Everyone blames the insurance company. But my pharmacy billed insurance 272 for a generic on the $4 Walmart list and it got paid in full. My doctor’s PA billed $440 for a 20 minute telemedicine call and it got paid in full. My insurance has never denied a medication or procedure ordered by my doctor. I think it’s not simply insurance companies that are the issue. For some reason people just feel more comfortable blaming them than admitting the doctors and other staff are massively overbilling.
Maybe we should try to fix that. They must be trying to hide other costs in those ridiculous bills to be. That’s not fair to me.
The Affordable Care Act requires that "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued if this is violated." So insurers bought hospital networks, inflated the bills, and took their profit from the other side of the equation. Before you forgive your insurance company and blame your pharmacy and doctor, check first that they aren't owned by the same corporation.
I would also add that those of us on HM are probably more likely to have good insurance versus what most Americans have access to.
Insurance carriers like low risk and thrive on people not fighting adverse decisions either because of a lack of time and resources or knowledge.
The variables matter. My insurance carrier has also never denied a claim, but I’m in more or less good health for my age, have an HSA (at a bank owned by the insurance company) with a significant annual contribution from the issuing employer, and I don’t have anything going on (at the time I write this) that would end up in medical review. And if I did have to deal with that, theres financial cushion available to me to rely on while I fight it out with insurance.
Do you have any examples? I am quite confident I have never been in this situation, I have never heard of anyone except Kaiser patients (who are FWIW very happy with their service) getting this.
I think the term used to describe the imposed cost regulation is 'Medical Loss Ratio (MLR)', and the providers that own both ends of the claims transactions can use inflated costs to artificially manipulate their MLR.
The gunman etched ‘Delay, Deny, Defend’ in those bullets.
UHG denies.
KP delays.
Both can lead to disastrous consequences.
Edit: And by delay, I don’t mean delay in seeing a specialist, I mean delay getting the most modern and up-to-date care. They have a tendency to practice population based treatment (and fiscally responsible), which may not be what is the most up to date. I understand it as an hospital administrator, but I can see the consequences as a physician.
My extended family has been Kaiser for decades and it has plenty of faults (Bay Area region). I’ve personally had multiple severe misdiagnosis by tired over worked doctors. I’ve had massive ER bills with trivial operations. I’ve gotten damagingly inaccurate mental health care, and at times long delays to see various specialists.
The partnership of Kaiser and Reagan are largely responsible for the healthcare system America has today.
Exactly this. Me and the wife were talking about this a few moments ago and concluded that the entire health system in the US is fucked. I've seen people post itemized bills from their outpatient procedure or brief hospital stay and, to a European, it's mind boggling. People in the US are getting gouged on everything healthcare related.
Wife's position is that the free market works fine for non essentials but when it comes to essentials that you don't have a choice but to pay (water, medicine, housing, food) the market can be dangerous. Telling someone that their life saving cancer treatment comes to 500k isn't far from putting a gun to their head and saying "gimme 500k or you're dead". It's why I support ideas like the British NHS (it's not perfect but it's free), zero water charges for homes (paid through income tax, with surcharges for heavy usage like swimming pools).
Housing and food are free market because they are easy to get substitutes for in most of the western world (move to a different neighborhood, buy different food). Those two categories don’t really belong with water and healthcare.
The barrier to entry to provide tap water or provide healthcare is very high.
> food are free market because they are easy to get substitutes for in most of the western world (move to a different neighborhood, buy different food)
In the US, a very small number of corporations own nearly all the supermarkets.
You can move all you want, it is the same stores (possibly under different brand name, but same ownership).
Housing in Ireland isn't a free market. We have had a chronic shortage of housing for decades, but the influx of asylum seekers has put more pressure on it. Renters stand in lines half a mile long to view a grotty shoe-box that costs more than a mortgage. But yeah, maybe in other places it's different.
Yes, food is a free market right now, and in addition, it's subsidised (well, production is). Wait 20 years though, if climate change driven storms and floods destroy whole crops, that could change things dramatically.
You could say that insurance creates that environment, and profits from it. Insurance actually makes more money on the big bill, since they just charge whatever premiums are required to pay it plus their percentage. The bigger the better.
And insurance creates the disconnect that allows a price to have no feedback control.
They are happy to collect their income and benefit from the system they create, so they should not be granted any excuses for it's failures.
