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How exactly does networks complicate that? Insurers had to scale (i.e. increase costs) after ACA was implemented because number of uninsured Americans went fro

How exactly does networks complicate that? Insurers had to scale (i.e. increase costs) after ACA was implemented because number of uninsured Americans went from 18 to 11%.

hakfoo 7y ago
Networks complicate things by reducing demand elasticity. For example, look at Maricopa County, Arizona. It's like 100km across and includes both a major capital city (Phoenix) and several suburbs with 6-figure populations (Mesa, Chandler, Glendale). Many of the marketplace health plans* would have networks which focused around central Phoenix. If you wanted to see an in-network doctor or urgent care and lived at the fringes of the county, it was a 30-minute drive or more. This meant people in the fringes had to pick the few plans that covered nearby facilities, even if there was a significant price difference. * This was during the first few years of the marketplace. By 2017 or so they were basically down to a single insurer, so even that degree of consumer leverage was gone.
ddingus 7y ago
Have you ever tried a policy change?
- bduerst 7y ago
  Yes. I have actually bought my own insurance through one of the state-run exchanges in the past.
  - ddingus 7y ago
    For anyone with complications, medical history that is non trivial, networks become very important, and do costs. Networks take people in and out of the chain of care providers, and costs swing dramatically. The whole affair adds zero value when compared to simpler Medicare For All type plans. People in my life got sick, and the financial carnage has gone on for decades. This pretty much rules out any favorable view on markets and private insurers I may have. And I am by no means a unique, or even uncommon case. If it were not for family, I would have picked up and left this cruel system a decade ago.
    - tptacek 7y ago
      Networks are very important with all kinds of insurance. The thing you notice when you switch from employer-covered insurance to ACA market insurance is all the fiddly choices your employer was making for you. You can say that having to make these choices is a process failure of the ACA, or you can say that having the freedom to make those choices yourself is a benefit of the ACA. I'm not sure what M4A has to do with this, and, in particular, to relate this story back to the thread, you should be aware that Medicare drug benefit administration is also privatized, and that somewhere between 1/3 to 1/2 of Medicare recipients also get Medicare Advantage, a private insurance rider to Medicare that is largely defined by network restrictions.
      - ddingus 7y ago
        M4A has everything to do with this. Millions of Americans have and are being harmed financially and or physically by this patchwork mess. The other thing you notice is insurers treat people who they know will cost them much differently. M4A will centralize most of this and will distribute cost and risk as widely as possible
        tptacek 7y ago
        Could you formulate a response like this that addresses the point I just made, which is that Medicare also includes, for a huge chunk of its recipients, network restrictions, and for all its prescription drug recipients private insurance?
        ddingus 7y ago
        For now it does. That will not always be the case, or should it be, the regulatory picture will appear very different than it does today. Those things simply do not add value. They do help to make more money. When health care is about making money, it is not about making people healthy. And it is not about cost either. Very large numbers of Americans are both impacted in a negative way, and long past the idea of private insurers being good primary care vehicles. They aren't. Private insurers should be forced out of primary care. If I had my way, doing that would be illegal. There is a basic conflict of interest between an insurer making money and what is best for sick people. I will tell you personally, the hell I have gone through, family members dead, others living with pain, financial damage, homes lost, I am very highly motivated to do all I can to see an end to our current, increasingly cruel and ineffective system. Talk about death panels. Yeah, happened to us. Unnecessary that it did too.

How exactly does networks complicate that? Insurers had to scale (i.e. increase costs) after ACA was implemented because number of uninsured Americans went from 18 to 11%.

hakfoo 7y ago

Networks complicate things by reducing demand elasticity. For example, look at Maricopa County, Arizona. It's like 100km across and includes both a major capital city (Phoenix) and several suburbs with 6-figure populations (Mesa, Chandler, Glendale). Many of the marketplace health plans* would have networks which focused around central Phoenix. If you wanted to see an in-network doctor or urgent care and lived at the fringes of the county, it was a 30-minute drive or more. This meant people in the fringes had to pick the few plans that covered nearby facilities, even if there was a significant price difference. * This was during the first few years of the marketplace. By 2017 or so they were basically down to a single insurer, so even that degree of consumer leverage was gone.

ddingus 7y ago

Have you ever tried a policy change?

bduerst 7y ago
Yes. I have actually bought my own insurance through one of the state-run exchanges in the past.
- ddingus 7y ago
  For anyone with complications, medical history that is non trivial, networks become very important, and do costs. Networks take people in and out of the chain of care providers, and costs swing dramatically. The whole affair adds zero value when compared to simpler Medicare For All type plans. People in my life got sick, and the financial carnage has gone on for decades. This pretty much rules out any favorable view on markets and private insurers I may have. And I am by no means a unique, or even uncommon case. If it were not for family, I would have picked up and left this cruel system a decade ago.
  - tptacek 7y ago
    Networks are very important with all kinds of insurance. The thing you notice when you switch from employer-covered insurance to ACA market insurance is all the fiddly choices your employer was making for you. You can say that having to make these choices is a process failure of the ACA, or you can say that having the freedom to make those choices yourself is a benefit of the ACA. I'm not sure what M4A has to do with this, and, in particular, to relate this story back to the thread, you should be aware that Medicare drug benefit administration is also privatized, and that somewhere between 1/3 to 1/2 of Medicare recipients also get Medicare Advantage, a private insurance rider to Medicare that is largely defined by network restrictions.
    - ddingus 7y ago
      M4A has everything to do with this. Millions of Americans have and are being harmed financially and or physically by this patchwork mess. The other thing you notice is insurers treat people who they know will cost them much differently. M4A will centralize most of this and will distribute cost and risk as widely as possible
      - tptacek 7y ago
        Could you formulate a response like this that addresses the point I just made, which is that Medicare also includes, for a huge chunk of its recipients, network restrictions, and for all its prescription drug recipients private insurance?
        ddingus 7y ago
        For now it does. That will not always be the case, or should it be, the regulatory picture will appear very different than it does today. Those things simply do not add value. They do help to make more money. When health care is about making money, it is not about making people healthy. And it is not about cost either. Very large numbers of Americans are both impacted in a negative way, and long past the idea of private insurers being good primary care vehicles. They aren't. Private insurers should be forced out of primary care. If I had my way, doing that would be illegal. There is a basic conflict of interest between an insurer making money and what is best for sick people. I will tell you personally, the hell I have gone through, family members dead, others living with pain, financial damage, homes lost, I am very highly motivated to do all I can to see an end to our current, increasingly cruel and ineffective system. Talk about death panels. Yeah, happened to us. Unnecessary that it did too.