5 ms·

>Alas, I guess "big company vs plucky surgeon in social media spat" is a simple script that requires no work, we don't need to be curious about who the hero(ine

>Alas, I guess "big company vs plucky surgeon in social media spat" is a simple script that requires no work, we don't need to be curious about who the hero(ine) and the villain are. spoken like someone who doesn't have a chronic illness requiring an expensive medication to be delivered every month for the rest of their life, who every year has to fight with the insurance company about the fact that multiple sclerosis does not go away and that the medication is still needed, and yet STILL has lapses in receiving the pre-approved and approved and re-approved treatment which causes new symptoms to occur and old ones to relapse while the bureaucrat at the insurance company who is incentivized to give you the runaround plays delay deny delay deny delay over the medication that has been effective for YEARS and will be needed indefinitely. No, we really do not need to be curious about who the villain is. If UHC is worried about their image, maybe they should DO THE THING THEIR CUSTOMERS FUCKING PAY THEM TO DO

JumpCrisscross 2y ago
> maybe they should DO THE THING THEIR CUSTOMERS FUCKING PAY THEM TO DO Health insurance in America is broadly profitable. But note that UHC just paying out claims puts them in the same place as California home insurers. Part of the job of a health insurer is to deny unnecessary claims, to be a check on providers, both in procedures and their pricing.
- Aurornis 2y ago
  > Health insurance in America is broadly profitable Health insurance is actually a lot less profitable than most big businesses. Something like half as profitable as the S&P 500 average. But ignoring that, there are also big non-profit insurers. They aren't appreciably different. There's a big misconception that if we could just remove profit from our healthcare system every problem would be solved. However, if you look at where healthcare dollars go, profit and administrative overhead (insurance, hospital admin, etc.) are a single digit percentage of overall spending. If you could wave your magic wand and make it go away tomorrow, things would barely change. Note that even countries with socialized medicine have administrative overhead in the single digit percentage range, so it's not actually possible to drive it to zero. We severely overestimate how much of our healthcare dollars go to profits and executive compensation. I think because those are the only safe targets to be mad at. Nobody wants to engage in conversations about getting surgeons to take lower compensation or limiting certain types of care (which is very much a thing in any medicine system). American healthcare is expensive, but we Americans also consume (and demand) much more healthcare than elsewhere in the world.
  - JumpCrisscross 2y ago
    We have a lot of unnecessary gatekeeping. Prescriptions come to mind. Unless it’s addictive or subject to group effects (e.g. antibiotics), it should be OTC. If someone kills themselves self administering another YouTube cure, that’s on the influencer and the patient.
    - s1artibartfast 2y ago
      I ran into a murderous rage last year trying to buy kidney friendly cat food because it required a prescription. Not sure who's life those regulations were saving.
      - JumpCrisscross 2y ago
        Omg, pet medicines! I wound up getting several when I went to India. Only edit I had to make was to the dose, since they were packaged for people.
      - sneak 2y ago
        The nice thing about having grown up in and around the underground cash economy that drives the USA is that I never forget that it’s usually cheaper and easier to just call your guy than to go wait in line like a schnook. My first box of Paxlovid was bought for cash. When Germany offered me only NSAIDs the 9th day after using a bone saw on me, the black market was there for me too. Seems cat food would be an easy one. Want me to ask my guys, or are you sorted now?
        s1artibartfast 2y ago
        The cat is dead now, but not before I was squeezed for a few grand by excessive regulation. At the time, I was wishing there was an underground option for blood testing. You don't need a 300k degree to stick a needle in a cat or read a PDF to me. Kinda like how a barber in my state need a 20k license and 1000 hours of training, but on steroids. At least at home haircuts aren't illegal (yet).
  - 2y ago
- franktankbank 2y ago
  > Part of the job of a health insurer is to deny unnecessary claims, to be a check on providers, both in procedures and their pricing. How can this occur with the given incentives? You have parent corp UHG who owns the whole vertical and you've got dumb fucking congress (deduced from Hanlon's razor) saying only a single part of that vertical is capped.
  - JumpCrisscross 2y ago
    > You have parent corp UHG who owns the whole vertical The group’s gross profits are in line with the legal 80/20 rule. And more-integrated models (Kaiser) exist with better satisfaction ratings.
    - lotsofpulp 2y ago
      Even Kaiser is bumping up against resource constraints (at least in Washington). I know quite a few Kaiser employed doctors and insureds, and they all report declining quality. Edit: I scrolled down and saw someone else say the same: https://news.ycombinator.com/item?id=43016691 https://news.ycombinator.com/item?id=43016691
- mysticllama 2y ago
  so glad the company that pays for my treatments can be "a check on providers" for me… /s
  - JumpCrisscross 2y ago
    > glad the company that pays for my treatments can be "a check on providers" for me Outside large hospitals, there is an alternative: pay yourself. You can usually draw down against an FSA or HSA, or just eat the cost. Only works if you’re wealthy, of course. But most small providers have a cash rate they’ll tell you verbally but never in writing that is below their official negotiated rate.
- nineplay 2y ago
  All of the job of for-profit health insurance companies is to make money for their investors. Everything else they do works towards that goal. Now all of the job of any for-profit company is to make money for their investors, that in and of itself is not a problem. The problem is that specifically, for health insurance companies, they make money by denying people health care. They have no incentive to pay claims beyond the minimum necessary. We have public health care too and it isn't perfect but they don't lie to our faces when telling us why they won't cover something.
  - s1artibartfast 2y ago
    With the 80-20 rule they actually make money on the claims they pay, not the ones they deny. It is essentially cost plus 20%. The tricky parts are balancing opex to profit, and balancing coverage with competitive costs.
- troyvit 2y ago
  Totally agree that if an insurance company just paid out every claim sent to it, the whole concept of insurance breaks down. However, in UHC's case: https://www.valuepenguin.com/health-insurance-claim-denials-and-appeals https://www.valuepenguin.com/health-insurance-claim-denials-... They deny 33% of all claims. I think they have a long way to go to prove they are doing what their customers pay them to do.