The poor insurance companies are not the abused parties here.
The insurance industry is the reason the drugs and all the other healthcare costs so much to begin with. They lobby and bribe hard to keep the US the only developed nation without nationalized healthcare and give you the illusion of free market choice while providing substandard care at inflated prices. It's regulatory capture at its worst. Their greed directly kills people every year.
That's why nobody shed a tear for that guy. His company was among the worst.
Insurance companies are a major of not the primary cause of those prices:
- they require deep discounts to put you in network, so providers increase their prices such that they end up whole after the mandatory discounts, that is why you can very often get your bills slashed to a fraction of the original if you pay crash
- obtrusive insurances means offices waste hours working on insurance instead of medical duties and many need to hire dedicated clerks
> Maybe we should try to fix that. They must be trying to hide other costs in those ridiculous bills to be. That’s not fair to me.
The thing is, your doctor is likely not making that much in the end. Because he needs to keep a staff of "offensive coders" who make sure that the insurance company actually pays for the correct procedures, and a couple of helpers to deal with all the paperwork.
Then they also need to deal with patients with poor insurance who can't pay. Trying to get payments from these patients is soul-crushing, and doctors typically just don't bother.
That's an interesting question. Here are some answers:
> Medicare physician payment has decreased by 26% since 2001. Additionally, a recent Harvey L. Neiman Health Policy Institute study found that physician reimbursement per Medicare patient decreased 2.3% between 2005 and 2021 when accounting for inflation. And this was despite a 45.5% increase in physician services to each patient. Again, less pay and more work.
It's even worse in the non-Medicare world. There's a reason hospitals are getting rapidly bought out by the private equity.
And to give some context, UnitedHealthcare has a payday service. For doctors. To help them borrow against future claim reimbursements. At the 35% rate.
The primary discussion being had is about a single company using AI to make life or death decisions, and getting it wrong repeatedly without consequences.
I assume you work for a pr cleanup team and are attempting to railroad the discussion.
How can there be competition when no one will tell you their prices?
Pick any major city in the US and tell me how an ordinary consumer can compare prices for a simple procedure like a chest xray. It’s not possible. Now how does one shop around for a cancer doctor or an ER visit?
Medicine is not a classical marketplace. Homo economicus doesn’t play his part.
The choice is possible here. There are many doctors. Each doctor CAN display there prices. They don't want to. Why? Because there's not enough competition for them to need to.
We also don't honor medical degrees obtained from non-US institutions. I know several folks who were doctors in India or elsewhere, who have blue collar jobs in the US because their schooling is not recognized here.
If your point is that artificially limiting supply of trained medical personnel leads to reduced access, inflated prices, and worse outcomes overall, then I'd agree.
It's a factor. I just think it would be easier to make sure there are residencies for US graduates whose training is more aligned with US Healthcare than to import foreign doctors who also require training for transition.
I'm not sure which would be easier, or if that's even a useful measure. Both seem like points of leverage to [in/de]crease supply. I think we should do everything we can do educate, enable, and employ citizens to the highest degree of which they are capable or desire. I feel similarly about putting the talent of new immigrants to work as well, and I don't see inherent conflict there. Growing the pie can mean larger shares for all.
Not all land is equally habitable, and there's also important things like the environment. Farmland dirt wouldn't be blowing away if there was interspersed forests to slow the wind down. I'm tired of the infinite growth cultists who are willing to sacrifice every 2nd order effect so line can go up.
You sound like one of those Malthusian cultists. :P
Fortunately for us all, Thomas Robert Malthus was wrong in 1798 or none of us would be here today. That he would continue to be wrong today should be no surprise. Relevant criticism of his rather gloomy take on population growth abounds: https://en.wikipedia.org/wiki/Malthusianism#Criticism
It seems to me like he didn't factor in the effects of the development and widespread application of new technologies to old problems.
As an individual I'm interested in maximizing quality of life, not maximum number of lives.
And no, I am not wromg. Houston has no zoning and was able to keep growth going and build lots of new houses. Of course they did so in a flood plain. Because growth cultists are willing to sacrifice everything, even lives for growth to continue just a little longer no matter the cost.
Everywhere or just in some places? There are more slaves today than in malthuses time.
People usually cite the green revolution as the refutation of malthus. I see it as an engineering tradeoff. Every 2nd order effect was sacrificed for a single KPI. An economist would call them unpriced negative externalities.
