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People get annoyed at insurers who will deny treatment but most of the time you can just pay it yourself. The government has decided that everyone should pay fo

People get annoyed at insurers who will deny treatment but most of the time you can just pay it yourself. The government has decided that everyone should pay for health insurance but you'll never be denied care if you pay for it yourself. So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's unlikely someone else will if they have to pay on your behalf. Essentially, place yourself in the role of each participant: - patient: wants to maximize care, money no object since it isn't theirs - medical practice: wants to maximize money spent on care - insurer: wants to minimize money spent on care Normally, the first two would be happy to collude to charge the third any amount of money since they'd both get what they want. And that is indeed what happens. So you get the natural result that the insurer doesn't want to support certain payments even if they were kind and pure-hearted. That they don't want to when they're neither should then not be a surprise. You can remove that pressure by turning the interaction into: - patient: wants to maximize care with minimized cost - practice: wants to minimize care with maximized cost The pressures between the two parties are now opposite and you can find the market equilibrium. With this opposition you'll suddenly find that patients start complaining about doctors ordering unnecessary procedures and so on, just like insurers claim in the other model. You can also work through with the other versions to model where equilibrium will set in and see if it's where it does. Most of the time you don't need to assume any moral valence for the participants. They might as well be machines. It is their roles that determine how they act, not their personalities.

elwebmaster 1y ago
How about this one: - patient: wants to maximize care, money no object since it isn't theirs - medical practice: wants minimize care since money is based on number of patients not care - insurer (government): wants to minimize money spent on care while maximizing care because money comes from healthy citizens who pay taxes
- renewiltord 1y ago
  There are two differently behaving conforming things in reality of these I think. Both Medicare and the UK/CA NHS in my knowledge conform to your description. In Medicare, this incentivizes maximizing patients on 'recurring revenue procedures' like dialysis. In the UK NHS (which I know better), it leads to the government denying certain kinds of care depending on the Adjusted QALYs / pound spent that the intervention will provide. TANSTAAFL after all, but yes, perhaps the interesting thing about the government being in that model is that patients can control government in a way that they cannot control insurance companies (i.e. they're not strictly oppositional) and consequently when the insurer is the government you get spend-bias in the direction of who has government power. In the US, that turns out to be old people. Additionally, governments have non-health-related sources of revenue so a government health plan can be used as a redistribution mechanism. But I think it leads to these outcomes predictably with a splitter placed on how much control the government exerts over the practice and how much control the patients exert on the government.
atomicnumber3 1y ago
>So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's unlikely someone else will if they have to pay on your behalf. Ok, hear me out for a minute. What if I wanted to pool with several people, so that if any of us had unexpected medical needs, it wouldn't bankrupt any of us. Knowing that most of us would not need it. And then, since we're all on the hook for each other's general health, we also agreed to share the cost of preventative care, because it was literally cheaper for us to all pay for preventative care than to try to just solo it and then hit the group with the cost of terminal cancer care instead of catching it early and doing a small excision. (and other such examples.) And then what if we made the pool HUGE, to even further spread out the costs? Sure wish there was a system that just did that, without trying to also generate insane profits off it.
- lingrush4 1y ago
  There's nothing stopping you from starting your own non-profit health insurance company. If greedy health insurance companies are really the root of the problem, you should be able to out-compete them fairly easily.
  - nradov 1y ago
    You are correct that health insurance companies aren't the problem here. But there are a lot of things stopping you from starting your own non-profit health insurance company. Medical insurance is heavily regulated at the state and federal levels. Launching a new one takes years of work just to get through the paperwork and legal compliance issues.
- xeromal 1y ago
  That assumes the humans will do their best to take care of themselves but given the ability they will be bailed out, they let their health go knowing they don't need to actively take care of themselves. The outliers drain the coffers
- fph 1y ago
  Aren't these basically mutual healthcare providers? We have them in Europe.
breadwinner 1y ago
The problem is that patients are usually not in a position to determine if the care the doctor says is needed is really needed or not. This is the same as taking your out-of-warranty car to the mechanic. How do you know if the mechanic is telling the truth? Still, this would be better than the current system. Even when you don't know if the doctor is telling the truth you can go by their reputation for telling the truth. Reputations will matter more, and doctors will care about maintaining their reputations in their community.
- nradov 1y ago
  Reputation is pretty much worthless. Patient reviews are largely based on how nice the doctor seems (bedside manner) and have no correlation with actual clinical outcomes.
  - breadwinner 1y ago
    That's with today's system not the proposed system.
    - nradov 1y ago
      The proposed system makes no sense. People have no way to accurately determine whether a clinician was telling the truth.
themafia 1y ago
> but you'll never be denied care if you pay for it yourself. If you can pay. You're still required to have insurance anyways. Which is a regressive tax and harms the people most in need of these services. It's a cruel joke. Those living paycheck to paycheck are screaming at you right now.
mylifeandtimes 1y ago
yup. So if you decide you want to have a child, you just get ready to fork out 40-80K for the birth. Because anyone can afford that, right? Oh, and by the way, if you are in Texas abortion is illegal. In case you didn't actually __decide__ to get (yourself, your partner) pregnant. So it's either 40-80K or 40 years. Easy choice.
- renewiltord 1y ago
  The ones who can't afford it (<200% federal poverty level) are covered in Texas. Friend who gave birth in Austin, TX talked to other mothers in the ward and one was having her second under that. There's lots of programs that cover this. Abortion should be legal, yes, but you won't be out that amount if you don't make enough. System seems fine, though I think I'd prefer if we completely subsidized childbirth and 12 months after for all (because those are people who will keep us solvent in the future).
- nradov 1y ago
  No one with health insurance pays $40K for a birth. Even for high-deductible health plans the current family out of pocket annual maximum is $21K. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... I'm not trying to defend Texas healthcare policies here but at least get your numbers right.
pazimzadeh 1y ago
Not true, I've been denied certain tests even though I offered to pay in cash if the doctor thought it wasn't medically necessary.

