8 ms·

I think the solution to most problems is make the c-suite criminally responsible for errors. Things will resolve themselves

spondylosaurus 3y ago
Enthusiastically agree, but considering how much political lobbying comes from health insurance giants I have no hope of it happening in my lifetime.
NickC25 3y ago
I think an even better solution is for our society to just admit that health insurance companies can't exist as for-profit entities that have to answer to Wall Street first and foremost. Think about it. A health care company collects money under the premise that "these premiums you're paying will cover you if something bad happens". If that something bad does happen (and for most people, it never will), that money should be available to pay for whatever happened. The insurer, now concerned about their margins and profits more than providing you the service that you've already paid them to do, just gets to trot out some poorly paid rep with no medical knowledge to override the medical advice of a trained medical professional. Now, you're not only injured, you're paying out of pocket for a service that won't actually do what you've paid it to do. The only winner here is the insurer's C-Suite and stockholders who get to brag on quarterly earnings calls that they've denied tens of thousands of claims (and they even get fiscally rewarded for it!). In a more modern and honest society we would call for-profit insurers what they actually are: a racketeering organization operating under the guise of fraud.
- deleted 3y ago
  [deleted]
- bugglebeetle 3y ago
  I agree if you stop at “health insurance companies can’t exist.” Being a nonprofit doesn’t stop you from being parasitic or malevolent.
- lotsofpulp 3y ago
  That does not solve the root problem. The root problem is healthcare is an extremely complex field, requiring extremely specialized knowledge that takes extreme investment to get. And everyone wants it, the demand is infinite and the demand has no elasticity. So a buyer of healthcare has a problem. They have no idea what they are buying, and have no idea if the seller is scamming them or incompetent. So you need a second opinion. But as stated above, people who can provide this opinion are few and far between. It is not like paying $100 to get a second opinion on your car. It is more like paying $500 to $10,000 or who knows how much to get a second opinion. So the root problem is people simply cannot afford the level of healthcare they desire. Everything else is just papering over that intractable problem.
  - burkaman 3y ago
    > They have no idea what they are buying, and have no idea if the seller is scamming them or incompetent. It's worse than that, important healthcare decisions are often made while you are unconscious, and you just have to pay for whatever choice was made. Not only do you not know what you're buying, you don't even know a purchase is being made. I am convinced that it doesn't make sense to discuss healthcare as if it is a market. Patients are not "buyers". You pass out, some random person calls 911 and they send a private ambulance, you wake up at the hospital, and now you owe money to the ambulance company. In what sense have you "bought" anything? There has to be more to the definition than just "money is involved". We don't talk about the parking ticket market or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!), and we shouldn't talk about the healthcare market.
    - lotsofpulp 3y ago
      That is a good point, but unless people work for free, someone is selling and someone is buying. While you might not have explicitly bought anything, your agent (whether it be family or the government) did buy something. More broadly, anytime you are dealing with limited resources (including time), you have to be buying and selling (i.e. there are opportunity costs to making a decision). > We don't talk about the parking ticket market You cannot buy a parking ticket, so this is not comparable. However, people do often calculate the cost of legally parking versus the probability * cost of potential fines. >or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!) This happens all the time, but everyone may not have the means to do it. It was one of the factors for my relocation within the US. Even businesses use it to determine where to expand or close operations. Warren Buffett mentioned it in his annual letter some years ago.
- nradov 3y ago
  That's not actually how the industry works in the general case. Health "insurance" companies no longer provide much insurance. Instead they mainly just create provider networks and administer claims on behalf of self-insured group buyers (mainly employers and unions). The remaining fully insured market is relatively small. Health insurers have low profit margins. You can read their audited financial statements for the publicly traded ones. Some are even non-profit. The Affordable Care Act (Obamacare) set a minimum 85% medical loss ratio. The insurers have to cover their operating costs and profit margins out of the remaining 15%. Even if we were to replace commercial insurers with some sort of "Medicare for all" system that would have only a marginal impact on costs to patients and availability of care. The real drivers here are the big employers. They are the ones ultimately paying most of the bills, and they insist that insurers ration care to control costs.
