The entire healthcare system is broken, not just health insurance companies
sensible-med.com
sensible-med.com
Socialize it all; call in the military doctors to provide care that's missing. Train up more. Break the education cartel and '(evil/dark) company' style hazing of new grads in grueling 12-36 hour deathmarch shifts. Train enough doctors to fulfill society's needs.
The cause of the malaise seems to be the same everywhere. See the biggest shift in the US healthcare system over the last 50 years for example:
There was a 3,200 percent increase in the number of healthcare administrators between 1975 and 2010, compared to a 150% increase in physicians, due to an increasing number of regulations:
https://www.athenahealth.com/knowledge-hub/practice-manageme...
>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009.) [3]
In contrast, the fields of medicine in the US less affected by this surge in government intervention; cosmetic and laser eye surgery, have seen prices increase at below the rate of inflation. [4]
[1] https://www.cms.gov/medicare/payment/prospective-payment-sys...
[2] https://www.hhs.gov/hipaa/for-professionals/privacy/laws-reg...
[3] https://www.hhs.gov/hipaa/for-professionals/special-topics/h...
That's what happens when you have thousands of insurance companies, each negotiating their own individual prices for everything. On top of that, you have to deal with insurers that will deny pre-approvals for medically necessary treatments on first request as a matter of course, then deny the first claim afterwards despite acquiescing to the pre-approval. And finally, patients may have primary, secondary, tertiary, and even quaternary insurers to ensure they're fully covered, so you have to figure out which fraction of the procedure each will pay.
Rather than doctors spending their entire days haggling with insurers, they've hired administrators to offload the work so they can get back to being doctors. Unfortunately, the byzantine structure which is privatized health insurance has only continued to grow in size and complexity, necessitating a growing number of administrators to handle the interface between the two.
In contrast, cosmetic and laser eye surgery have mostly escaped the effects of these interventions, and are consequently the only fields of medicine where 1. most spending is out of pocket, and 2. prices have increased at below the rate of inflation.
As for the socialized health care panacea, if you look at the health care systems of other countries where they have fully socialized expenses, you see huge problems, not exactly the same as the U.S.'s, but absolute disasters nonetheless. Health care as a centralized institution doesn't work.
The funny thing is, most people you talk to on either side of the aisle are for it. The healthcare lobby is so large as to buy politicians to make it seem like a wedge issue, but even a ton of conservatives agree with single payer in principle.
I'd wager if you put it to a national vote, it'd break something like 80-20 for.
I'll never forget Trump being cornered, and him saying he's not going to let people die in the streets, and his audience booing. He claimed they were all donors and lobbyists taking the audience seats, and despite his typical theatrics, I now believe that to be the truth.
Either way, today it is a leftist idea I think, so there will exist some people who oppose it out of spite.
I don't know a single person happy with the system today, which is damning. Just look at the reaction from recent events...
The role of govt is a catch 22 - it is by design a monopoly, and monopolies are usually inefficient, so too much govt power gets monopoly capture but too little means govt can’t break the monopolies.
The largest issue with US healthcare is lack of price-quality transparency and competition.
This means tons of middle player monopolies e.g PBMs.
I can’t go shop around for a procedure on a marketplace and pay out of pocket, the same rates an insurer would.
I can’t deal directly with service provider or the labs. It has to be intermediaries.
The # of medical licenses are capped, they’re not growing in proportion to population.
Demand-supply dynamics, the basis of capitalism is wildly inefficient in US.
Get rid of employer given insurers, make a law that insurers cannot negotiate a lower price than out of pocket price. Every procedure price should be openly put on an easily searchable marketplace.
Make it easy to start new practices, more doctors and nurses and hospitals.
The prices will come down.
Single payer is a bandaid fix. It does nothing to fix the supply problem.
