This isn't a response to anything I just said. I really don't understand why people collapse into all this handwaving when people point out the obvious: the money in our system is going to providers, and, in particular, it's going to practitioners.
(And the independent practicioners are having to use a significant portion of the money they take in to… fight the insurers!)
The idea that the problem with our system is health insurers is just slopulism. We have grave problems with our system! But they start with the providers, where the majority of all the funding in our system goes, not to the scapegoats they've stoop up in our insurers. The distinction is vitally important, because the most popular answer to this problem is to extend Medicare to everybody, and Medicare is just as victimized by this as everything else is!
We pay doctors too much, and we artificially restrict the supply of practitioners. Those doctors routinely overprescribe. Every other problem in the system is marginal.
And by inflating that amount...
> Using newly available federal price transparency data, the researchers found that UnitedHealthcare pays Optum physician practices about 17% more than non-Optum practices in the same region. In markets where UnitedHealthcare holds a large share of the insurance business, that difference was even larger, up to 61%.
their capped-by-law 20% cut of premiums goes up, too. "Oh, those mean old providers we own charge so much! We have to raise premiums again!"
Fun thing about the NHE: you can project it as far back as you want. The data is there.
What? Insurers have been playing this game far further back than 2023.
If an insurer doubles the time a doc has to fight over denials and has to hire extra billing staff to assist, where do you imagine that cost shows up?
Again: how will the “insurers force provider costs up” show up in said tables?
It’s caused by the insurer. It shows as a provider’s cost. But it doesn’t mean said doc is making any more money at the end of the day.
The insurer does, though! Their 20% cut got bigger, and the "computer says no" denials are cheap!
TL;DR: Where in your link does "doc spends needless hours on phone fighting insurer" show up as a cost?
But it's not a "Cost of Health Insurance" item. It's an expense at the practicioner level! They have to factor that non-billable time into what they charge for the procedure!
Read their definitions: https://www.cms.gov/files/document/quick-definitions-nationa...
"Administration" is the insurer's side of it.
If an insurer manages to double a doctor's administrative costs for billing/appeals/etc., where does it show up in your tables, per your link's PDF of definitions?
> Insurers are almost literally a rounding error.
Again, the argument is that the raw cost of health insurance does not reflect its externalities imposed on the other items in your list; that insurers drive up hospital and practice costs, as they have to staff up enormous amounts of staff and expensive physician time to deal with the insurer.
Some of which is those practicioners' admin cost from dealing with the insurers. (And, you know, doing the actual work.)
Denials are nice and cheap. Fighting them is not.
And as noted in that other conversation, this is one aspect of many. UHC isn’t pursuing vertical integration for funsies.
Again, I want to be clear: I'm not here to defend the American health system. It's a disaster. It's just clear to me you don't have a bead on why that is. (The answer is artificial scarcity of practitioners, overprescription, and lack of price transparency).
So is “insurance doesn’t have any externalities that might hide in my very broadly categorized numbers”.