  - FireBeyond 3y ago
    > The Affordable Care Act (Obamacare) set a minimum 85% medical loss ratio. The insurers have to cover their operating costs and profit margins out of the remaining 15%. That's also a perverse incentive though. With capped "profit" windows, how is a company to make more money? Well if healthcare costs increase, then premiums need to. 15% of 1.3X is bigger than 15% of X, after all. And healthcare providers are unlikely to object to higher prices. And what if your insurer gets involved in vertical integration - perhaps Kaiser style, perhaps less formal? Now you get to reduce the actual cost to you (the insurer) by removing the middleman, and you get increased profit by keeping the price the same. It might show up on a different ledger on your books, but nonetheless...
    - lotsofpulp 3y ago
      > And what if your insurer gets involved in vertical integration - perhaps Kaiser style, perhaps less formal? Now you get to reduce the actual cost to you (the insurer) by removing the middleman, and you get increased profit by keeping the price the same. It might show up on a different ledger on your books, but nonetheless... Regulators are not this dumb or corrupt. This is not a big money making business, as evidenced by Buffett/Bezos/Dimon’s foray failing: https://www.latimes.com/business/story/2021-01-04/buffett-bezos-dimon-healthcare https://www.latimes.com/business/story/2021-01-04/buffett-be...
- JohnFen 3y ago
  > A health care company collects money under the premise that "these premiums you're paying will cover you if something bad happens" That's not the premise of insurance, though. The premise of insurance is that a large group of people pools their money (through paying premiums), out of which the people in need of assistance get paid. It's not that you'll be "repaid" your premiums in services. It's pooled risk, not a kind of savings or investment. In order for it to work financially, most people have to never have claims in excess of what they paid in. The whole point is to be able to cover exceptional and rare disasters. I think one of the ways that health insurance (at least in the US) has gone horribly wrong is that it became a means to pay for routine medical things rather than just exceptional ones.
  - lotsofpulp 3y ago
    > I think one of the ways that health insurance (at least in the US) has gone horribly wrong is that it became a means to pay for routine medical things rather than just exceptional ones. This is solved by high deductible health plans. > In order for it to work financially, most people have to never have claims in excess of what they paid in. The whole point is to be able to cover exceptional and rare disasters. This is where the problem is. Humans will have health problems and will have claims, especially after age 50. Which means (assuming a stable population), the present value of premiums has to equal the present value of all the healthcare you will need (until you get to Medicare, age 65). Which is a large number, especially considering the obesity/hypertension/diabetes/heart disease rates. Which means premiums are effectively just another tax (except they are no longer mandated). A big wrinkle here is declining proportion of younger populations to pay for older populations, so the premiums young people pay for healthcare older people receive now, but when the young people are older, there will be fewer younger people to pay for them, so it is also a marginal “age” tax, where the younger people pay for more than what they will receive. Exactly the same as Medicare taxes.
    - ethbr1 3y ago
      This isn't solved by high deductible health plans, because they just kick the can down the road by letting customers self-segregate into different risk profiles. - Young with no health issues? HDHP. - Suddenly get sick or are older with medical needs? Wait until next year's open enrollment and switch to a higher tier plan. Guess which risk pool has to pay out more in claims (against a neutral population average). And therefore has to increase premiums. The issue is that we should categorically ban non-catastrophic health insurance. Everyone gets an order-of-magnitude yearly disposable income * 2 deductible plan. Everything else is out of pocket. Surprise! Suddenly discount options appear. Suddenly hospitals are competing on price. Etc.
- coredog64 3y ago
  Please Google “medical loss ratio”
ncallaway 3y ago
I think that, and making the doctor who denies the claim responsible personally and professionally as if they were providing care to a patient.
beambot 3y ago
To play devil's advocate: Wouldn't that just result in healthcare systems being run by people too incompetent to realize the liability they're signing up for? That seems more likely (apriori) than healthcare systems magically becoming efficient, responsible, and ethical actors.

spondylosaurus 3y ago

Enthusiastically agree, but considering how much political lobbying comes from health insurance giants I have no hope of it happening in my lifetime.

