[HN Gopher] How much health insurers pay for almost everything i...
___________________________________________________________________
How much health insurers pay for almost everything is about to go
public
Author : nojito
Score : 449 points
Date : 2022-07-01 16:58 UTC (6 hours ago)
(HTM) web link (khn.org)
(TXT) w3m dump (khn.org)
| rdxm wrote:
| AceJohnny2 wrote:
| Anecdote: I recently had my yearly glasses update. Cost was $188
| to me + $20 of insurance copay, so the glasses provider charged
| $208 for the glasses.
|
| That's not _too_ bad, so I asked how much it would be to replace
| /update the lenses on my old frames, entirely at my charge.
|
| It would've been $450. Just for the lenses.
|
| I passed. I find it scandalous how much they can charge when
| _just before_ they were perfectly happy to accept less than half
| that amount.
|
| Instead I got another pair on EyeBuyDirect for $80.
|
| It's not just the insurers themselves, but the whole system. Burn
| it all down.
| zdragnar wrote:
| They likely had lenses already available for the frames they
| had in stock, or were frequently making batches of them.
|
| OTOH the frames you already owned may be out of style, so they
| would have needed to grind a totally custom pair of lenses,
| just for you.
| [deleted]
| lostcolony wrote:
| Nah. Outside of the vision cartel you can get replacement
| lenses for any pair of frames < $100, with all the various
| coatings and special shit for low hundreds. Likewise, using
| insurance to just replace the lenses, if a plan includes
| that, is often $50 or less. It's just shopping at the vision
| cartel without insurance = huge sticker price.
| sib wrote:
| Any tips for how to stay "outside the vision cartel"? (In
| the US, if that is relevant...)
| atrus wrote:
| zenni optical. I mostly use contacts, but I have several
| 'backup' glasses. You can get decent looks frame for like
| $11 shipped.
| pastor_williams wrote:
| This doesn't work as an explanation, lenses are always cut to
| the frame.
|
| My brother in law owned a lens cutting shop and they have
| boxes filled with lenses ground to all sorts of prescriptions
| that are circular plugs 3 or 4 inches in diameter. When the
| order comes in they use the pupil measurements and the frames
| to cut the lenses for the prescription down to fit into the
| frame.
|
| I don't know how well I explained that but you can watch this
| video to see exactly how it works:
| https://www.youtube.com/watch?v=uCjGNUPO0WU
| sib wrote:
| Thanks for this explanation - makes complete sense but
| never thought about it!
| jasonwatkinspdx wrote:
| I've been buying glasses from the cheap Chinese websites for
| ages now. There's some utility to being able to take your time
| in a show room, but the online venders are so cheap it only
| took one or two tries for me to find frames I like reliably.
| And they're $60 instead of $600 even with some premium
| coatings/features.
| karaterobot wrote:
| > It's not just the insurers themselves, but the whole system.
| Burn it all down.
|
| Painstakingly, methodically, improve it, taking care at each
| step that you're making it better. :)
| uoaei wrote:
| This is exactly how to corner yourself into a local optimum
| that balances how much people are pissed off, rather than how
| much people see benefits.
| quarantaseih wrote:
| The chaos of "nothing" is very destructive. That
| realization is at core of why Im a conservative.
| karaterobot wrote:
| I'm not sure I agree. If it did happen, that's another
| problem to be fixed.
|
| I do know that the way to design complicated, successful
| systems is to start with simple, successful systems and
| build on them: starting to design a complicated system from
| scratch seems like a recipe for much bigger problems, and
| that's what you'd have to do after "burning it all down".
| That's even assuming that "build something new" was the
| second step implied after "burn it all down", though you'll
| note that was not stated in the original comment.
|
| I think we can agree that "burn it all down, and that's it"
| is the worst possible solution.
| nazka wrote:
| Do you think this can have med to long term effect on revenues
| earnings and so stocks?
| alanfriedman wrote:
| For anyone looking to download the data, here are a few links:
|
| Empire Blue (Anthem): https://www.empireblue.com/machine-
| readable-file/search/
|
| United Healthcare: https://transparency-in-coverage.uhc.com/
|
| Aetna (Seems like the right page, but I don't see any download
| links -- possibly because they haven't been posted yet):
| https://health1.aetna.com/app/public/#/one/insurerCode=AETNA...
|
| Search keywords:
| https://www.google.com/search?q=machine+readable+files+trans...
