6 ms·

I'd wager that America is culturally closer to the UK and Italy than Germany (ironically enough), particularly with regard to our attitudes towards social welfa

I'd wager that America is culturally closer to the UK and Italy than Germany (ironically enough), particularly with regard to our attitudes towards social welfare. A decade after ACA's full implementation, I'm thinking that we maybe can't be trusted with Germany's model. It's all-or-nothing, as far as the greater system goes; sprinkle some private coverage on top for the wealthy, if you must.

stogot 2y ago
Before revolutionizing the system, why not start with capping insurer profits and pay it back to policyholders? That will put a limiter on the greed machine
- MrLeap 2y ago
  As I understand it, the ACA caps profits by requiring that insurance companies spend 80% of their revenue on "medical care and quality improvement". Therefore, the only ways for insurance companies to make more money is if they get a lot more customers OR if the price of medical care skyrockets. I suspect the reason why UHC has decided to deny so many claims is that this will allow them to marginally lower he price of their premiums relative to their competitors. This'll get them more money via method 1. The whole industry is working around the clock on method #2. Anyone more informed, feel free to correct me.
  - ethbr1 2y ago
    That's broadly correct. One of the most under-appreciated wins of the ACA was capping non-care premium costs (read: admin, et al). From working on automation inside the system at insurers at the time, I can definitively say this spurred health insurers to streamline and lower operational cost overheads. With regards to the denials, I think you're right too. People like to point at insurers and blame them, but it's easy to forget they're just the middleman. There's "cost of care" on the other side of them. At the end of the day, premiums need to balance with costs... (somewhat, in aggregate) There are probably some edge cases where there are opportunities to profit, mostly to do with privately-administered but publicly-funded areas of health insurance (read: FEP and Medicare Advantage), but generally it's trying to get premiums lower for competitive reasons.
  - stogot 2y ago
    Oh I wasn’t aware of this, thanks for describing the mechanics

stogot 2y ago

Before revolutionizing the system, why not start with capping insurer profits and pay it back to policyholders? That will put a limiter on the greed machine

MrLeap 2y ago
As I understand it, the ACA caps profits by requiring that insurance companies spend 80% of their revenue on "medical care and quality improvement". Therefore, the only ways for insurance companies to make more money is if they get a lot more customers OR if the price of medical care skyrockets. I suspect the reason why UHC has decided to deny so many claims is that this will allow them to marginally lower he price of their premiums relative to their competitors. This'll get them more money via method 1. The whole industry is working around the clock on method #2. Anyone more informed, feel free to correct me.
- ethbr1 2y ago
  That's broadly correct. One of the most under-appreciated wins of the ACA was capping non-care premium costs (read: admin, et al). From working on automation inside the system at insurers at the time, I can definitively say this spurred health insurers to streamline and lower operational cost overheads. With regards to the denials, I think you're right too. People like to point at insurers and blame them, but it's easy to forget they're just the middleman. There's "cost of care" on the other side of them. At the end of the day, premiums need to balance with costs... (somewhat, in aggregate) There are probably some edge cases where there are opportunities to profit, mostly to do with privately-administered but publicly-funded areas of health insurance (read: FEP and Medicare Advantage), but generally it's trying to get premiums lower for competitive reasons.
- stogot 2y ago
  Oh I wasn’t aware of this, thanks for describing the mechanics