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>It took 3 hours of my time. About 3 hours of medical assistant time and about an hour of two different doctors time to get this simple 5 minute CT approved. This is all on top of the time of admins at the insurance company.

At this rate, most of the costs are human wages, not the medical equipment and its operating cost.

If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper. That's UK.

Why the insurance companies has a privilege to deny a medical test when fully-qualified doctor said it's necessary in the first place?

If the government regulation set the standard medical procedures and its price, insurance companies has no privilege to deny the requests, only the fully-qualified doctor decide the treatments, it can also cut some costs and more importantly, it's fair. That's Japan.

> Why the insurance companies has a privilege to deny a medical test

They aren’t denying the test, they’re denying payment for it from the insurance company. Also, many times, the insurance company is not making its rules, but they are implementing them per the payer’s instruction. The payer can be the government, who outsourced Medicare and Medicaid administration, it could be employers that self fund employee’s insurance, etc.

That's denying, or more like denying the the whole purpose of insurance.

Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad.

So the better incentive design is not to allow the insurance company to deny the payment.

Take a look at my country(Japan) and my insurance company for example. They offer a free cancer test. Why? The treatment of later stage cancer costs so much money. Since they can't deny the payment, it's better to find the cancer as early as possible. That will reduce their cost, increase their profit. It also lead to healthier people as a bonus.

Then who will contain costs? Healthcare providers are also for profit, and have an incentive to get paid.

US insurance companies can’t deny providing insurance, but they can dictate following established guidelines, and requiring justification for straying from them. They are also requiring to pay out 80% of the premiums they collect.

It is not an ideal system, especially with stories like the above, but in the US, there is a ton of money being extracted in the healthcare field, and someone must be the arbiter to prevent waste and abuse. In many countries it’s the government, but absent that, who will?

Note that since the ACA law passed, healthcare costs have stopped rising at the meteoric rates they used to. Again, the system isn’t close to perfect, but someone with knowledge (doctors in government or insurance company) must be used to prevent abuse by healthcare providers billing excessively. Or at least in a lower trust society.

I have a close family member who is a doctor works at health insurance companies and sees doctors trying to experiment with off label uses of medications that cost thousands of dollars per month. If the insurance company approved every one, the premiums would have to skyrocket for it to stay in business, so they follow the CDC and FDA and other research to create rules so that it’s used in cases where it has a chance of working.

> Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad.

A for-profit company has no incentive to deny a test that may prevent even costlier treatments down the line. It must stay within budget, however. Socialized systems also have a budget and they also deny/limit/delay treatment all the time.

Also, look at the profit margins of insurances, they aren't that great (about 5% tops). If you sincerely believe a government bureaucracy can do a better job at this for less than the profit margin of a private company, by all means, vote for it.

Cancer testing absent symptoms has come under increasing scrutiny in terms of effectiveness. A "positive" test puts immense pressure on care providers to do something, even though doing something may not actually improve outcomes. It also adds immense stress to the patient.

>They aren’t denying the test, they’re denying payment for it from the insurance company.

What's the difference?

The difference is the person can still get the test.

Only if they're rich!

Then the solution is taxpayer funded healthcare, not private insurance companies.

> If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper.

Not true, administrative overhead accounts for less than 10% in healthcare costs in the US [1].

NHS sets a price for services, which providers have to follow. That evidently leads to waiting times and shortages, as well as lower wages and inferior equipment. There's no free lunch, you need to pick your poison.

There's also a difference between costs and prices. Labor costs in the US are higher, because all staff earns better than in the UK. The industry is highly regulated and liabilities are high as well.

In the US, lots of hospitals run a loss for treating Medicare patients, as well as people who end up not paying. In order to stay in business, hospitals charge as much as they possibly can, and it's very opaque. If you get a huge hospital bill, you must negotiate.

Lastly, technology in the US needs to be up-to-date all the time, otherwise you run the risk of costly lawsuits. That's not the case in countries where settlements are far lower.

Ultimately, the headline is wrong, a CT does not cost $1100, it costs whatever you or your insurance pays for it. You can get it for 450$ or even less. You need to shop around, but it's quite difficult, because prices are not transparent.

[1] https://www.americanprogress.org/issues/healthcare/reports/2...

No we do not. The government has screwed the system up enough, giving this government even more control is a terrible idea. Just stop enforcing monopolies, Force providers to have a clear pricing structure and let market forces deal with it.

The market forces did deal with it and created entities large enough to perform regulatory capture and here we are.

