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Comment by ceejayoz | Hacker News Reader

"The money is still going into the pockets of practitioners."

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!"

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Show me the more recent NHE table where this effect shows up and I'll be ready to have the conversation, but right now this seems like a dodge. Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023. I don't remember thinking that the health system in 2022 was good.

Fun thing about the NHE: you can project it as far back as you want. The data is there.

> Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023.

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?

I feel like we've been in this argument before, and I like you just fine as a commenter, but do feel like you're tying yourself into knots to avoid a simple conclusion plainly supported by the data. I didn't post a trend story about what companies are doing or who they're acquiring; I posted the macro NHE table from last year. It simply refutes the argument you're trying to make.

> I posted the macro NHE table from last year.

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?

It literally breaks practice and net cost of insurance out!

> It literally breaks practice and net cost of insurance out!

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.

This is special pleading.

Oh, now who's dodging?

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?

You have no evidence for this argument. It's just vibes. The numbers here are stark. It's not like it's close, between providers and insurers. Insurers are almost literally a rounding error.

You asserted "the macro NHE table from last year… simply refutes the argument you're trying to make", but that claim is false. You are welcome to answer the question about where "doc spends two hours on phone arguing with UHC" falls in the expenditure list; it's not insurance, but it's caused by it.

> 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.

$360B in admin/net cost of insurance. $2.5T in practitioner costs.

> $2.5T in practitioner costs.

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.

You stated this claim upthread, for the record, and tracked down an actual Canada vs. US statistic on this, which turned out to account for roughly 3.6% of total provider inpatient/outpatient expense.

In 2011, when my premiums were $1600 a month. I dropped my plan when it hit $4900/month to go on my employer’s crappier plan.

And as noted in that other conversation, this is one aspect of many. UHC isn’t pursuing vertical integration for funsies.

That's not an argument; it's just vibes. Whenever we get actual numbers to look at, your arguments fall apart.

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).

> That's not an argument; it's just vibes.

So is “insurance doesn’t have any externalities that might hide in my very broadly categorized numbers”.

Non-falsifiable argument is non-falsifiable. I could literally present you evidence that 2.2T of our medical expenditure is due to a price-fixing ring in syringes, and you'd still be able to use the same argument.

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