elwebmaster 1y ago

How about this one: - patient: wants to maximize care, money no object since it isn't theirs - medical practice: wants minimize care since money is based on number of patients not care - insurer (government): wants to minimize money spent on care while maximizing care because money comes from healthy citizens who pay taxes

renewiltord 1y ago
There are two differently behaving conforming things in reality of these I think. Both Medicare and the UK/CA NHS in my knowledge conform to your description. In Medicare, this incentivizes maximizing patients on 'recurring revenue procedures' like dialysis. In the UK NHS (which I know better), it leads to the government denying certain kinds of care depending on the Adjusted QALYs / pound spent that the intervention will provide. TANSTAAFL after all, but yes, perhaps the interesting thing about the government being in that model is that patients can control government in a way that they cannot control insurance companies (i.e. they're not strictly oppositional) and consequently when the insurer is the government you get spend-bias in the direction of who has government power. In the US, that turns out to be old people. Additionally, governments have non-health-related sources of revenue so a government health plan can be used as a redistribution mechanism. But I think it leads to these outcomes predictably with a splitter placed on how much control the government exerts over the practice and how much control the patients exert on the government.

atomicnumber3 1y ago

>So if you think you do require some care, just ask the medical practice whether they accept self-pay and then you can decide if it's worth paying or not. If you think it's not, it's unlikely someone else will if they have to pay on your behalf. Ok, hear me out for a minute. What if I wanted to pool with several people, so that if any of us had unexpected medical needs, it wouldn't bankrupt any of us. Knowing that most of us would not need it. And then, since we're all on the hook for each other's general health, we also agreed to share the cost of preventative care, because it was literally cheaper for us to all pay for preventative care than to try to just solo it and then hit the group with the cost of terminal cancer care instead of catching it early and doing a small excision. (and other such examples.) And then what if we made the pool HUGE, to even further spread out the costs? Sure wish there was a system that just did that, without trying to also generate insane profits off it.

lingrush4 1y ago
There's nothing stopping you from starting your own non-profit health insurance company. If greedy health insurance companies are really the root of the problem, you should be able to out-compete them fairly easily.
- nradov 1y ago
  You are correct that health insurance companies aren't the problem here. But there are a lot of things stopping you from starting your own non-profit health insurance company. Medical insurance is heavily regulated at the state and federal levels. Launching a new one takes years of work just to get through the paperwork and legal compliance issues.
xeromal 1y ago
That assumes the humans will do their best to take care of themselves but given the ability they will be bailed out, they let their health go knowing they don't need to actively take care of themselves. The outliers drain the coffers
fph 1y ago
Aren't these basically mutual healthcare providers? We have them in Europe.

breadwinner 1y ago

The problem is that patients are usually not in a position to determine if the care the doctor says is needed is really needed or not. This is the same as taking your out-of-warranty car to the mechanic. How do you know if the mechanic is telling the truth? Still, this would be better than the current system. Even when you don't know if the doctor is telling the truth you can go by their reputation for telling the truth. Reputations will matter more, and doctors will care about maintaining their reputations in their community.

nradov 1y ago
Reputation is pretty much worthless. Patient reviews are largely based on how nice the doctor seems (bedside manner) and have no correlation with actual clinical outcomes.
- breadwinner 1y ago
  That's with today's system not the proposed system.
  - nradov 1y ago
    The proposed system makes no sense. People have no way to accurately determine whether a clinician was telling the truth.

themafia 1y ago

> but you'll never be denied care if you pay for it yourself. If you can pay. You're still required to have insurance anyways. Which is a regressive tax and harms the people most in need of these services. It's a cruel joke. Those living paycheck to paycheck are screaming at you right now.

mylifeandtimes 1y ago

yup. So if you decide you want to have a child, you just get ready to fork out 40-80K for the birth. Because anyone can afford that, right? Oh, and by the way, if you are in Texas abortion is illegal. In case you didn't actually __decide__ to get (yourself, your partner) pregnant. So it's either 40-80K or 40 years. Easy choice.

renewiltord 1y ago
The ones who can't afford it (<200% federal poverty level) are covered in Texas. Friend who gave birth in Austin, TX talked to other mothers in the ward and one was having her second under that. There's lots of programs that cover this. Abortion should be legal, yes, but you won't be out that amount if you don't make enough. System seems fine, though I think I'd prefer if we completely subsidized childbirth and 12 months after for all (because those are people who will keep us solvent in the future).
nradov 1y ago
No one with health insurance pays $40K for a birth. Even for high-deductible health plans the current family out of pocket annual maximum is $21K. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... I'm not trying to defend Texas healthcare policies here but at least get your numbers right.

pazimzadeh 1y ago

Not true, I've been denied certain tests even though I offered to pay in cash if the doctor thought it wasn't medically necessary.