The government created these entities by giving the insurance companies a priveliged position in their regulatory structure starting in WW2, and increasing this with every promised legislative "fix" including the creation of the HMO in the 70's with the HMO Act of 1973, all the way through Obamacare, which was considered to be the best thing since Sliced Bread, right up until "We can't handle any of this Capitalism shit, we need Single Payer!"

From my Non-American view, this is a classic case for the need of regulation. The government define a set of medical treatments that were scientifically proved, don't allow the insurance companies to deny the request of medical treatments from the doctor.

The only problems we face is some malicious doctors requests unnecessary treatments, or malicious doctor and patient working together to request the money for treatments that didn't happen. But these are trivial fraud techniques and it happens anyway regardless of context so it can be dealt with usual criminal law system.

The Affordable Care Act (Obamacare) included mandatory insurance funding for homeopathy, chiropractors, acupuncture, and naturopaths. My wife worked at a chiropractors office who got paid by Medicare to shock elderly diabetics legs while they chowed down on candy bars. Homeopathy is one of the dumbest scams known to man, and I don’t really know about the other two but I wouldn’t call them “medicine”. The more government there is around to fund things, the more dumb bloat there is and we’ll get more glorified massage therapists cutting children’s “tongue ties” and selling amber teething necklaces for $40. Let people waste their own money on this stuff.

Not everything magically works well under free market forces. Two examples are healthcare and prison management.

Because you incentivize either people being sick, or in prison. It's really as simple as that.

> we need to move to a single payer system

The only reason you say that is that you haven't actually experienced Medicare.

It's much much much worse than what you experienced with your insurance company.

The only type that is even remotely sane is Medicare Advantage which is administered by private insurance companies.

What you have described is a huge problem, I 100% agree, but it will not be solved by single-payer.

> The only reason you say that is that you haven't actually experienced Medicare.

I have experienced Medicare (along with pre- and post-ACA Gold level individual marketplace plans, small group plans, premium employer-sponsored plans, and Medicaid). The only system I’ve experienced which is better than Medicare was my state’s Medicaid system. Every private insurance plan I’ve had has been significantly worse in every metric—more expensive, less coverage, super stressful (imaging having a kidney stone and having to decide whether to spend $300 + coinsurance to go to the emergency room on a Sunday night or wait in excruciating pain until you can get an appointment for a $10 office visit instead the next day).

On Original Medicare with a Medigap plan I pay $377/mo in premiums and have 100% coverage for hospitals, doctors, surgeries, ambulances. There are no provider restrictions. The “coverage area” is the whole country. Outpatient services in hospitals is fine. There’s no arguing over billing, no copays, no coinsurances, no hassle.

Drug coverage is a whole different thing, but it sucks about as much as it did with private insurance—which it would, since Part D is just a marketplace of private insurers! Notably, though, any drugs I get in a clinic, like super expensive biologics, are covered under Original Medicare for that $377 premium.

What is your experience that makes you think so differently?

I completely agree that Medicaid is the best one of all. But I need to point out that (at least in my state) Medicaid is simply contracted out to local insurers, it is not run by the government.

It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone.

And you have to buy private insurance to fix what the government doesn't do right.

Medicare Advantage is the same exact thing: you have to buy private insurance and the one the government offers is terrible.

So basically your experience exactly confirms what I said.

Medicare for all is not a good plan. Medicare Advantage for all however is a good plan.

And Medicare Advantage is simply private insurance companies that are paid by the government.

And personally I think that's the best option. Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely.

Thank you for sharing your thoughts with me.

> It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone.

I’m not sure I understand this comment. There is a guaranteed issuance period after you become eligible for Medicare. Several states also either have permanent guaranteed issuance periods, or annual guaranteed issuance enrolment periods. What do you mean when you say the plans are not available to everyone?

> And you have to buy private insurance to fix what the government doesn't do right.

Sure, but supplemental insurance exists in Canada and the UK too, even though those care systems are quite good. Most people don’t need it because the basic services are comprehensive and reasonable. A Medicare for All plan just needs to offer the same level of service that you see in other universal health care systems.

> Medicare for all is not a good plan.

There are multiple plans that are described as “Medicare for All”. Which specific version of this concept do you think is bad? Why?

> Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely.

The main thing I don’t understand about this approach is where cost savings and improved patient experience are supposed to come from. Having multiple insurers means that all the billing and administrative overhead costs continue to exist. Insurers will demand a profit margin on top of the actual cost of providing services. We’ll still have the restricted networks and copays and coinsurances and denials and appeals and prior authorisations and formulary exceptions and annual enrolments that make navigating care in the U.S. a nightmare. Can you explain how you think these problems would be mitigated under a “Medicare Advantage for All” type system?