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Also the largest insurers increasingly own the doctors you’re seeing too. Also the pharmacy you get your drugs from. Also the entity that negotiates prices be

Also the largest insurers increasingly own the doctors you’re seeing too. Also the pharmacy you get your drugs from. Also the entity that negotiates prices between pharma companies and your insurer. More healthcare consumption = better, across the board

doctorpangloss 1y ago
Uh, no… they want to deny claims. The best situation for insurers is that you are healthy for a while, then abruptly die of something that cannot be treated.
- frollogaston 1y ago
  They are accepting claims that are way more expensive than in any other country, so I don't think this is their game
- estearum 1y ago
  Uh no, they don't. Not if they're also the ones who provide healthcare. Simply denying claims isn't even remotely close to the financially (and obviously not the politically) optimal strategy. The optimal strategy if you own both the insurer and the provider is a combination of premiums, copays, deductibles, and maybe even some totally unnecessary care to drive up volume. Lower margin on dramatically higher volume is still dramatically more money. Lower margin actually provides political cover for your $400 billion revenue years.
hibikir 1y ago
Even when it's not the insurer, it's at least a hospital. Many a doctor around me that used to have a private practice sold to one of the hospital chains, as they promised more money than by owning, solely due to superior collective action advantages. A large insurer can bully a private practice into cutting costs, but a hospital network that handles 40% of ERs in the metro area? The insurance company can lose. So everyone makes more money but the people paying insurance.
- dnissley 1y ago
  On top of that the ACA prevents new physician owned hospitals from being established and placed restrictions on expansions of existing ones
  - estearum 1y ago
    To be fair, this is because there's long-standing [but disputed] evidence that healthcare providers drive up costs/utilization when they can refer to hospitals they have equity stakes in. Messy business!
  - MostlyStable 1y ago
    Are you talking about Certificates of Need? Those have been around for a lot longer than the ACA [0] [0] https://en.wikipedia.org/wiki/Certificate_of_need#History https://en.wikipedia.org/wiki/Certificate_of_need#History
NooneAtAll3 1y ago
> More healthcare consumption = better, across the board no more paid money for less healthcare consumed = better for insurence thus all the declined treatments
- estearum 1y ago
  Not quite true. If you own the providers, getting people to pay deductibles and copays (i.e. getting treated) will yield way more money than just having them pay premiums.
  - frollogaston 1y ago
    But undercutting the other insurers/providers should earn you more, if it were competitive, which I guess it's just not
    - estearum 1y ago
      Correct, which is another reason why they are buying the healthcare providers. It allows the insurers (“pay-viders”) to strong arm independent doctors and smaller insurers out of the market.
      - frollogaston 1y ago
        Ok, I get it now. No other explanation has made sense so far, it's a cartel.
- msandford 1y ago
  The insurers are legally obligated to pay out 80-95% of their premiums for treatment. So the only way to grow profits is to spend 2x and much and charge 2x as much. Sure you only make the same 5-20% margin, but it's on 2x the revenue so it's 2x the gross profits.

doctorpangloss 1y ago

Uh, no… they want to deny claims. The best situation for insurers is that you are healthy for a while, then abruptly die of something that cannot be treated.

frollogaston 1y ago
They are accepting claims that are way more expensive than in any other country, so I don't think this is their game
estearum 1y ago
Uh no, they don't. Not if they're also the ones who provide healthcare. Simply denying claims isn't even remotely close to the financially (and obviously not the politically) optimal strategy. The optimal strategy if you own both the insurer and the provider is a combination of premiums, copays, deductibles, and maybe even some totally unnecessary care to drive up volume. Lower margin on dramatically higher volume is still dramatically more money. Lower margin actually provides political cover for your $400 billion revenue years.

hibikir 1y ago

Even when it's not the insurer, it's at least a hospital. Many a doctor around me that used to have a private practice sold to one of the hospital chains, as they promised more money than by owning, solely due to superior collective action advantages. A large insurer can bully a private practice into cutting costs, but a hospital network that handles 40% of ERs in the metro area? The insurance company can lose. So everyone makes more money but the people paying insurance.

dnissley 1y ago
On top of that the ACA prevents new physician owned hospitals from being established and placed restrictions on expansions of existing ones
- estearum 1y ago
  To be fair, this is because there's long-standing [but disputed] evidence that healthcare providers drive up costs/utilization when they can refer to hospitals they have equity stakes in. Messy business!
- MostlyStable 1y ago
  Are you talking about Certificates of Need? Those have been around for a lot longer than the ACA [0] [0] https://en.wikipedia.org/wiki/Certificate_of_need#History https://en.wikipedia.org/wiki/Certificate_of_need#History

NooneAtAll3 1y ago

> More healthcare consumption = better, across the board no more paid money for less healthcare consumed = better for insurence thus all the declined treatments

estearum 1y ago
Not quite true. If you own the providers, getting people to pay deductibles and copays (i.e. getting treated) will yield way more money than just having them pay premiums.
- frollogaston 1y ago
  But undercutting the other insurers/providers should earn you more, if it were competitive, which I guess it's just not
  - estearum 1y ago
    Correct, which is another reason why they are buying the healthcare providers. It allows the insurers (“pay-viders”) to strong arm independent doctors and smaller insurers out of the market.
    - frollogaston 1y ago
      Ok, I get it now. No other explanation has made sense so far, it's a cartel.
msandford 1y ago
The insurers are legally obligated to pay out 80-95% of their premiums for treatment. So the only way to grow profits is to spend 2x and much and charge 2x as much. Sure you only make the same 5-20% margin, but it's on 2x the revenue so it's 2x the gross profits.