden with several broken ribs from CPR, but they are forced to because no one asked the patient what they wanted. When you ask people what they want, most would prefer to accept their time has come and not put themselves and their family through the trauma of being kept alive in such a manner. But this was tantamount to killing them, ergo, death panel.
  - derg 7y ago
    That was not what they were talking about though. It was "THE GOVERNMENT IS GOING TO DECIDE IF YOU LIVE OR DIE BASED ON YOUR USEFULNESS" type of Death Panel.
    - mywittyname 7y ago
      But that's the origin of the concept. Clearly, the government advocating advanced directives is a slippery slope to straight up utility calculations (in the minds of these people).
merpnderp 7y ago
If your profit is limited to a max percentile by law, the only way you can possibly increase profits is to increase expenditures. Insurance companies have every incentive to increase costs so they can increase premiums, their only path to increased profits.
- jvagner 7y ago
  If we're getting to the point where we can openly talk about getting rid of the industry -- unlikely but not an impossibility -- perhaps the industry itself missed a few opportune -- not opportunistic -- steps. My health insurance company is a non-profit. And I also supplant my coverage through a religious non-profit health expense coverage company. I'm not religious, but I answered their screening questions honestly and they accepted me. Providers and cover-ers are playing a game where the costs are an insurance against non-payment in and of itself. We've all heard the stories of a $10K bill here which would cost $400 elsewhere. If insurance companies want to be super-profitable, and if costs are aligned to unreasonable pricing tenets that can't be justified long term, the system will collapse, and deservedly. There are many ways to do capitalism, and some of them are bad for too many parties except the organization.
- irq-1 7y ago
  Salaries and shiny new buildings are expenses, and not constrained by profit caps.
  - mrfredward 7y ago
    The minimum loss ratio in the ACA sets a minimum for how much is paid out as claims. New buildings don't count toward meeting the requirement.

Insurance companies actively work to not-deliver the thing they are paid to deliver.

derg 7y ago

They are quite literally, the death panels republicans were screaming about during the effort to pass the ACA.

tialaramex 7y ago
To be fair: This role actually has to exist in some form. By definition healthcare will cost resources and so providing all conceivable care will cost infinite resources. You don't have infinite resources, so there will be rationing, your choice is _how_ to ration, not whether. In the UK for example we have NICE the National Institute for Clinical Excellence, which uses a methodology called Quality Adjusted Life Years (QALYs) to decide what a treatment is "worth". Resources are, as I said, finite, so we need to decide how many blind toddlers regaining their sight is worth one teenager who will otherwise die of brain cancer; how many hip replacements that let a nice little old lady walk to the shops without excruciating pain are worth a new treatment that prevents a newborn baby dying from exposure to the air? Politicians have to periodically re-learn that meddling with this is not in their interests. The UK had a period recently for example in which politicians overrode NICE to create a cancer fund. Cancer is sad you see, so a pile of money was put aside to buy people cancer drugs. Nothing else, only cancer drugs, because cancer is sad. But, wait, we just got done arguing about how many blind toddlers is worth one dead teenager - well, the cancer fund said the answer is Infinity. If we can save one cancer-struck teenager, with that fund we should, no matter how many toddlers are blind instead because blind toddlers don't get access to that fund. And eventually the voting populace realised this was bullshit and turned on the cancer fund and it went away again.
- derg 7y ago
  Yes, that is entirely fair and I'm being somewhat flippant about it but there's a huge disconnect over private insurance and the fact that it's in their best interest to spend the least amount possible for maximum gain, whereas any government run system should have the interests of it's citizens in mind, and a healthy society is generally a more productive and happy society
mywittyname 7y ago
Well no, "death panels" where the political term used to describe mandating doctors discuss end-of-life treatment for patients. Effectively, they would have a conversation with the patient and their family over what treatment will look like and when treatment should cease when the patient is terminal. The bulk of the costs of care comes during the last few months of life. Medical staff are required to keep a person alive without considering their quality of life. So a person may not want to live out their life intubated, catheterized, and bedridden with several broken ribs from CPR, but they are forced to because no one asked the patient what they wanted. When you ask people what they want, most would prefer to accept their time has come and not put themselves and their family through the trauma of being kept alive in such a manner. But this was tantamount to killing them, ergo, death panel.
- derg 7y ago
  That was not what they were talking about though. It was "THE GOVERNMENT IS GOING TO DECIDE IF YOU LIVE OR DIE BASED ON YOUR USEFULNESS" type of Death Panel.
  - mywittyname 7y ago
    But that's the origin of the concept. Clearly, the government advocating advanced directives is a slippery slope to straight up utility calculations (in the minds of these people).

merpnderp 7y ago

If your profit is limited to a max percentile by law, the only way you can possibly increase profits is to increase expenditures. Insurance companies have every incentive to increase costs so they can increase premiums, their only path to increased profits.

jvagner 7y ago
If we're getting to the point where we can openly talk about getting rid of the industry -- unlikely but not an impossibility -- perhaps the industry itself missed a few opportune -- not opportunistic -- steps. My health insurance company is a non-profit. And I also supplant my coverage through a religious non-profit health expense coverage company. I'm not religious, but I answered their screening questions honestly and they accepted me. Providers and cover-ers are playing a game where the costs are an insurance against non-payment in and of itself. We've all heard the stories of a $10K bill here which would cost $400 elsewhere. If insurance companies want to be super-profitable, and if costs are aligned to unreasonable pricing tenets that can't be justified long term, the system will collapse, and deservedly. There are many ways to do capitalism, and some of them are bad for too many parties except the organization.
irq-1 7y ago
Salaries and shiny new buildings are expenses, and not constrained by profit caps.
- mrfredward 7y ago
  The minimum loss ratio in the ACA sets a minimum for how much is paid out as claims. New buildings don't count toward meeting the requirement.