| nope96 wrote:
| Blue Cross https://www.bcbsil.com/member/policy-forms/machine-
| readable-...
|
| So are there programs I can use to parse this? It looks like a
| json file with links to more gziped json files...
| smm11 wrote:
| Very soon we'll have Congressional hearings after oil companies
| see profits climb 7000 percent over last year, and they'll look
| sad and do nothing.
|
| I expect much the same from health insurance companies.
| pkaye wrote:
| I'd be curious how their profits compare to pre covid profits
| given then many oil companies were losing a lot during covid
| due to sharp drop in demand.
| boston_clone wrote:
| Thankfully, that data is public. [0]
|
| And it's still damning. Billions of dollars of profit were
| made, every single quarter. I have absolutely no sympathy for
| these companies, especially when they also likely received
| huge sums of cash from the federal government for this "sharp
| drop in demand".
|
| >Over 10 percent of the more than 7,000 oil, gas, and
| petrochemical companies that received PPP funds totaling
| between $3 billion and $6 billion reported no jobs retained
| as a result of the loan. The CEOs of Exxon and Chevron got
| raises in 2020, while Exxon announced that it is suspending
| the company's contribution to the US employee retirement
| savings plan beginning in October and Chevron is cutting
| 6,700 workers around the globe [1]
|
| 0. https://www.macrotrends.net/stocks/charts/XOM/exxon/gross-
| pr...
|
| 1. https://www.sierraclub.org/sierra/bailout-billions-
| dollars-f...
| benreesman wrote:
| This would be great news in a world where healthcare company
| revenue (which never quite trickles all the way down to retail
| shareholders) wasn't just a one-way wratchet.
|
| More opaque: costs more. More transparent: costs more.
|
| Want a better deal? Choose better parents pleb.
| chevman wrote:
| Wait till you find out how much it actually costs
| doctors/providers to render some of these services!
|
| Do you like 90% margins? Doctors sure do! :)
| throwaway12245 wrote:
| So do lawyers.
| pishpash wrote:
| Lawyers don't have the ability to kill you.
| willcipriano wrote:
| A prosecutor could have you killed.
| [deleted]
| nojito wrote:
| Net margins != gross margins
| programmertote wrote:
| Spouse of a third year resident here. My wife has volunteered
| at several primary care (i.e. generic doctor) clinics in
| Manhattan and nearby area (Queens, Astoria, Brooklyn and even
| in Boundbrook, NJ). These are all owned by the doctors. She
| worked in all kinds of operations of a clinic from billing,
| sending prescription, taking patient history, etc.
|
| Back-of-the-napkin calculation based on my wife's experience --
| if you are a primary care (generic) doctor in a highly
| populated area and you see ~40 patients a day and each patient
| pays $100/visit.
|
| $100 * 40 patients * 22 days per month of work * 12 months =
| $1056000 (about $1 million USD)
|
| We are using $100/patient/visit and that's being very
| conservative. Most of these doctors would encourage the
| staff/volunteers who do the billing to put as many relevant
| billing codes as possible in the system (e.g., if someone comes
| in with a cough, they'll try to bill for anything related to
| cough symptom although they already knew it's just for seasonal
| allergy). This is necessary also because a lot (not all) of the
| patients are on medicare/aid and the reimbursement from
| medicare/aid is not as good as the ones from the private
| insurance companies. The cost of the labor is mostly just one
| assistant or at most two for ~$20-$30/hour max. Not sure about
| the insurance cost (but we assume that it would cost
| ~$20-$30K/year for malpractice insurance?) and renting the
| clinic (some docs do own the clinic). All in all, we believe
| that having your own practice can net you a lot more than what
| you'd make by working as an attending/hospitalist at a hospital
| (on average, hospitalists make between $250K-$300K/year, which
| is still commendable).
|
| But if you live in a rural area, which tend to have smaller
| population density, then you are probably better off working
| for a hospital because as a hospitalist, you can make close or
| a little more than $300K/year as a general doctor. My wife
| knows a couple of doctors in Palmdale, CA, who work as
| hospitalists in two hospitals (6 days a week alternating
| between two hospitals; the days start at around 9am and ends
| around 3-4pm). They rake in ~$600K/year from salaries (not
| including bonuses). A friend of mine just completed his
| residency and got an offer from a hospital near Dyersburg
| (Tennessee) for $300K/year salary with $40K sign-on bonus. The
| specialists earn more of course:
| https://www.whitecoatinvestor.com/how-much-do-doctors-make/. A
| cardiologist friend of mine told me that he got an offer from a
| hospital in Montana that pays $800K+/year.