If I have cancer and I need to start treatment as soon as possible I’m not going to waste precious time comparing rates of infusion centers, especially given that one may be able to take me in for treatments 2 weeks sooner. That two weeks could make all the difference
If I have a heart attack, stroke, car accident, etc, that incapacitates me, I am simply incapable of shopping around for the best price. I am going to be taken in for emergency care and treated to the point of stabilization (or better, depending on whether I have a guardian who can approve more. Said guardian could theoretically shop around at this point but it is difficult given the potential emotionality involved and danger in moving someone who is critically injured)
Increasing provider supply is certainly a huge part of fixing things, if it’s done correctly. If you merely lower standards you just increase supply with substandard practitioners that overall worsen outcomes
5%? 10%?
I'm not saying stuff like that doesn't happen but insurance for healthcare in this country is totally insane. If car insurance worked the same way Geico would be paying for my gas and oil changes. Heck they'd be paying to have the car cleaned once a month.
A little boo boo or an urgent care visit can be shopped for, sure, but that’s all cheap stuff compared to emergency or end of life care! That’s the stuff people actually stress about in my opinion. So why not fix that?
Another example: a mother “shops around” to find a cheap place to deliver her baby. Great! But maybe she’s unlucky and needs emergency C-section or another emergency intervention. What good is shopping around if it’s not actually practical?
People expecting children are exactly the type of people who should be able to shop around. Even in the case of an emergency delivery it's an event that you have what, 6 months to plan for?
I see you conveniently ignored the fact that any emergency before age 65 is hard to shop around for. From a hospital bed and all that…
Anyway i simply think the idea of “shopping around” for medical care is barbaric. As a concept. We’re talking about peoples lives here. I think as a country we should have some actual pride and treat our citizens well. Not like an inconvenience.
just my opinion, as a lucky person with great health insurance.
I'd gladly "overpay" a few (or even many) percent if that's what it takes to get systematic protection from being a pawn in a game of 10d chess between doctors needing to overtreat to recoup their enormous investments, insurers pushing back by possibly declining to pay for what I actually need to get done, and medical administration and billing companies, and industry for the size of which I have yet to hear a compelling economic argument.
Still, a problem at least as big as finding various options and their prices seems to be finding somebody incentivized to give an honest evaluation of whether a given treatment is medically necessary at all.
Sometimes I wonder if it wouldn't make sense to have a doctor "on a retainer" that just gets a fixed yearly compensation for advising what to do, and what to better decline, but there's probably tons of ways this could go wrong in either direction (overtreatment vs. missing important issues) as well.
https://www.webmd.com/a-to-z-guides/what-is-a-concierge-doct...
It's funny (not funny haha) how Democrats always seem to have a few undercover sabotagers in their ranks that get elected having lied to voters and then undermine Democrat's agenda, Lieberman, Manchin, Sinema, now Fetterman.
Barack Obama himself said in an interview that this option wouldn't be on the table, because it would kill millions of jobs. When there is great inefficiency in a system, remember that the "wasted" money is going to someone. Some voting districts in the eastern USA rely heavily on jobs in medical payment administration.
Obamacare was always a compromise between what the democrats wanted and what the centrists and republicans would allow.
There's still obvious limits. Imagine everybody spending 80% of their income on healthcare, of which 100% goes to doctors performing effective and required procedures: Society would still collapse, since people do have needs other than healthcare.
We got the breast pump, some Chinese product that, on Amazon, retails for no more than 50$. Given the quality I was frankly surprised to see that the health insurance had been charged 300$. Not even the iPhone of breast pumps in the market would cost that much.
It was vendored to us by some organization that is no doubt making a living from selling cheap Chinese produced breast pumps and charging a 600% markup.
This is the exact same thing that is happening to Tylenol, a 50 cent drug that is marked up to 79$ when given at a hospital. To ambulance trips. To routine checkups. To medical exams. To X-rays and to cat scans.
Literally everything that is covered by insurance is enjoying exorbitant mark ups. Buyers can’t vote with their wallets because there is no choice. The illusion of choice is barely even there, as difference health insurance coverage covers the same things only at different price points.
As a buyer of health insurance you can’t not pay for the 300$ breast pump, or the 79$ Tylenol. There is no choice you can choose to avoid that.
