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> 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 h

> 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
        You stated this claim upthread, for the record, and tracked down an actual Canada vs. US statistic on this, which turned out to account for roughly 3.6% of total provider inpatient/outpatient expense.
        ceejayoz 6mo ago
        In 2011, when my premiums were $1600 a month. I dropped my plan when it hit $4900/month to go on my employer’s crappier plan. And as noted in that other conversation, this is one aspect of many. UHC isn’t pursuing vertical integration for funsies.
        tptacek 6mo ago
        That's not an argument; it's just vibes. Whenever we get actual numbers to look at, your arguments fall apart. Again, I want to be clear: I'm not here to defend the American health system. It's a disaster. It's just clear to me you don't have a bead on why that is. (The answer is artificial scarcity of practitioners, overprescription, and lack of price transparency).
        ceejayoz 6mo ago
        > That's not an argument; it's just vibes. So is “insurance doesn’t have any externalities that might hide in my very broadly categorized numbers”.

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
        You stated this claim upthread, for the record, and tracked down an actual Canada vs. US statistic on this, which turned out to account for roughly 3.6% of total provider inpatient/outpatient expense.
        ceejayoz 6mo ago
        In 2011, when my premiums were $1600 a month. I dropped my plan when it hit $4900/month to go on my employer’s crappier plan. And as noted in that other conversation, this is one aspect of many. UHC isn’t pursuing vertical integration for funsies.
        tptacek 6mo ago
        That's not an argument; it's just vibes. Whenever we get actual numbers to look at, your arguments fall apart. Again, I want to be clear: I'm not here to defend the American health system. It's a disaster. It's just clear to me you don't have a bead on why that is. (The answer is artificial scarcity of practitioners, overprescription, and lack of price transparency).
        ceejayoz 6mo ago
        > That's not an argument; it's just vibes. So is “insurance doesn’t have any externalities that might hide in my very broadly categorized numbers”.