He absolutely wrote about land use and the planning thereof.
> There are more slaves today than in malthuses time.
By total number of individuals, maybe (though ChatGPT seems to think otherwise). By percentage of world population, not even close.
> I see it as an engineering tradeoff.
I see some of that. I see both negative feedback loops and virtuous cycles of positive feedback. Constructive and destructive interference. I also see an incredible explosion of education, information availability, flexible automated manufacturing, advanced material sciences, driving of food calories toward $0, lifting of disease which robbed humanity of unfathomable time and energy, and on and on. I see world solar panel production supplying world electric demand sometime in the 2030s. I see us getting better at regenerative agriculture. Mars has as much land area as Earth, and I think we can go farther if we put our minds to it.
There literally aren't limits. Except the ones we place on ourselves.
>There literally aren't limits. Except the ones we place on ourselves.
This is the most delusional take I've ever seen. Limitations are built into the universe as entropy. No limits is only a locality mirage that exists only because you don't live long enough to see the limit get hit.
That being said air is free because it's a mirage, the sun powers plants and animals to continuously recycle it but once that source runs out then we hit a limit. As a local phenomena we can treat air as if it's free even though it's not.
But air is like one of the few things that are like this. The next thing, water, people pay for water. And people pay for water because there is a limit on it. On top of that the fact that we pay for everything else means that even as a local phenomena there are limits. If you think humanity has been on a continuous quest of breaking barriers and jumping over limitations, that's false. All humanity has been doing is optimization. Best utilizing what we already have to delay the impending termination of when humans hit the final limit.
> That being said air is free because it's a mirage, the sun powers plants and animals to continuously recycle it but once that source runs out then we hit a limit.
> And people pay for water because there is a limit on it.
Both exist in massive quantity in the asteroid belt. Europa has larger oceans than Earth. Your personal financial limitations aside, I was talking about what the human race can accomplish as a whole when we set our minds to it.
> All humanity has been doing is optimization. Best utilizing what we already have to delay the impending termination of when humans hit the final limit.
Final limit? Never heard of it. Is that a band name? The https://en.wikipedia.org/wiki/Kardashev_scale considers a type III civilization capturing and using all of the energy emitted by an entire galaxy. And folks have proposed larger more capable civilizations yet.
Sometimes free market doesn't lead to competition.
UK national railway is sort of free market. The state runs the network, sells the tickets and decides the routes, but provides are chosen in open tenders - lowest price wins. They get paid for operating the route for the state-owned network.
But it then usually turns out that the only operator who can bid on the new tender for the route is the existing one. After all, they have a ready supply of trains meeting the technical spec! And if, say, the drivers go on strike demanding yet another pay rise, the providers shrug their arms and ask the state for a top up. After all, the state doesn't have an alternative either.
Free markets lead to maximizing corporate profits, but it's not a given that these correlate to a positive outcome for the society.
I don't think you've got that right. There is an extra level:
Network Rail - the gov owned infrastructure, rails etc.
Rolling Stock - privately owned trains
Operators - lease rolling stock, employ staff, sell tickets
The problem we have is that the operators are barely profitable so always cutting quality/service because there is this other layer of private rolling stock company acting as landlords which are sucking all the profit out.
We have a similar problem with energy. There are the customer facing providers which are basically a brand and a call centre which are selling the power from energy generation companies. When they get trapped in some bad contract as a gamble on the energy market, they go bust.
It feels like a deliberate con that the customer facing providers, the brands the public knows about, keep going bust and earn public ire from their crap services but they are really scapegoats for a less visible layer of private company which are doing the real profiteering as landlords.
>“The people in our industry are mission-driven professionals working to make coverage and care as affordable as possible and to help people navigate the complex medical system,” Michael Tuffin, the president and CEO of powerful health insurance lobby AHIP, wrote on LinkedIn on Thursday. “We condemn any suggestion that threats against our colleagues — or anyone else in our country — are ever acceptable.”
I looked at this guy's LinkedIn and he was the "SVP, External Affairs" for the UnitedHealth Group from 2015 until 2023.
Maybe this shocking and extreme and sad murder of the CEO will get a discussion going on the state of healthcare in the US? But if anything productive comes from this it’ll make murder for your cause viable and that’s a road to chaos.