|
| Just wanted to share what I know about how much the doctors can
| make in the United States.
| kstrauser wrote:
| There's no way a single assistant could handle 40 patients
| per day. At that volume, you'd have at least 2 assistants.
|
| Malpractice insurance can be _way_ the hell more expensive
| than that: https://www.nerdwallet.com/article/small-
| business/how-much-i...
|
| Rent will probably be another $60K per year.
|
| The receptionist will want to be paid, as will the biller. If
| you're lucky, one of them will have time to be the designated
| person to call and argue with the insurance companies every
| time they deny a payment because it was a waning gibbous moon
| that day, but realistically, if you have providers seeing 40
| patients per day, that's another full time person.
|
| The EMR system will be quite a few thousand dollars up front,
| plus another several thousand per year.
|
| You'll have to provide health insurance for all of your
| employees, and worker's comp, and an office liability policy.
|
| And finally, _great_ insurance (from the billing physicians
| POV) will pay about 40% of the allowed amount. Really crappy
| insurance, like Medicaid, is basically a write-off. BTW,
| Medicare has decent reimbursement. Not great, but several
| _times_ more than Medicaid will pay.
|
| In my experience as being the one who's written the checks
| for medical practices in a couple of different states over
| the last 2 decades, you are grossly overestimating revenue
| and underestimating expenses.
| cddotdotslash wrote:
| > Most of these doctors would encourage the staff/volunteers
| who do the billing to put as many relevant billing codes as
| possible in the system
|
| Is there any way to fight back against this? I've personally
| experienced getting a bill after a routine office visit with
| tons of charges I didn't recognize and procedures they
| absolutely did not perform. In some cases, it equates to $0
| after my insurance pays, but in others it results in quite a
| bit of extra expenses (especially since I'm on a HDHP).
| kstrauser wrote:
| As the spouse of a doctor, this made me giggle. If her practice
| had 90% margins, my life would be a lot different than it is.
| Her _actual_ net margin, as in what she brings home after
| paying all the bills, is closer to 15%.
| InefficientRed wrote:
| A private practice owned by the MDs reporting relatively low
| net margins is meaningless without knowing what the MDs are
| taking out as income.
| kstrauser wrote:
| Her practice, as are most, is an S Corp. In other words,
| the net income _is_ her take-home income.
|
| Put another way, the rent, employee pay, supplies,
| malpractice insurance, etc. etc. etc. add up to about 85%
| of her gross revenue. That 15% difference is how much she
| personally makes.
| rr888 wrote:
| Doctors and Surgeons in America are incredibly highly paid.
| People love hating insurance and drug companies but the cost of
| people is driving much of the price.
| ageitgey wrote:
| I'm one of the co-founders of Turquoise Health, mentioned in the
| article here. We've been downloading and parsing this data all
| day. It's a really big deal in the industry that the prices that
| insurance companies pay doctors are now being shared publicly. It
| will have all sorts of positive impacts over time, hopefully
| making rate negotiations more consistent and fair between
| different insurance plans. Right now, 10x differences in prices
| paid for the same healthcare service from the same doctor between
| insurance plans is not uncommon.
| jerry1979 wrote:
| How do you account for case-based charges?
| antisthenes wrote:
| Are you guys hiring?
| baby wrote:
| Another proof that more transparency decreases corruption and
| improves efficiency?
| BurningFrog wrote:
| Once it's been shown to work it may be proof.
|
| The track record of healthcare reforms intended to cut costs
| is rather abysmal.
| epgui wrote:
| Does it really need to be proved?
|
| I'd argue that it's a mathematical/logical truth in
| principle, and that the only thing that requires proof is
| whether this particular implementation is successful at
| what it aims to do.
| tomrod wrote:
| Very cool work!
|
| The article mentions that yall are working on hospital data. Is
| insurer data beginning to roll in?
| codegeek wrote:
| I appreciate what you all are doing. We need people to try and
| really fix our Healthcare Industry. However, I do have a
| question. Are you trying to get rid of Insurance mafia at all
| for at least some things like basic preventive care etc because
| I am sure that drives costs up a lot if Insurance companies are
| always between a doctor and a patient. I really hope something
| can be done where I can just go to a doctor/hospital, ask how
| much and pay for it out of pocket instead of crazy premiums and
| all the other BS we have to go through everytime.
