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Comment by rayiner | Hacker News Reader

> This is definitely a case where the insurance company holds the majority of the blame.

What facts are the basis of your conclusion? There is no health system in the developed world where a doctor's recommendation will guarantee expensive inpatient treatment without a layer of bureaucratic review.

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You are right--Doctors absolutely share blame. Take my dentist's behavior, for example. When the oral hygienist is done doing all the real work, my dentist sits down for 10 minutes to count my teeth and say the words "You should floss more." She bills $85 for that sentence and calls it "Oral hygiene instructions". My insurance company (IMO rightly) denies paying for this. It's ridiculous and the dentist knows they're going to call bullshit on it, but they bill it anyway, and then I'm technically on the hook to pay for it. So far, the dentist has not yet attempted to balance bill that charge, and I will drop them like a bad habit if they ever do.

Doctors and dentists in the US are not bound by the same regulations (or even a similar stringency of regulation) involving billing practices and procedure codes.

I'd imagine you'd struggle to find a healthcare system in which a doctor's prescribed care is assuredly covered by insurance, by the insurance provider, and then later rescinded after care has already started.

The ACA made rescission of health insurance more difficult for insurers, but it absolutely happens. There are people at insurers tasked with looking for fraudulent omissions in policy applications for high loss ratio individual policyholders to target for rescission.

This one is pre-ACA but the insurer focused on an "omission" to justify the rescission: https://www.cnn.com/2009/POLITICS/06/16/health.care.hearing/...

This is strange - I work in insurance, and you really aren’t allowed to do that after the policy is signed. Or at least it’s very tightly controlled and limited to straight up fraud.

There are many health systems in the developed world, though, where the system doesn't make this the patient's problem. It shouldn't be possible to have a scenario where the provider believes eight weeks of treatment will be covered, the patient moves to an inpatient facility based on this understanding, and then the bureaucratic review layer decides six days layer that the provider was wrong.

The goal should be to provide every human being with the best care possible. If a system can't handle that, then we need to assess why and make changes.

Show me a country where that's the goal. Every other developed country has a goal that's something like: "provide the best outcomes for the population as a whole, at a cost the public is willing to pay."

We should make it the goal as a species. We have the resources and technology. We decide to be limited by economics.

No, economics is just how we describe resource limits and tradeoffs in a methodical way.

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