Insurance companies aren't the main villain of the U.S. health system | Hacker News Reader

Insurance companies aren't the main villain of the U.S. health system

noahpinion.blog

7 pointspaulpauper13 comments

Insurance companies aren't the main villain of the U.S. health system

Not an expert in this but I know that ever since I retired and opted to not have insurance everything is cheaper. I tell people I am paying cash and they need not argue with any insurance companies and I get a look of relief from whomever I am speaking with. The local pharmacy said they would give me a 20% discount on every prescription including generics. I did not even ask for one. I only state that to increase the probability I get what I want.

It's really frustrating though when the opposite happens - you ask for a cash price and they look stupefied.

Usually though HSAs + high deductible plans are the best of both worlds. Most of the time you just pay with cash (tax free!). But if you get in something serious you know you're not going to go bankrupt.

But if you get in something serious you know you're not going to go bankrupt.

Absolutely true. In my case and per my preference I put the money I would have spent on insurance to eat healthier foods, get quality supplements, good walking shoes and other things that improve my overall health. It's not for everyone and perhaps I am taking illogical risks but I have come to terms with such risks. I suppose time will tell if I chose poorly. The unknown for me is if I would qualify for a black bar on HN.

The smiling doctor who writes you prescriptions and sends you to the MRI and refers you to a specialist without ever asking you for money knows full well that you’re going to end up having to wrangle with the insurance company for the cost of all those services.

Because you shouldn't have to. That smiling doctor is giving you things that they think you need. They're not doing it for giggles.

It is not the doctor's job to control costs. If the insurance company's doctor disagrees with your doctor, they should have to show medical cause. If we have a problem where 30% of the medical claims made are wrong -- unnecessary procedures, useless drugs, mis-diagnosis -- then we somehow have even worse problems than insurance companies.

But those doctors aren't wrong. They are "smiling" because they think they can help. They are the experts in the room, with the most knowledge of the patient and the case.

Blaming the doctor for the problems you're going to have with the insurance companies is absurd.

I cannot second this enough. Nearly every case of bilking I have experienced from healthcare has come from the providers:

- My insurance was billed 300k for our first child's birth because the hospital decided to bill my wife's emergency C-section twice (once for her and once for the child).

- A dermatologist faked a surgery after my visit so they could get a higher billing code.

- The hospital promised us services they didn't actually have, then when complications arose, forced us to use their "preferred" ambulance service to transfer. (Whose billing reputation is so bad that our insurance company automatically assigned us an arbitration firm and told us not to pay the bill).

- Our pediatrician's office just recently swapped our appointment details with another kids with the same first name - whoops! I had to call and unscramble the billing codes for them.

Insurance companies are powerless - they are legally obligated to respond to the billing codes provided to them. And they live in a competitive market, unlike the hospitals that have legally enforced monopolies.

American healthcare is messed up, but part of the reason it is messed up is that the incentives are screwed up and your insurance provider is the only advocate for cost reform.

Should be a "health Insurance " Ombudsman - who the government has given legal power ( via government legislation) to resolve some of these decisions. up to some government determined limits . The running costs of the ombudsman would be paid by the health insurance companies. ( Maybe as a ratio of the claims against each company. ) This gives healthcare companies a motivation to reduce ombudsman issues. Such systems exist in other countries.

Drugs are expensive, especially cutting-edge ones that have not gone generic. It's not just because of gouging, but recouping the cost of developing them, and the marketing. Paying out of pocket is not possible with chemo. Also, it's hard to predict risk, so insurance is needed there too. So expensive product + uncertainty means insurance.

I also think drug prices are a pretty overrated topic when medical costs come up. I asked my friend how much he pays for Humira, on paper a $100k a year treatment, and he says "nothing". Insurance pays, like $15k a year to the manufacturer, and then "forgives" the rest of the cost for him.

The MSRP often is a made up number that nobody pays. Keeping up deception is a win-win for the parties involved: the manufacturer gets a crazy number through negotiation with Medicare, and the insurance company gets to brag about how much money it saved clients.

If an insurance companies is paying CEO $10 million a year, as in this recent case, there is "fat in the system" ie money that could be directed to reducing insurance premiums in my opinion.

But the CEOs of the largest hospital chains/service providers earn even more than that. So this argument would be just as true (if not moreso) that there is more "fat in the system" on the provider side.

Dupe: https://news.ycombinator.com/item?id=42371103

> In general, I think it’s a very bad look to endorse murder.

Stopped reading right there. You don't need to endorse it to recognize that all other means of redress have been corrupted or hijacked. If you leave someone only one option, don't be surprised when they take that course of action.

> It's mostly the providers overcharging you, not the middlemen.

Yeah, I’m not reading the rest of this article if the author doesn’t understand how insurance companies work. Doctors hate them too for a reason.

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