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One should not profit from denying care. All health systems ration care. Doing so in a way that people profit from denying care is immoral.

jampekka 2y ago
And inefficient to boot!
tptacek 2y ago
If you believe that, you should have a bigger problem with what providers bill, because that's the ultimate origin of the constraints.
- gedpeck 2y ago
  I take it then that we agree that for profit health insurance companies profiting from denying care is immoral. That there are other immoral actors is not germane to the discussion.
  - tptacek 2y ago
    No, we don't agree. I think there are different values implicated in our system, in a system like the UK NHS, and a system like Australia's (for the record: I'd take Australia's over ours). The UK does a good job of hiding economic concerns from its users, at a cost in availability of services, especially high-end and experimental interventions. The UK makes these rationing decisions knowing that some people are going to be denied life-saving care, but in exchange for that everybody else in the system will get predictable access to their care. The American system does a good job of getting services delivered to customers; it does a better job of that than the NHS does, if you measure in interventions performed; it does such a better job at that that it's a real problem in our system: we overprescribe and overdeliver interventions that drive costs and decrease certainty as payers work out which things to cover and which not. The flip side of that is that everyone in that system can tell themselves that the system is doing what it can to gate delivery on whether care is truly needed and will be effective, and that it's not categorically denying care because of top-down mandates. Neither set of values is totally benign. You can prefer one or the other. I can go all 12 rounds on this topic, but if I keep writing about this I'm not going to write the work thing I'm supposed to write, so I'll leave it there.
    - gedpeck 2y ago
      Then your reply above to me was a red herring and as such a bad faith reply. The American system does a good job of getting services delivered to customers; Therein lies one of the reasons the U.S. system is immoral. There are lots of people who can’t afford to be customers. It is immoral to profit from denying someone healthcare.
- bugglebeetle 2y ago
  Your argument would be more convincing (well, not really because it’s typical bad faith contrarianism) if insurers weren’t also some of the largest hospital and clinic owners in the U.S. and use this to rob people blind on both ends.
  - tptacek 2y ago
    Which hospital chains are you referring to?
    - ceejayoz 2y ago
      UHC is the largest single employer of doctors in the US. https://www.statnews.com/2024/07/25/united-health-group-medicare-advantage-strategy-doctor-clinic-acquisitions/ https://www.statnews.com/2024/07/25/united-health-group-medi... > It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system. They purchase physician groups... and then pay themselves higher rates. https://www.statnews.com/2024/11/25/unitedhealth-higher-payments-optum-providers-converts-expenses-to-profits/ https://www.statnews.com/2024/11/25/unitedhealth-higher-paym... > UnitedHealth Group is paying many of its own physician practices significantly more than it pays other doctor groups in the same markets for similar services, undermining competition and driving up costs for consumers and businesses, a STAT investigation reveals.
loeg 2y ago
It follows that providers should provide care for free. Anything else is profiting from denying care. I guess you're just a full communist? If that's the case, just come out and say it so we can agree to disagree and move on.
- gedpeck 2y ago
  There are other options. Think about it a bit. Nonprofit insurance companies for one. National healthcare is another option that does not require communism. Don’t be a lazy thinker.

jampekka 2y ago

And inefficient to boot!

tptacek 2y ago

If you believe that, you should have a bigger problem with what providers bill, because that's the ultimate origin of the constraints.

gedpeck 2y ago
I take it then that we agree that for profit health insurance companies profiting from denying care is immoral. That there are other immoral actors is not germane to the discussion.
- tptacek 2y ago
  No, we don't agree. I think there are different values implicated in our system, in a system like the UK NHS, and a system like Australia's (for the record: I'd take Australia's over ours). The UK does a good job of hiding economic concerns from its users, at a cost in availability of services, especially high-end and experimental interventions. The UK makes these rationing decisions knowing that some people are going to be denied life-saving care, but in exchange for that everybody else in the system will get predictable access to their care. The American system does a good job of getting services delivered to customers; it does a better job of that than the NHS does, if you measure in interventions performed; it does such a better job at that that it's a real problem in our system: we overprescribe and overdeliver interventions that drive costs and decrease certainty as payers work out which things to cover and which not. The flip side of that is that everyone in that system can tell themselves that the system is doing what it can to gate delivery on whether care is truly needed and will be effective, and that it's not categorically denying care because of top-down mandates. Neither set of values is totally benign. You can prefer one or the other. I can go all 12 rounds on this topic, but if I keep writing about this I'm not going to write the work thing I'm supposed to write, so I'll leave it there.
  - gedpeck 2y ago
    Then your reply above to me was a red herring and as such a bad faith reply. The American system does a good job of getting services delivered to customers; Therein lies one of the reasons the U.S. system is immoral. There are lots of people who can’t afford to be customers. It is immoral to profit from denying someone healthcare.
bugglebeetle 2y ago
Your argument would be more convincing (well, not really because it’s typical bad faith contrarianism) if insurers weren’t also some of the largest hospital and clinic owners in the U.S. and use this to rob people blind on both ends.
- tptacek 2y ago
  Which hospital chains are you referring to?
  - ceejayoz 2y ago
    UHC is the largest single employer of doctors in the US. https://www.statnews.com/2024/07/25/united-health-group-medicare-advantage-strategy-doctor-clinic-acquisitions/ https://www.statnews.com/2024/07/25/united-health-group-medi... > It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system. They purchase physician groups... and then pay themselves higher rates. https://www.statnews.com/2024/11/25/unitedhealth-higher-payments-optum-providers-converts-expenses-to-profits/ https://www.statnews.com/2024/11/25/unitedhealth-higher-paym... > UnitedHealth Group is paying many of its own physician practices significantly more than it pays other doctor groups in the same markets for similar services, undermining competition and driving up costs for consumers and businesses, a STAT investigation reveals.

loeg 2y ago

It follows that providers should provide care for free. Anything else is profiting from denying care. I guess you're just a full communist? If that's the case, just come out and say it so we can agree to disagree and move on.

gedpeck 2y ago
There are other options. Think about it a bit. Nonprofit insurance companies for one. National healthcare is another option that does not require communism. Don’t be a lazy thinker.