And since I bought the $300 dollar breast pump, I contributed to the bloated premiums by causing the expenses for breast pumps to be much higher than it needs to be. So I should apologize to you all. But of course I have no option except to make premiums higher for all of you because I want my wife to have a breast pump.
There is no other way to fix any of this nonsense except to socialize healthcare completely.
The $300 breast pump and $79 Tylenol is harder to understand. Why can't insurance companies step in and say this is crazy we're not paying for it?
Is it like the $3000.00 hammer? i.e. we want the jet fighter to come in under a certain cost so there are bundled items that are ridiculously expensive. The hospitals or some other 3rd party somehow put the insurance company in a posistion where they can't say no even though they want to?
Or is there some perverse incentive? Insurance companies benefit from an expensive breast pump / Tylenol? If that's the case why do they ever deny claims?
Is the amount too small in grand scheme of things?
Do they get some kick back for some types of care that make eating this cost still worthwhile?
While I somewhat agree with that claim, I suspect that there are many systemic policies designed into healthcare by policy makers that create these inefficiencies in the first place.
1) why can’t an insurance offer a lower cost option? It’s because of the policy of what they are required to provide.
2) why do hospitals charge so much markup for everything? It’s probably because there is a lot that they can’t charge you for, they can’t charge you by hour by doctor and nurse quantity. So they have to charge arbitrary markups on random items. This allows for hidden profits esp by savvy financial data people.
3) what incentives are there to give cost effective services in the medical field? There are none. Customers will pay regardless, and insurance will cover regardless. Game theory wise, it is in the best interest for insurance companies a to cooperate with with medical service companies to push larger and larger bills to consumers.
https://www.cms.gov/medicare/payment/prospective-payment-sys...
Agreed about the absurdity of the Tylenol though.
I sympathize with strict regulation but the market sells the exact same “medical device” at much lower cost and my point stands - there is no option to pay market price for a breast pump instead of the insurance hiked price, regardless of whether it is a 3rd party pocketing the margin or if the margin is the cost of additional regulation.
No offense, but you also had the option to just buy a breast pump for $50. That option would have the cost of the goods just between the entity selling the pump and you. No one else need be involved, no one else needs to share in paying for your transaction.
But…you got to save $50.
Game theory wise, I’m forced to pay money to then be given the “choice” between spending 50$ or spending 0$ for the exact same outcome. Even if I was a values driven person and chose the 50$ option out of principles, the system is designed so that everyone would choose the 0$ option.
So it is a choice, in the sense that I could choose to give you the 50$ instead. But there is no logical reason to take that option.
The deeper philosophical question here is not insurance paid vs socialized medicine…it’s why are we making a $50 breast pump a medical benefit at all?
Even under a socialized healthcare system if we are going to wrap a bureaucracy around an inexpensive anything …costs will inflate.
This does not change the point that the insurance company, physician, and medical device company are all complicit in a scam that jacks up the cost of healthcare for everyone.
You should probably describe how that works exactly…cause I don’t see collusion here.
- Insurance companies negotiate almost all of their costs upfront…they don’t want to pay more. It’s not in their best interest, there job is to not spend more than $.01 more than they have to on anything they do So if they are actually paying $300 for a $50 item, it’s because it’s probably costs an additional $250.01 for them to somehow fulfill that $50 item to you through another provider.
- The doctor generally (beyond occasional pharma dinners) has no kickback for prescribing any device or drug from the sale of that product.
- The pharma company or device manufacturer certainly wants to maximize their revenue, but will they try and soak the folks prescribing and paying? Probably not for long.
Which Interventions Can Be Paid For: The Explanatory Power of “Prasad’s Law” (hcrenewal.blogspot.com) - https://news.ycombinator.com/item?id=21728864
I had lots of experiences with people who weren’t helped by the money that was spent on their behalf.
Eat less (alot less), Eat healty (alot healthier), Move more (Pick weight up, put it down.. then go walk for a while)
PBS is the problem - everyone should know healthcare is first and foremost their problem. Most healthy lifestyle people dont need healthcare.