| sinab wrote:
| Where are health providers hosting these data? Could you give
| an example? Thank you.
| WFHRenaissance wrote:
| What do you serve to gain from scraping all of this
| information?
| dugmartin wrote:
| I was guessing it was this bit at the bottom of their landing
| page:
|
| > Are you a transparent provider or payer? > There is a
| market for transparency. Let patients find you by claiming >
| your provider page and listing your services. It only takes
| 10 minutes.
|
| But following through that link says it is a free program.
| ageitgey wrote:
| We build products that help healthcare providers and
| insurance companies broker contracts between themselves
| based on actual market information instead of guessing at
| prices. The goal is to drive down prices by making the
| market more efficient.
|
| Part of that is assuming that prices will be public, so we
| encourage them to claim their own page and take control of
| the rates listed there.
| jjoonathan wrote:
| The information on their landing page was immediately
| relevant to me
|
| https://turquoise.health/
|
| I hope they have a good business plan and manage to stick
| around!
| ageitgey wrote:
| Thanks! So far, so good. We don't sell anything to
| consumers. Our products are aimed at the healthcare
| industry which lets us post information for consumers for
| free and we have pretty good product-market fit.
|
| Obligatory "if anyone is interested in joining a fast
| growing, series A company doing impactful work, hit up our
| careers page!"
| atlasunshrugged wrote:
| Interesting, I'm curious since you're in the industry,
| why do you think medical tourism has never taken off in a
| big way in the U.S.? I feel like I saw more people
| willing to go to Poland or Ukraine for things like dental
| work when I lived in Europe than people in the U.S.
| willing to go to Mexico or some other destination.
| Red_Leaves_Flyy wrote:
| Not the person you asked.
|
| I want my medical providers to be local to me so they're
| liable to my local community. I also want to keep my
| organs and have insurance cover the costs.
| ageitgey wrote:
| The US is really, really large and many people living
| there have never left it. There's also a belief that US
| healthcare is the gold standard (which is probably true
| at the very high end, but not necessarily on average).
|
| In other words, it's a hard sell to convince a factory
| worker to travel 5-10 hours on a plane to a place they
| have no familiarity with to get what they believe to be
| inferior treatment. They might not even have a passport.
|
| This is much less of an issue in Europe where countries
| are tiny and almost everyone travels between them on a
| regular basis.
|
| Also, medical tourism is mostly limited to what the
| industry calls Shoppable Services - outpatient treatments
| that are not emergent/not life threatening. There is a
| bit of a cottage industry in Mexico for some services,
| like bariatric surgery for obesity or dental work, but it
| isn't a huge volume. The really expensive stuff in the US
| is emergency treatment which you can't shop for anyway.
|
| All that said, I think the interest in buying
| prescriptions from overseas has never been higher.
| rootusrootus wrote:
| Anecdotally, most of the people in my circle of friends
| and family are perfectly satisfied with what we get
| locally. If you have adequate insurance and no major
| medical issues, you don't save much by flying down to
| Mexico. I do have some extended family that have gone to
| Mexico for treatment, however, mostly of the dental
| variety. But it was major reconstruction, so it was worth
| the effort.
|
| I do remember reading a story a couple years back where
| an insurance company paid for their customer to fly to
| Mexico, flew down a US orthopedic surgeon, and paid him
| pretty well for his services. The cost of the flights,
| surgeon, and medical facility in Mexico were
| significantly less than it would cost them in the US, so
| everybody won except the US hospital. As I recall, the
| hospital in Mexico was collocated with a resort, so it
| was a nice place to recuperate as well.
|
| Not sure how common that really is, though, stories like
| that make the news for a reason.
|
| Edit: Pretty sure this is the story I was thinking about:
| https://www.advisory.com/daily-briefing/2019/08/13/cancun
| wildrhythms wrote:
| How does the healthcare industry use this data typically?
| ageitgey wrote:
| Our industry-focused products are based on knowing how much
| every service costs at every healthcare provider. It's the
| underpinning of our products.
|
| We also post a lot of the rates publicly in a consumer-
| friendly searchable format, but we don't charge any money for
| that. But this data will let us greatly expand the scope of
| that free service.
| treeman79 wrote:
| A few times I've seen a 10x price decrease when I asked to pay
| cash before.
|
| Sometimes the co-pay alone is more then cash for procedure.
|
| Weekly injections and MRIs is the worst offenders I've seen.
