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Comment by avalys | Hacker News Reader

1. Who decides what care is "needed"? Everyone is going to die eventually. I have a relative who believes they "need" ivermectin to prophylactically safeguard against contracting covid. Are insurance companies obligated to provide ivermectin to everyone who demands it, or should they apply some standard of efficacy and cost/benefit analysis?

2. Profits to shareholders and other people contributing their time and resources are also "needed", as without profits the only incentive to provide healthcare is charity, and charity has not proven to be an effective organizing principle to allocate the time and attention of millions of individuals in a complex society.

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Insurance companies refusing valid, evidence-based treatments != denying unproven demands. Likewise, framing healthcare as either for-profit or purely charitable ignores successful state-driven models worldwide that operate without prioritizing shareholder returns. Such false dichotomies and misdirection don’t justify profit-driven rationing of essential medical services.

> Everyone is going to die eventually

So why provide healthcare at all?

Medicine is still more art than science. We only have clear evidence-based treatment guidelines for a limited set of conditions, and even with those there are a lot of exceptions. While health insurers do occasionally make egregious errors in denying claims or prior authorization requests, most of those fall into gray areas. Like if a patient is immobilized by severe hip pain should they go straight to joint replacement surgery or try physical therapy for a few months first? Ask 10 different physicians and you'll get 10 different treatment plans.

And health insurers don't increase shareholder returns by denying claims. Due to the minimum medical loss ratio it's rather the opposite. Most of the pressure to tighten coverage rules actually comes from large self-funded employers who use those insurers not to provide insurance but rather to administer their health plans.

https://www.cms.gov/marketplace/private-health-insurance/med...

> Who decides what care is "needed"? Everyone is going to die eventually.

When the decision maker is accountant, RN, or AI versus physician, I know who _shouldn't_ be deciding it.

The two experiences I've seen first hand (coincidentally both UHC):

A willingness to deny vastly improved QOL for a simple surgery unless I spend an extended amount of time to determine whether somehow, a nasal spray would straighten the cartilage of a 95% deviation to the septum.

As a paramedic, the realization that UHC routinely denied paying for HEMS (air ambulance) for serious car accident patients to trauma centers because of "lack of pre-authorization".

Most people don't decide about their own medical "needs." They trust doctors, who are by and large expert and professional, yet frequently discredited by insurance companies.

Insurance companies have too much power in this dynamic, and there should be limits to what they can deny once doctors deem it needed.

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