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Okay, and how much did insurers pay back in rebates to companies large enough to have their own pools? Assuredly that has also grown. People in this thread ask

Okay, and how much did insurers pay back in rebates to companies large enough to have their own pools? Assuredly that has also grown. People in this thread ask why don’t businesses lobby for public health. Wrong: why doesn’t Apple lobby for public health? Follow the money. It’s so naive to think it’s solely about providers. Who anyways, when there is fraud, they are defrauding CMS, not UNH.

nradov 1y ago
Huh? What rebates do you mean? Most large employers like Apple are already self funded and the health plans merely act as third-party administrators, assembling networks and processing transactions. The ACA does include a minimum medical loss ratio so health plans that come in under the limit are forced to issue premium refunds to customers. There is plenty of waste, fraud, and abuse committed by providers against all payers including Medicare, Medicaid, and commercial health plans. Most providers are honest and follow the rules in good faith but there are a few bad apples who attempt to exploit all payers.
- vjvjvjvjghv 1y ago
  "The ACA does include a minimum medical loss ratio so health plans that come in under the limit are forced to issue premium refunds to customers." The loss ratio seems to be a good incentive for insurance to pay more to hospitals in order toincrease their own cut of the premiums they are taking in.
  - nradov 1y ago
    Sure, that's part of it and the minimum medical loss ratio does create some perverse incentives. But in most markets there are intense competitive pressures between health plans which motivates them to negotiate lower rates with network providers. Your employer would be happy to switch from Aetna to Humana (or whatever) next year if it cuts their employee healthcare costs by 3%.
    - vjvjvjvjghv 1y ago
      It seems they have decided it’s easier to save money by jacking up deductibles and copays.
      - nradov 1y ago
        Of course. Those employers are (mostly) not running charities so they'll always attempt to shift as many healthcare costs to employees as they can without triggering tax penalties, or hurting recruiting and retention. This is one reason why society would be better off with eliminating special tax advantages for employer-sponsored health plans. Having employers act as payers and intermediaries reduces consumer choice and hides the true cost of health coverage.
- doctorpangloss 1y ago
  > Most large employers like Apple are already self funded and the health plans merely act as third-party administrators, assembling networks and processing transactions. Ha ha, “merely act as third-party administrators.” Dude, does United Health or Apple deny your claims? Anyway, it’s a simple question. Why doesn’t Apple lobby for public health?
  - nradov 1y ago
    If there's a UnitedHealthcare plan for Apple employees (and I don't know which company Apple currently uses) then Apple sets the policy for what is and isn't covered. UHC simply enforces the policy set by Apple so blaming UHC in that scenario is simply naive and displays a total misunderstanding of how the healthcare financing system actually works. UHC would be happy to offer a custom plan for Apple employees that pays 100% of every claim with no questions asked if Apple wanted it — it would be less work for UHC and they would merely pass the costs on to Apple (plus a very small profit margin). The largest employers do have a financial incentive to maintain the current broken system. Despite the hassles, their economies of scale in running self-funded employee health plans give them a cost advantage over smaller competitors. I suspect that's part of the reason why they don't lobby for reforms but I'm not privy to internal Apple decisions.
    - doctorpangloss 1y ago
      Okay. So you’re saying tax dodging giant corporations like to save money? Why does it have to be so complicated? The government HAS to pay for treatments that are FDA approved. UNH and Apple, working together, do not. Furthermore, Apple doesn’t have to cover everyone, the government would! It’s that simple! For people reading this thread: Apple gets paid a rebate at the end of the year by United. The employee whose paycheck has a cut out for “health plan” does not. It’s that simple. Apple gets to pay the employees less when it chooses United. Apple has not lost many antitrust cases, but it has lost them for paying employees less! This is their MO! Your cheaper ACA plans do not pay rebates for unused services. The government, which pays for the health costs of the people whose claims are denied, does not pay you a rebate. Your auto insurance sometimes “pays” you a “rebate,” if for some idiosyncratic reason Gavin Newsom decides that’s how it should work. So generally, Apple is not lobbying for public health because the status quo lets them save a TON of money by overcharging their own employees for “health plans.” I don’t think you should throw around “total misunderstanding” like that either. You don’t know me, or know how much I know about this stuff. Not every generalization is Wrong. It can be wrong, but not Wrong. And anyway, you have a problem with my generalizations, and then you say “total misunderstanding,” which is itself a generalization. It’s bad faith. I am choosing rhetorically to generalize, in a way that aligns very well with the truth, and you are choosing meaningless specificity that may be ever so slightly more truthful, but doesn’t align with the emotions - the anger against giant corporations, the government, etc. - at all. We’re both being intellectually honest, but only one of us is co-opted. That is my feedback to you.