| elromulous wrote:
| Could this backfire - similarly to how publicly traded
| companies' CEOs disclosing their pay caused their pay to
| skyrocket?
| huitzitziltzin wrote:
| This is a good question and the answer is absolutely yes.
|
| It could raise prices. Consumers have _some_ incentive to
| care how much they are spending on health care, but they aren
| 't generally the claimant on savings they realize for their
| insurance plans. (Obviously the incentives for uninsured or
| self-insured patients (to the extent that there's anyone in
| the latter category) are quite different, but those
| populations are small.)
|
| On the other hand, every hospital has a strong, strong
| incentive to care _a lot_ about how much their competitors
| are getting for the same procedures. (Much more than
| consumers, for example.)
|
| It's possible that these disclosures lead to prices falling
| as hospitals seek to undercut each other. However, most US
| hospital markets feature a small number of competing hospital
| systems in an oligopoly. The price-cutting pressures in such
| markets are much, much weaker. There is a "mutually assured
| destruction" aspect to price competition in such markets
| which may keep prices from falling.
|
| The latter incentive can raise prices too. IF you know your
| competitors across town are getting an extra $5,000 for a
| knee replacement and you know that the two of you are the
| only game in town for hospitals, you may raise your prices
| rather than lowering them.
|
| On balance I think this is the right policy, in part because
| I want this data myself as a researcher. But it is not
| unambiguous that this will lead to price reductions.
|
| Source: am a health economist.
| marricks wrote:
| Can you support that claim? I couldn't find when CEO pay went
| public but it sounds very likely like one of those causes
| were correlation definitely doesn't imply causation.
| elromulous wrote:
| This[1] Wikipedia article talks about it some, and links to
| this[2] paper.
|
| [1]https://en.m.wikipedia.org/wiki/Executive_compensation_i
| n_th...
|
| [2]https://www.degruyter.com/document/doi/10.2202/1535-167X
| .120...
|
| Edit: adding an additional paper on the topic https://www.p
| rinceton.edu/~amas/papers/CEODisclosureMandate....
| bawolff wrote:
| It makes sense to me. Transparency benefits the party that
| is more free to go elsewhere. Lots of companies, fewer good
| ceos, means that the ceos can leverage this better than the
| company can.
|
| To put another way - at work, if you knew how much every
| employee made at work, it would probably be helpful in
| salary negotiations. Dont see why it would be different for
| ceos
| zeruch wrote:
| All CEO pay for public companies is exposed in the 10Ks.
|
| What I suspect the person was referring to is the change
| where compensation became more tied to equity valuation.
| lesuorac wrote:
| CEO pay wasn't always public and the compensation is only
| mostly equity because it has a tax advantage [1].
|
| [1]: https://americansfortaxfairness.org/tax-fairness-
| briefing-bo...
| akira2501 wrote:
| That's an odd way to look at it, as a "backfire."
|
| We're introducing more information into the market. If some
| prices went up as a result, isn't that an indication that the
| lack of pricing information was being used to artificially
| depress prices?
|
| If so.. this isn't a "backfire" so much as an "obvious and
| necessary correction?"
| burnished wrote:
| Medical care is not the kind of good that you can just say
| 'oh the market will correct it', because most of the
| assumptions you make about 'the market' don't apply to
| essential services.
| dwaltrip wrote:
| Based off some of the other comments, here is the idea I'm
| picking up on:
|
| If a particular market isn't that competitive and has
| oligopolistic aspects, more transparency may increase the
| "effectiveness" of the oligopoly. Instead of hospitals that
| were charging more lowering prices to compete, we could see
| hospitals that were charging less raises prices because
| they know the competitive pressures are weak and they don't
| want to leave money on the table.
|
| Seems plausible to me, depending on how oligopolistic most
| hospital markets are.
| snarf21 wrote:
| We really need to move to reference based pricing. We can cut
| so much waste out of the current system including brokers.
| Reference based pricing also get rids of the loopholes for
| things like anesthesiologists being "out of network" at a
| hospital/facility that is "in network". It also gets rid of the
| situation where if you offer cash you get one price but if you
| submit for the same code, it could be 3x or 10x or even more.
| whatshisface wrote:
| What's reference-based pricing?
| antisthenes wrote:
| It's basically price-controls.
|
| A regulatory body looks at how much something "should" cost
| based on its history of reimbursement and the cost of its
| inputs and then sets a cap of say, cost + 20%.