We’re not going to have meaningful conversation about the state of healthcare in the US because that in and of itself would be an admission of guilt in the insurance industry. At best, we should expect thoughts and prayers all around.
Thoughts and prayers are not a covered medical procedure. Additionally, your future burial pre-authorization is denied as it’s not medically necessary.
Here's a tangent from outside the US, where health insurance is "great". Overall, it's true that it's not insane as in the US, but scratch below the surface and all insurances have a bottom line. A friend of mine was diagnosed with cancer, it looked especially bad, but she's through chemo and it looks promising now. Recently the health insurance told her since it's actually hopeless they want to stop paying her medical leave money, they want to make her "retired" because she's not coming back to work anyway so the pension system should take over. She was a freelancer most of her life, so didn't pay that much into it, and will drop from 1500 to 700 euros of monthly income. There are things you can do, appeal, apply for state aid etc but try to do that when you are recovering from cancer, chemo, have three kids, and your health insurance is telling you to give up it's hopeless.
Now make the insurance a for-profit business trying to maximize shareholder value and you get what you get.
Expect extra security and physical spacing in enclaves, luxury hotels, etc.
I doubt this is going to be copied soon. But the temperature of discontent is being raised, and fhe extraction of rent by our oligarchs along with the cost pollution forced into all of American life will jar loose a few more events over time. [https://www.thebignewsletter.com/p/an-assassin-showed-just-h...] which was posted elsewhere on HN today highlights human nature as why the Sherman Anti-Trust Act is a good idea.
Taking out a tank requires a team of trained operators with multiple attack drones, reconnaissance drones (possibly deployed by a separate team), usually a minefield, and constant innovation to overcome electronic warfare and new types of improvised armor. All of this would be difficult to accomplish in a civilian context, especially under adversarial conditions.
Even if you think that this can somehow be circumvented with improvements in drone technology, think about who has an easier time using it - the state or would-be assassins.
No fly zones, RF jammers, Police forces themselves are equipped with counter offense drones. I am sure there are even more counter measures not known to the public or disclosed.
After 9/11 all major wealth epicentres really started taking security a lot more seriously beyond just plain robbery.
Comparing them to out dated and corrupt armed force is selling them short.
But let's say that it isn't. Just for the sake of argument.
Will it still hold against $100 drones? $50 drones? $10 drones?
History is replete with examples of lessons of the eternal struggle between offense and defense. While we have come of age in a time where defense has conquered offense there is no guarantee that this will remain the status quo.
If we are entering a period where offense exceeds the capabilities of defense how will the wealthy respond? In the age of technology destroying the status quo is there any reason to believe that this will extend to the status quo of the wealthy having an advantagous defensive posture?
What does the future where anyone can fuck someone elses shit up without regard to their social status look like?
Assassinations have been a thing for thousands of years and a lot more people were a lot more angry for long stretches of history. Trump alone faced two attempts this year (one almost got him, and killed a bystander). Shinzo Abe was gunned down by a rando two years ago. WWI was started by one, same goes for many other wars. Not sure why you think this is anything new.
The killing seems to have been cathartic for many, and the killer inscribed words onto his ammunition that directly referenced health insurance industry tactics used to prevent claim payouts.
It's hard to feel any sympathy for these CEOs and companies. They've had it coming for a long time, and I bet people see the killer as a vigilante hero bringing justice to those normally immune to it.
Rich people want to be seen, they want to show their wealth, their status and their power. What is the point of having money and power when you need to hide among the plebs? It is like breathing for them. You can willingly stop breathing for a while but eventually you need to inhale. And they are going to start brandishing their wealth and their status again.
What do you think causes more deaths, CEO assassins, or healthcare CEOs? If you depend on insurance for healthcare, the reality is the power of a healthcare CEO.
Indeed. Some people even express sympathy for him!
I asked my ex (an endocrinologist), and he told me that if the shooter stands trial before the jury made of doctors, the deliberations will be done in 5 minutes. And the shooter will go free.
That's how much doctors hate the insurance CEOs. I also highly recommend this clip (also from an actual doctor): https://www.youtube.com/watch?v=vWA2aQYXDbo - and it's not actually a joke. The policy lampooned in this video was real, BCBS walked it back after the assasination.
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Maybe we should try to fix that. They must be trying to hide other costs in those ridiculous bills to be. That’s not fair to me.