JumpCrisscross 2y ago

> maybe they should DO THE THING THEIR CUSTOMERS FUCKING PAY THEM TO DO Health insurance in America is broadly profitable. But note that UHC just paying out claims puts them in the same place as California home insurers. Part of the job of a health insurer is to deny unnecessary claims, to be a check on providers, both in procedures and their pricing.

Aurornis 2y ago
> Health insurance in America is broadly profitable Health insurance is actually a lot less profitable than most big businesses. Something like half as profitable as the S&P 500 average. But ignoring that, there are also big non-profit insurers. They aren't appreciably different. There's a big misconception that if we could just remove profit from our healthcare system every problem would be solved. However, if you look at where healthcare dollars go, profit and administrative overhead (insurance, hospital admin, etc.) are a single digit percentage of overall spending. If you could wave your magic wand and make it go away tomorrow, things would barely change. Note that even countries with socialized medicine have administrative overhead in the single digit percentage range, so it's not actually possible to drive it to zero. We severely overestimate how much of our healthcare dollars go to profits and executive compensation. I think because those are the only safe targets to be mad at. Nobody wants to engage in conversations about getting surgeons to take lower compensation or limiting certain types of care (which is very much a thing in any medicine system). American healthcare is expensive, but we Americans also consume (and demand) much more healthcare than elsewhere in the world.
- JumpCrisscross 2y ago
  We have a lot of unnecessary gatekeeping. Prescriptions come to mind. Unless it’s addictive or subject to group effects (e.g. antibiotics), it should be OTC. If someone kills themselves self administering another YouTube cure, that’s on the influencer and the patient.
  - s1artibartfast 2y ago
    I ran into a murderous rage last year trying to buy kidney friendly cat food because it required a prescription. Not sure who's life those regulations were saving.
    - JumpCrisscross 2y ago
      Omg, pet medicines! I wound up getting several when I went to India. Only edit I had to make was to the dose, since they were packaged for people.
    - sneak 2y ago
      The nice thing about having grown up in and around the underground cash economy that drives the USA is that I never forget that it’s usually cheaper and easier to just call your guy than to go wait in line like a schnook. My first box of Paxlovid was bought for cash. When Germany offered me only NSAIDs the 9th day after using a bone saw on me, the black market was there for me too. Seems cat food would be an easy one. Want me to ask my guys, or are you sorted now?
      - s1artibartfast 2y ago
        The cat is dead now, but not before I was squeezed for a few grand by excessive regulation. At the time, I was wishing there was an underground option for blood testing. You don't need a 300k degree to stick a needle in a cat or read a PDF to me. Kinda like how a barber in my state need a 20k license and 1000 hours of training, but on steroids. At least at home haircuts aren't illegal (yet).
- 2y ago
franktankbank 2y ago
> Part of the job of a health insurer is to deny unnecessary claims, to be a check on providers, both in procedures and their pricing. How can this occur with the given incentives? You have parent corp UHG who owns the whole vertical and you've got dumb fucking congress (deduced from Hanlon's razor) saying only a single part of that vertical is capped.
- JumpCrisscross 2y ago
  > You have parent corp UHG who owns the whole vertical The group’s gross profits are in line with the legal 80/20 rule. And more-integrated models (Kaiser) exist with better satisfaction ratings.
  - lotsofpulp 2y ago
    Even Kaiser is bumping up against resource constraints (at least in Washington). I know quite a few Kaiser employed doctors and insureds, and they all report declining quality. Edit: I scrolled down and saw someone else say the same: https://news.ycombinator.com/item?id=43016691 https://news.ycombinator.com/item?id=43016691
mysticllama 2y ago
so glad the company that pays for my treatments can be "a check on providers" for me… /s
- JumpCrisscross 2y ago
  > glad the company that pays for my treatments can be "a check on providers" for me Outside large hospitals, there is an alternative: pay yourself. You can usually draw down against an FSA or HSA, or just eat the cost. Only works if you’re wealthy, of course. But most small providers have a cash rate they’ll tell you verbally but never in writing that is below their official negotiated rate.
nineplay 2y ago
All of the job of for-profit health insurance companies is to make money for their investors. Everything else they do works towards that goal. Now all of the job of any for-profit company is to make money for their investors, that in and of itself is not a problem. The problem is that specifically, for health insurance companies, they make money by denying people health care. They have no incentive to pay claims beyond the minimum necessary. We have public health care too and it isn't perfect but they don't lie to our faces when telling us why they won't cover something.
- s1artibartfast 2y ago
  With the 80-20 rule they actually make money on the claims they pay, not the ones they deny. It is essentially cost plus 20%. The tricky parts are balancing opex to profit, and balancing coverage with competitive costs.
troyvit 2y ago
Totally agree that if an insurance company just paid out every claim sent to it, the whole concept of insurance breaks down. However, in UHC's case: https://www.valuepenguin.com/health-insurance-claim-denials-and-appeals https://www.valuepenguin.com/health-insurance-claim-denials-... They deny 33% of all claims. I think they have a long way to go to prove they are doing what their customers pay them to do.