|
| The problem is having an independent body that is free of
| influence of health insurance companies and hospitals, both
| of which have perverse incentives to continue profiteering.
| db48x wrote:
| Not to mention the fact that it will eventually cause a
| supply shortage.
| snarf21 wrote:
| The sibling is right but in this case we'd probably do
| something like Medicare + 20%, which is actually close to
| what most insurers do for _some_ of the codes already. It
| just removes the cost of negotiation, brokers, out of
| network, etc. and actually lets you know the cost up front
| for most appointments. We also need to get rid of service
| levels for most appointments. It is just used as an excuse
| to up charge by having patients fill out pointless
| paperwork. We also need to reimagine our service provider
| models. We have already move to CMAs to take blood
| pressure, etc. We also need to move to PA or LPN instead of
| a Dr for most cases. Ear infections, colds, flus, etc. are
| a majority of family appointments and can be handled by
| lower levels. The Dr can then review cases and deal with
| the more complicated cases where her expertise is most
| needed.
| arcticbull wrote:
| Or we can have one network every doctor is in, and the state
| pays for everything. All doctors are independent contractors
| to the state. Everything is paid for. There's one price for
| everything. Everyone is covered. All this garbage just
| disappears.
|
| Then there's one nice fee schedule like this, with all the
| prices on it, but it doesn't even matter, unless you're a
| physician doing your billing. [1]
|
| [edit] As you can see from the PDF, a dermatology consult
| (A025) is $72CAD.
|
| [1] https://www.health.gov.on.ca/en/pro/programs/ohip/sob/phy
| sse...
| FollowingTheDao wrote:
| Sorry, but the only thing that will help is Medicare for all.
| We need to get rid of insurance companies completely.
| nullfield wrote:
| Where is the - if it exists - list of locations where different
| entities have published their machine-readable files?
| logicalmonster wrote:
| Question to somebody who might know as this seems like a relevant
| thread to ask in.
|
| If a person wants to pay directly in cash/credit-card for
| services rendered by a doctor, do doctors' agreements with
| insurance companies generally prevent them from offering a cash
| discount to cash-paying patiences lower than the insurance
| company negotiated price?
| pishpash wrote:
| Sometimes they aren't allowed to offer a cash option at all, if
| you've told them you have insurance.
| jjeaff wrote:
| I have come across quite a few doctors that will not treat
| you at all if you don't have insurance.
| yardie wrote:
| Yes, not only do they offer it but some insurers will give you
| credit card gift cards to help pay for treatment. That is how
| dysfunctional our medical system is at this moment. Providers
| will lock insurers at one rate, negotiate a different rate for
| self-insured that could be lower/higher. And insurers get wind
| of this and try to sneak pay the self rate.
| coredog64 wrote:
| If a doctor accepts Medicare patients, that sets a price floor
| for cash. Legally, if you accept Medicare money, you cannot
| offer anyone a better price than you charge Medicare.
| dimal wrote:
| I'm not a fan of Trump, but I have to admit, the executive order
| [0] that forced this disclosure looks fantastic, really
| fantastic. But if I'm reading it right, it seems like it's just
| an order to _enforce_ requirements ObamaCare that were intended
| to increase transparency.[1] Obama and Trump actually
| accomplished something _together_!
|
| [0]
| https://www.federalregister.gov/documents/2017/10/17/2017-22...
|
| [1]
| https://www.federalregister.gov/documents/2020/11/12/2020-24...
| yieldcrv wrote:
| most of your friends/everyone are independents and they're just
| lying to you so they didn't get blocked yet, most of the
| population can see the chronology plainly without the partisan
| disclaimers
| dontcare007 wrote:
| Thanks again President Trump!
| kstrauser wrote:
| I'll admit, this is one thing, perhaps literally the only
| thing, he did that I think is excellent for individual
| Americans.
| nicodjimenez wrote:
| Yep. That, and space force, and cheap energy, and
| renegotiating trade agreements, and not starting any new
| wars.
| BurningFrog wrote:
| This is rapidly becoming a Monty Python sketch :)
| sodality2 wrote:
| "Cheap energy" is not the boon you think it is. You have to
| consider other factors - deregulating the food industry and
| getting rid of the FDA would save millions of taxpayer's
| money, would lower prices of the supply chain and let
| consumers pay significantly less for food, yet would have
| drastic side effects. Cheap energy that requires
| deregulation, more alarming and precarious climate effects,
| etc might not be a net positive.