nradov 1y ago

Huh? What rebates do you mean? Most large employers like Apple are already self funded and the health plans merely act as third-party administrators, assembling networks and processing transactions. The ACA does include a minimum medical loss ratio so health plans that come in under the limit are forced to issue premium refunds to customers. There is plenty of waste, fraud, and abuse committed by providers against all payers including Medicare, Medicaid, and commercial health plans. Most providers are honest and follow the rules in good faith but there are a few bad apples who attempt to exploit all payers.

vjvjvjvjghv 1y ago
"The ACA does include a minimum medical loss ratio so health plans that come in under the limit are forced to issue premium refunds to customers." The loss ratio seems to be a good incentive for insurance to pay more to hospitals in order toincrease their own cut of the premiums they are taking in.
- nradov 1y ago
  Sure, that's part of it and the minimum medical loss ratio does create some perverse incentives. But in most markets there are intense competitive pressures between health plans which motivates them to negotiate lower rates with network providers. Your employer would be happy to switch from Aetna to Humana (or whatever) next year if it cuts their employee healthcare costs by 3%.
  - vjvjvjvjghv 1y ago
    It seems they have decided it’s easier to save money by jacking up deductibles and copays.
    - nradov 1y ago
      Of course. Those employers are (mostly) not running charities so they'll always attempt to shift as many healthcare costs to employees as they can without triggering tax penalties, or hurting recruiting and retention. This is one reason why society would be better off with eliminating special tax advantages for employer-sponsored health plans. Having employers act as payers and intermediaries reduces consumer choice and hides the true cost of health coverage.
doctorpangloss 1y ago
> Most large employers like Apple are already self funded and the health plans merely act as third-party administrators, assembling networks and processing transactions. Ha ha, “merely act as third-party administrators.” Dude, does United Health or Apple deny your claims? Anyway, it’s a simple question. Why doesn’t Apple lobby for public health?
- nradov 1y ago
  If there's a UnitedHealthcare plan for Apple employees (and I don't know which company Apple currently uses) then Apple sets the policy for what is and isn't covered. UHC simply enforces the policy set by Apple so blaming UHC in that scenario is simply naive and displays a total misunderstanding of how the healthcare financing system actually works. UHC would be happy to offer a custom plan for Apple employees that pays 100% of every claim with no questions asked if Apple wanted it — it would be less work for UHC and they would merely pass the costs on to Apple (plus a very small profit margin). The largest employers do have a financial incentive to maintain the current broken system. Despite the hassles, their economies of scale in running self-funded employee health plans give them a cost advantage over smaller competitors. I suspect that's part of the reason why they don't lobby for reforms but I'm not privy to internal Apple decisions.
  - doctorpangloss 1y ago
    Okay. So you’re saying tax dodging giant corporations like to save money? Why does it have to be so complicated? The government HAS to pay for treatments that are FDA approved. UNH and Apple, working together, do not. Furthermore, Apple doesn’t have to cover everyone, the government would! It’s that simple! For people reading this thread: Apple gets paid a rebate at the end of the year by United. The employee whose paycheck has a cut out for “health plan” does not. It’s that simple. Apple gets to pay the employees less when it chooses United. Apple has not lost many antitrust cases, but it has lost them for paying employees less! This is their MO! Your cheaper ACA plans do not pay rebates for unused services. The government, which pays for the health costs of the people whose claims are denied, does not pay you a rebate. Your auto insurance sometimes “pays” you a “rebate,” if for some idiosyncratic reason Gavin Newsom decides that’s how it should work. So generally, Apple is not lobbying for public health because the status quo lets them save a TON of money by overcharging their own employees for “health plans.” I don’t think you should throw around “total misunderstanding” like that either. You don’t know me, or know how much I know about this stuff. Not every generalization is Wrong. It can be wrong, but not Wrong. And anyway, you have a problem with my generalizations, and then you say “total misunderstanding,” which is itself a generalization. It’s bad faith. I am choosing rhetorically to generalize, in a way that aligns very well with the truth, and you are choosing meaningless specificity that may be ever so slightly more truthful, but doesn’t align with the emotions - the anger against giant corporations, the government, etc. - at all. We’re both being intellectually honest, but only one of us is co-opted. That is my feedback to you.