https://www.statnews.com/2024/07/25/united-health-group-medi...
> It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system.
They purchase physician groups... and then pay themselves higher rates.
https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...
> UnitedHealth Group is paying many of its own physician practices significantly more than it pays other doctor groups in the same markets for similar services, undermining competition and driving up costs for consumers and businesses, a STAT investigation reveals.
The UK does a good job of hiding economic concerns from its users, at a cost in availability of services, especially high-end and experimental interventions. The UK makes these rationing decisions knowing that some people are going to be denied life-saving care, but in exchange for that everybody else in the system will get predictable access to their care.
The American system does a good job of getting services delivered to customers; it does a better job of that than the NHS does, if you measure in interventions performed; it does such a better job at that that it's a real problem in our system: we overprescribe and overdeliver interventions that drive costs and decrease certainty as payers work out which things to cover and which not. The flip side of that is that everyone in that system can tell themselves that the system is doing what it can to gate delivery on whether care is truly needed and will be effective, and that it's not categorically denying care because of top-down mandates.
Neither set of values is totally benign. You can prefer one or the other.
I can go all 12 rounds on this topic, but if I keep writing about this I'm not going to write the work thing I'm supposed to write, so I'll leave it there.
The American system does a good job of getting services delivered to customers;
Therein lies one of the reasons the U.S. system is immoral. There are lots of people who can’t afford to be customers.
It is immoral to profit from denying someone healthcare.
I mean, yeah. They're doing all the work.
In part, because dealing with insurers is immensely costly in staff and time.
(Other parts include the immense cost of twelve years of secondary education here; a million bucks in student loans isn't uncommon.)
> a lot of that work is wasteful and unnecessary (see: spinal fusion surgeries, back imaging)
Which makes the "insurers are there to reduce waste!" argument especially tough to stomach.
https://www.washingtonpost.com/business/2023/08/04/doctor-pa... / https://archive.is/ZBRMx
> Polyakova and her collaborators find doctor pay consumes only 8.6 percent of overall health spending. It grew a bit faster than inflation over the time period studied, but much slower than overall health-care costs.
> “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”
Does anyone think American healthcare was thereby fixed? I don't!
Now, FWIW, I'm happy to accept that US doctors are overpaid, and that there are feasible ways to make progress on that front. It's an important conversation to have. But it has virtually nothing to do with what makes US healthcare so brutal and kafkaesque.
Last time we did this song and dance you doubled down on incorrect assumptions about how Medicare functions. So, no, it's not likely I'll come to the same conclusions as you.
Medicare's rates are about a half to a third of what private insurers have managed to negotiate. Funny how that works.
Doctors are not the problem with American health care, for-profit insurance is.
Lol, nice defence