|
| Likewise, "not starting any new wars" can be perceived as
| bowing to foreign nations by anyone who wants to frame it
| negatively, or vice versa as an amazing success for
| diplomacy.
| kstrauser wrote:
| Thank you for saying so. Flooding the market with cheap,
| low-quality crude would drop the price of gasoline, but
| it'd be horrid for the environment.
| nicodjimenez wrote:
| If you really think the war on fossil fuels in the West
| is in the citizen's best interests, you are delusional.
|
| In the West everything is a scam. Our health system is a
| scam, the military industrial complex is a scam, our
| education system is a scam, our currency is a scam, our
| media is a scam, the president is a scam. What makes you
| think that ANYTHING going on in the West ISN'T a scam?
| Izikiel43 wrote:
| >> West
|
| I think you meant USA
| nicodjimenez wrote:
| USA especially but also Western Europe.
| willcipriano wrote:
| Go to the gas station and tell the struggling families
| how good for the environment it is that they have to
| choose between essentials and going to work.
| kstrauser wrote:
| Yeah, that sucks. We've gotten ourselves into a bad
| situation where we're still dependent on a horrible form
| of energy for common needs. That doesn't change the fact
| that every gallon of gas we burn screws up the entire
| planet just a little bit more.
| willcipriano wrote:
| If anyone made a mess it isn't the single mom trying to
| feed her kids, she shouldn't be the one who is punished.
|
| How about huge tax on international travel? On the order
| of say 500%, make it totally unaffordable. A trip to
| Europe produces far more carbon than a few years worth of
| trips to the grocery store and isn't at all necessary.
| kstrauser wrote:
| I mean, that seems like peak Big Government Overreach,
| but to each their own. Alternatively, people could quit
| buying wholly inappropriate vehicles. If your job
| requires you to carry lots of cargo around, then a pickup
| makes a lot of sense. If you drive a spotless Ram 2500
| that never leaves the suburb, then I don't want to hear a
| damn thing about the price of gasoline.
|
| And even if you personally don't drive an idiotically
| wasteful vehicle, a huge portion of Americans do, and
| their gas guzzlers drive up demand for the same fuel that
| you and I want to purchase, causing its price to
| skyrocket.
|
| We don't all need to be driving something like a Nissan
| Versa, but a _lot_ of people whose real requirements
| would be met perfectly by something like that are driving
| Yukons and whining about gas prices.
| willcipriano wrote:
| Those cars produce less carbon than your vacation halfway
| across the globe and aren't used purely for recreational
| purposes.
|
| It seems like carbon really isn't your issue here.
| kstrauser wrote:
| I haven't gone on a distant vacation in many years, so
| not I'm not sure why you're bringing that up. But yes, a
| suburban-dwelling, daily commuter Expedition is
| absolutely a recreational choice, and an irresponsible
| one at that.
| willcipriano wrote:
| > But yes, a suburban-dwelling, daily commuter Expedition
| is absolutely a recreational choice, and an irresponsible
| one at that.
|
| Just like air travel. If making one unaffordable is
| positive, why not the other?
| 0des wrote:
| > "not starting any new wars" can be perceived as bowing
| to foreign nations
|
| This is an interesting take on peace in the middle east.
| sodality2 wrote:
| Hey, I agree with you there, but my point is that any
| aspect of politics can (and will) be reframed by both
| sides to support their preconceived beliefs.
|
| I've edited my comment to speak in a more neutral
| political tone.
| nicodjimenez wrote:
| The "both sides" idea is an illusion, the two sides
| disagree on everything but on one very important point
| there is no disagreement...
| sodality2 wrote:
| I'm not sure what you're referring to. I said that in any
| political situation, people tend to posit the evidence to
| support their own beliefs. It sounds like you're
| referring to false balance [0]. But that's not what I'm
| doing at all - I'm not posing any political beliefs as
| equally valid, I'm stating that everyone will change the
| parameters of an argument in order to solidify their
| beliefs.
|
| [0]: https://en.wikipedia.org/wiki/False_balance
| nicodjimenez wrote:
| <laughing emoji />
| [deleted]
| 0des wrote:
| I appreciated the right to trying life saving treatment even
| if it isn't officially approved or completed trials yet.
| karmanyaahm wrote:
| IPv6 mandate too
| InefficientRed wrote:
| That has nothing on Al Gore, who invented the internet! And
| in much the same way as any other president doing something
| popular and uncontroversial: it would've happened almost no
| matter who was at the top.