NickC25 3y ago

I think an even better solution is for our society to just admit that health insurance companies can't exist as for-profit entities that have to answer to Wall Street first and foremost. Think about it. A health care company collects money under the premise that "these premiums you're paying will cover you if something bad happens". If that something bad does happen (and for most people, it never will), that money should be available to pay for whatever happened. The insurer, now concerned about their margins and profits more than providing you the service that you've already paid them to do, just gets to trot out some poorly paid rep with no medical knowledge to override the medical advice of a trained medical professional. Now, you're not only injured, you're paying out of pocket for a service that won't actually do what you've paid it to do. The only winner here is the insurer's C-Suite and stockholders who get to brag on quarterly earnings calls that they've denied tens of thousands of claims (and they even get fiscally rewarded for it!). In a more modern and honest society we would call for-profit insurers what they actually are: a racketeering organization operating under the guise of fraud.

deleted 3y ago
[deleted]
bugglebeetle 3y ago
I agree if you stop at “health insurance companies can’t exist.” Being a nonprofit doesn’t stop you from being parasitic or malevolent.
lotsofpulp 3y ago
That does not solve the root problem. The root problem is healthcare is an extremely complex field, requiring extremely specialized knowledge that takes extreme investment to get. And everyone wants it, the demand is infinite and the demand has no elasticity. So a buyer of healthcare has a problem. They have no idea what they are buying, and have no idea if the seller is scamming them or incompetent. So you need a second opinion. But as stated above, people who can provide this opinion are few and far between. It is not like paying $100 to get a second opinion on your car. It is more like paying $500 to $10,000 or who knows how much to get a second opinion. So the root problem is people simply cannot afford the level of healthcare they desire. Everything else is just papering over that intractable problem.
- burkaman 3y ago
  > They have no idea what they are buying, and have no idea if the seller is scamming them or incompetent. It's worse than that, important healthcare decisions are often made while you are unconscious, and you just have to pay for whatever choice was made. Not only do you not know what you're buying, you don't even know a purchase is being made. I am convinced that it doesn't make sense to discuss healthcare as if it is a market. Patients are not "buyers". You pass out, some random person calls 911 and they send a private ambulance, you wake up at the hospital, and now you owe money to the ambulance company. In what sense have you "bought" anything? There has to be more to the definition than just "money is involved". We don't talk about the parking ticket market or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!), and we shouldn't talk about the healthcare market.
  - lotsofpulp 3y ago
    That is a good point, but unless people work for free, someone is selling and someone is buying. While you might not have explicitly bought anything, your agent (whether it be family or the government) did buy something. More broadly, anytime you are dealing with limited resources (including time), you have to be buying and selling (i.e. there are opportunity costs to making a decision). > We don't talk about the parking ticket market You cannot buy a parking ticket, so this is not comparable. However, people do often calculate the cost of legally parking versus the probability * cost of potential fines. >or the taxation market (just move to a different country if you aren't satisfied with your taxation provider!) This happens all the time, but everyone may not have the means to do it. It was one of the factors for my relocation within the US. Even businesses use it to determine where to expand or close operations. Warren Buffett mentioned it in his annual letter some years ago.
nradov 3y ago
That's not actually how the industry works in the general case. Health "insurance" companies no longer provide much insurance. Instead they mainly just create provider networks and administer claims on behalf of self-insured group buyers (mainly employers and unions). The remaining fully insured market is relatively small. Health insurers have low profit margins. You can read their audited financial statements for the publicly traded ones. Some are even non-profit. The Affordable Care Act (Obamacare) set a minimum 85% medical loss ratio. The insurers have to cover their operating costs and profit margins out of the remaining 15%. Even if we were to replace commercial insurers with some sort of "Medicare for all" system that would have only a marginal impact on costs to patients and availability of care. The real drivers here are the big employers. They are the ones ultimately paying most of the bills, and they insist that insurers ration care to control costs.
