3 ms·

> Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023. What? Insurers have been playing this g

> Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023. What? Insurers have been playing this game far further back than 2023. If an insurer doubles the time a doc has to fight over denials and has to hire extra billing staff to assist, where do you imagine that cost shows up?

tptacek 6mo ago
I feel like we've been in this argument before, and I like you just fine as a commenter, but do feel like you're tying yourself into knots to avoid a simple conclusion plainly supported by the data. I didn't post a trend story about what companies are doing or who they're acquiring; I posted the macro NHE table from last year. It simply refutes the argument you're trying to make.
- ceejayoz 6mo ago
  > I posted the macro NHE table from last year. Again: how will the “insurers force provider costs up” show up in said tables? It’s caused by the insurer. It shows as a provider’s cost. But it doesn’t mean said doc is making any more money at the end of the day. The insurer does, though! Their 20% cut got bigger, and the "computer says no" denials are cheap! TL;DR: Where in your link does "doc spends needless hours on phone fighting insurer" show up as a cost?
  - tptacek 6mo ago
    It literally breaks practice and net cost of insurance out!
    - ceejayoz 6mo ago
      > It literally breaks practice and net cost of insurance out! But it's not a "Cost of Health Insurance" item. It's an expense at the practicioner level! They have to factor that non-billable time into what they charge for the procedure! Read their definitions: https://www.cms.gov/files/document/quick-definitions-national-health-expenditures-accounts-nhea-categories.pdf https://www.cms.gov/files/document/quick-definitions-nationa... "Administration" is the insurer's side of it.
      - tptacek 6mo ago
        This is special pleading.
        ceejayoz 6mo ago
        Oh, now who's dodging? If an insurer manages to double a doctor's administrative costs for billing/appeals/etc., where does it show up in your tables, per your link's PDF of definitions?
        tptacek 6mo ago
        You have no evidence for this argument. It's just vibes. The numbers here are stark. It's not like it's close, between providers and insurers. Insurers are almost literally a rounding error.
        ceejayoz 6mo ago
        You asserted "the macro NHE table from last year… simply refutes the argument you're trying to make", but that claim is false. You are welcome to answer the question about where "doc spends two hours on phone arguing with UHC" falls in the expenditure list; it's not insurance, but it's caused by it. > Insurers are almost literally a rounding error. Again, the argument is that the raw cost of health insurance does not reflect its externalities imposed on the other items in your list; that insurers drive up hospital and practice costs, as they have to staff up enormous amounts of staff and expensive physician time to deal with the insurer.
        tptacek 6mo ago
        $360B in admin/net cost of insurance. $2.5T in practitioner costs.
        ceejayoz 6mo ago
        > $2.5T in practitioner costs. Some of which is those practicioners' admin cost from dealing with the insurers. (And, you know, doing the actual work.) Denials are nice and cheap. Fighting them is not.

tptacek 6mo ago

I feel like we've been in this argument before, and I like you just fine as a commenter, but do feel like you're tying yourself into knots to avoid a simple conclusion plainly supported by the data. I didn't post a trend story about what companies are doing or who they're acquiring; I posted the macro NHE table from last year. It simply refutes the argument you're trying to make.

ceejayoz 6mo ago
> I posted the macro NHE table from last year. Again: how will the “insurers force provider costs up” show up in said tables? It’s caused by the insurer. It shows as a provider’s cost. But it doesn’t mean said doc is making any more money at the end of the day. The insurer does, though! Their 20% cut got bigger, and the "computer says no" denials are cheap! TL;DR: Where in your link does "doc spends needless hours on phone fighting insurer" show up as a cost?
- tptacek 6mo ago
  It literally breaks practice and net cost of insurance out!
  - ceejayoz 6mo ago
    > It literally breaks practice and net cost of insurance out! But it's not a "Cost of Health Insurance" item. It's an expense at the practicioner level! They have to factor that non-billable time into what they charge for the procedure! Read their definitions: https://www.cms.gov/files/document/quick-definitions-national-health-expenditures-accounts-nhea-categories.pdf https://www.cms.gov/files/document/quick-definitions-nationa... "Administration" is the insurer's side of it.
    - tptacek 6mo ago
      This is special pleading.
      - ceejayoz 6mo ago
        Oh, now who's dodging? If an insurer manages to double a doctor's administrative costs for billing/appeals/etc., where does it show up in your tables, per your link's PDF of definitions?
        tptacek 6mo ago
        You have no evidence for this argument. It's just vibes. The numbers here are stark. It's not like it's close, between providers and insurers. Insurers are almost literally a rounding error.
        ceejayoz 6mo ago
        You asserted "the macro NHE table from last year… simply refutes the argument you're trying to make", but that claim is false. You are welcome to answer the question about where "doc spends two hours on phone arguing with UHC" falls in the expenditure list; it's not insurance, but it's caused by it. > Insurers are almost literally a rounding error. Again, the argument is that the raw cost of health insurance does not reflect its externalities imposed on the other items in your list; that insurers drive up hospital and practice costs, as they have to staff up enormous amounts of staff and expensive physician time to deal with the insurer.
        tptacek 6mo ago
        $360B in admin/net cost of insurance. $2.5T in practitioner costs.
        ceejayoz 6mo ago
        > $2.5T in practitioner costs. Some of which is those practicioners' admin cost from dealing with the insurers. (And, you know, doing the actual work.) Denials are nice and cheap. Fighting them is not.