When they do, we (the US) have an amazing system and amazing access to therapies to help them deal with the issues as they arise.
AI will help people from diagnosis to outcomes in amazing ways.... ask Claude what to do if youve just been diagnosed with MS. It profound how it will help a patient navigate the next steps.
But markets are not a-priori useful to the broader society just by being markets! A necessary (but not sufficient) condition for a market to be useful is that it substantially avoids lasting and structural market failures.
Market failures are almost as common and ubiquitous as markets! They vary in duration and consequence.
The ultimate market failure is to have costs which include a profit margin but little or no competition to get the benefits of a market.
Healthcare like other mandatory purchases (you can buy an ambulance ride and six figures of hospital while unconscious!) is especially prone to market failure.
The United States especially (though late neoliberal “capitalism” to some degree generally) and HN/SV/EA especially now go so far as to actively endorse induced market failure as the goal.
Fuck that. Fuck everyone who is on board with it.
This is your goblin brainchild @pg: renounce it.
Other countries allow you to go straight from high school to medical school, plus other countries have free schooling.
One approach could be to expand the availability of accelerated Baccalaureate-MD programs. Those cut education time by up to two years but are currently available at only a few schools.
https://students-residents.aamc.org/medical-school-admission...
But, honestly, good for them. I wish other white collar ICs understood the power of banding together to lobby for your professions interests.
I’m very skeptical that there are many doctors that support removing the supply cap. Of course, many doctors understand that the supply cap increases their salaries and thus the cost of care. But that’s different from actively supporting policies that will lower their salaries.
Well you should find out before arguing from your absolute.
And the AMA isn't the only organization representing physicians. Many of them aren't even members. It's not like a union or something.
Even today there is no legal quota limit on residencies. There's only a cap on slots funded by the federal government through Medicaid. Other organizations are free to fund as many slots as they want. If you have the means you could go to your local non-profit teaching hospital and donate money to expand their program.
Original claim: doctor salaries are part of the problem.
Substantiation: Doctors in the U.S. earn way more than doctors elsewhere. It logically follows that higher salaries lead to higher healthcare costs. For reference, the average doctor in the U.S. earns over $360K. In Germany, that number is around 85K euros.
Then you claimed that some doctors think this is a problem.
I responded by saying that the AMA lobbied to artificially restrict the supply of doctors. This is a well known fact. It’s literally in the introduction (with sources) on their Wikipedia page: https://en.m.wikipedia.org/wiki/American_Medical_Association
> the AMA has frequently lobbied to restrict the supply of physicians, contributing to a doctor shortage in the United States.[10][11][12][13] The organization has also lobbied against allowing physician assistants and other health care providers to perform basic forms of health care. The organization has historically lobbied against various forms of government-run health insurance.[8]
So all that is left unsubstantiated is your claim that “a bunch of doctors do recognize the issue.” Ok, which ones? How widespread is this belief? Why is the AMA acting against these beliefs?
He had 12 years of training before he could so his first surgery. Once he invited me to observe a couple of operations that he did, which was super interesting. He told me afterwards that smart people with steady hands could probably be trained in 3 months to do the routine surgical work.
Generally speaking the supply and demand curves taught in Econ 101 don't apply to healthcare.
He would have been saved in the US. If health insurers ration care in the US, they are just replacing the role of bureaucrats in socialized medicine countries. You can’t solve the problem of too much demand and too little supply without a free market. Yet everyone keeps trying (and pretending) in the medical care field
Have you been to an "emergency" room in the US? The ones I'm familiar with have those same kind of waiting times. Our healthcare system basically has both the worst aspects of "government" (extremely bureaucratized, top-down command, and no market dynamics) plus the worst aspects of "private" (profit skimming and no democratic accountability).
Personally I think we need to start with reform focused on the provider side - like why the fuck can providers just send you a bevy of bills with fraudulent charges, making it your responsibility to sort out? In any other industry, that would be considered plain fraud. But this doesn't mean I'm going to shout down other people's ideas of where they think reform should start by bringing up failures from other systems as some imagined contrast where our system is at all effective.