- FireBeyond 3y ago
  > The Affordable Care Act (Obamacare) set a minimum 85% medical loss ratio. The insurers have to cover their operating costs and profit margins out of the remaining 15%. That's also a perverse incentive though. With capped "profit" windows, how is a company to make more money? Well if healthcare costs increase, then premiums need to. 15% of 1.3X is bigger than 15% of X, after all. And healthcare providers are unlikely to object to higher prices. And what if your insurer gets involved in vertical integration - perhaps Kaiser style, perhaps less formal? Now you get to reduce the actual cost to you (the insurer) by removing the middleman, and you get increased profit by keeping the price the same. It might show up on a different ledger on your books, but nonetheless...
  - lotsofpulp 3y ago
    > And what if your insurer gets involved in vertical integration - perhaps Kaiser style, perhaps less formal? Now you get to reduce the actual cost to you (the insurer) by removing the middleman, and you get increased profit by keeping the price the same. It might show up on a different ledger on your books, but nonetheless... Regulators are not this dumb or corrupt. This is not a big money making business, as evidenced by Buffett/Bezos/Dimon’s foray failing: https://www.latimes.com/business/story/2021-01-04/buffett-bezos-dimon-healthcare https://www.latimes.com/business/story/2021-01-04/buffett-be...
JohnFen 3y ago
> A health care company collects money under the premise that "these premiums you're paying will cover you if something bad happens" That's not the premise of insurance, though. The premise of insurance is that a large group of people pools their money (through paying premiums), out of which the people in need of assistance get paid. It's not that you'll be "repaid" your premiums in services. It's pooled risk, not a kind of savings or investment. In order for it to work financially, most people have to never have claims in excess of what they paid in. The whole point is to be able to cover exceptional and rare disasters. I think one of the ways that health insurance (at least in the US) has gone horribly wrong is that it became a means to pay for routine medical things rather than just exceptional ones.
- lotsofpulp 3y ago
  > I think one of the ways that health insurance (at least in the US) has gone horribly wrong is that it became a means to pay for routine medical things rather than just exceptional ones. This is solved by high deductible health plans. > In order for it to work financially, most people have to never have claims in excess of what they paid in. The whole point is to be able to cover exceptional and rare disasters. This is where the problem is. Humans will have health problems and will have claims, especially after age 50. Which means (assuming a stable population), the present value of premiums has to equal the present value of all the healthcare you will need (until you get to Medicare, age 65). Which is a large number, especially considering the obesity/hypertension/diabetes/heart disease rates. Which means premiums are effectively just another tax (except they are no longer mandated). A big wrinkle here is declining proportion of younger populations to pay for older populations, so the premiums young people pay for healthcare older people receive now, but when the young people are older, there will be fewer younger people to pay for them, so it is also a marginal “age” tax, where the younger people pay for more than what they will receive. Exactly the same as Medicare taxes.
  - ethbr1 3y ago
    This isn't solved by high deductible health plans, because they just kick the can down the road by letting customers self-segregate into different risk profiles. - Young with no health issues? HDHP. - Suddenly get sick or are older with medical needs? Wait until next year's open enrollment and switch to a higher tier plan. Guess which risk pool has to pay out more in claims (against a neutral population average). And therefore has to increase premiums. The issue is that we should categorically ban non-catastrophic health insurance. Everyone gets an order-of-magnitude yearly disposable income * 2 deductible plan. Everything else is out of pocket. Surprise! Suddenly discount options appear. Suddenly hospitals are competing on price. Etc.
coredog64 3y ago
Please Google “medical loss ratio”

ncallaway 3y ago

I think that, and making the doctor who denies the claim responsible personally and professionally as if they were providing care to a patient.

beambot 3y ago

To play devil's advocate: Wouldn't that just result in healthcare systems being run by people too incompetent to realize the liability they're signing up for? That seems more likely (apriori) than healthcare systems magically becoming efficient, responsible, and ethical actors.