4 ms·

I don't know how it works in the US, but here in Germany i am pretty sure your health care provider has to pay for it. They can't keep your arm in a cast becau

I don't know how it works in the US, but here in Germany i am pretty sure your health care provider has to pay for it. They can't keep your arm in a cast because fixing it with an operation is top expansive.

jjk166 6y ago
This isn't a question of denying someone service, this is a question of what form the service takes. I am certain your health care provider won't pay 1 million dollars for a different cast design that reduces the time you wear it by 1%, nor should it. In the scenario I'm describing, both options are medically adequate, one is just more convenient but also substantially more expensive. Insurance pays for what you need, but it is quite common to deny claims which are not medically necessary.
- chefkoch 6y ago
  In the case of this cancer,the maintainance drug is around $1000 a pill so you get to that million pretty quickly.
  - jjk166 6y ago
    Okay, so the insurance company would pay $10 Trillion for one person to receive the cure for that cancer then? Obviously there is a limit. The fact is that $1000 is not the cost of producing the pill, that is the amount they can charge for the pill while still getting people to pay for it. When there is no competition, and people would die without it, prices get very high very quickly. There is an extremely large barrier to entry for new medicines, and pharmaceutical companies are structured to recoup the massive development costs by charging large sums for inexpensive to produce goods that they have essentially a monopoly over. If it costs billions of dollars to develop a cure, that cure is going to have to be expensive, but a cure administered repeatedly can amortize those costs over many low-cost doses, while a one-time cure can't. Insurance companies are all about spreading costs over time - paying out large sums to large numbers of people all at once is a lot more problematic than smaller, predictable payouts over a longer period of time. It is in their best interest as well for you to manage the disease.
    - gadf 6y ago
      Thank you for this analysis I believe it's making my case more clear.
gadf 6y ago
I think bringing healthcare insurance providers into an argument about whether there's a cartel of pharmaceutical companies artificially keeping up prices it's really not a good idea. It's possibly different in Europe but I think if you have any experience of the US system it's clear that there's some form of rorting and artificially inflated prices where the health insurance providers are in cahoots with all the providers and are somehow gouging the prices there. if you pay cash right now maybe cost you 300 if you put in your insurance the same thing maybe cost 3000 and then there's even a second order incentive effect where "health care professionals" want to give you these extra treatments if it's going through insurance.

jjk166 6y ago

This isn't a question of denying someone service, this is a question of what form the service takes. I am certain your health care provider won't pay 1 million dollars for a different cast design that reduces the time you wear it by 1%, nor should it. In the scenario I'm describing, both options are medically adequate, one is just more convenient but also substantially more expensive. Insurance pays for what you need, but it is quite common to deny claims which are not medically necessary.

chefkoch 6y ago
In the case of this cancer,the maintainance drug is around $1000 a pill so you get to that million pretty quickly.
- jjk166 6y ago
  Okay, so the insurance company would pay $10 Trillion for one person to receive the cure for that cancer then? Obviously there is a limit. The fact is that $1000 is not the cost of producing the pill, that is the amount they can charge for the pill while still getting people to pay for it. When there is no competition, and people would die without it, prices get very high very quickly. There is an extremely large barrier to entry for new medicines, and pharmaceutical companies are structured to recoup the massive development costs by charging large sums for inexpensive to produce goods that they have essentially a monopoly over. If it costs billions of dollars to develop a cure, that cure is going to have to be expensive, but a cure administered repeatedly can amortize those costs over many low-cost doses, while a one-time cure can't. Insurance companies are all about spreading costs over time - paying out large sums to large numbers of people all at once is a lot more problematic than smaller, predictable payouts over a longer period of time. It is in their best interest as well for you to manage the disease.
  - gadf 6y ago
    Thank you for this analysis I believe it's making my case more clear.

gadf 6y ago

I think bringing healthcare insurance providers into an argument about whether there's a cartel of pharmaceutical companies artificially keeping up prices it's really not a good idea. It's possibly different in Europe but I think if you have any experience of the US system it's clear that there's some form of rorting and artificially inflated prices where the health insurance providers are in cahoots with all the providers and are somehow gouging the prices there. if you pay cash right now maybe cost you 300 if you put in your insurance the same thing maybe cost 3000 and then there's even a second order incentive effect where "health care professionals" want to give you these extra treatments if it's going through insurance.