|
| (Point is, most legislation and XOs are largely bipartisan.
| Policy is driven much more by the machinations of hundreds
| of thousands of faceless/nameless actors than by the guy at
| the top. In both good ways and bad. The same is true in
| companies. The genius of leaders is mostly in their
| salesmanship.)
| tacocataco wrote:
| > The genius of leaders is mostly in their salesmanship.
|
| The topic of a couple Adam Curtis's documentaries IIRC.
|
| Obama's first presidential campaign won marketing awards:
| https://www.theguardian.com/media/2009/jun/29/barack-
| obama-c...
| imwillofficial wrote:
| I hope this becomes the norm all over
| PaulDavisThe1st wrote:
| Can anyone provide any hints on the search keywords to find this
| data at a given insurer's website?
| Olreich wrote:
| > "What we're learning from the hospital data is that insurers
| are really bad at negotiating"
|
| Do the insurers have any incentive to negotiate well? Since their
| customers are not very price-sensitive (since they aren't
| marketing directly to patients or doctors), I would imagine they
| don't have a huge incentive to do anything but apply a markup to
| whatever prices the hospital tells them it costs.
| lotsofpulp wrote:
| If insurers' customers were not price sensitive, then they
| would have higher profit margins than 5%.
| throwaway12245 wrote:
| Aren't all customers "price sensitive" ?
| lotsofpulp wrote:
| Mostly true, I should have clarified "customers who have a
| choice to buy an alternative".
| jjoonathan wrote:
| The accusation here isn't that they are skimming a
| disproportionate amount, it's that they aren't doing their
| job, which is to put downwards pressure on provider prices.
| lotsofpulp wrote:
| The fact that there are at least 5 large insurers competing
| nationwide and all have 5% or less profit margins means
| there is lots of competition, and if they are not providing
| the best prices, their customers will go elsewhere.
|
| See pharmacy forums as an example for all the pharmacists
| complaining about how independent pharmacies are so tough
| to operate due to ever smaller payments from insurance
| companies for the past 10 years.
| uoaei wrote:
| I would like to understand better your definition of
| "competing" because accidental cartels happen all the
| time in highly regulated and captured markets such as
| healthcare.
| lotsofpulp wrote:
| Nobody chooses to earns a 5% profit margin if they can
| earn 6%. Low single digits is objectively a low profit
| margin, for any business, and so must indicate that
| competitors exist Who prevent charging higher prices to
| increase the profit margins.
| jjoonathan wrote:
| > if they are not providing the best prices, their
| customers will go elsewhere
|
| Nope. Not if they can inject enough noise into the
| comparison process to hide the differences. There's a
| reason they threw so much money at getting
| bronze/silver/gold standards killed. They knew it was
| critical to avoid being squeezed.
|
| > pharmacists complaining
|
| Pharmacists are a tiny part of the bloat picture and it's
| always easier to put the screws to smaller players. Come
| back when drugs and hospital stays stop costing twice as
| much as the rest of the developed world, or stop growing
| 10% y/y (on top of regular inflation) and then I'll
| believe that insurance companies are doing their
| negotiating job.
| lotsofpulp wrote:
| > There's a reason they threw so much money at getting
| bronze/silver/gold standards killed.
|
| I am not aware of these standards being killed. I select
| a Gold HSA plan every year.
|
| https://www.healthcare.gov/choose-a-plan/plans-
| categories/
|
| > Come back when drugs and hospital stays stop costing
| twice as much as the rest of the developed world, and
| then I'll believe that insurance companies are doing
| their negotiating job.
|
| > Come back when drugs and hospital stays stop costing
| twice as much as the rest of the developed world, and
| then I'll believe that insurance companies are doing
| their negotiating job.
|
| How are they supposed to negotiate if there is only 1
| hospital in an area or a drug company owns the patent to
| a drug so they are the only seller? The insurance company
| is mandated to cover emergency care at the hospital and
| pay whatever price for the medicine if it has sufficient
| efficacy data, per the laws.
|
| When there are generic drugs available, insurance does
| pay less for those drugs.
| jjoonathan wrote:
| I could be wrong or I could be remembering that they were
| _effectively_ killed by inserting a key loophole. I 'll
| have to dig up my notes and probably do some research to
| figure that out.
|
| My point about performance -- 2x, 10%y/y -- stands.
| lotsofpulp wrote:
| There is no point to comparing US expenses to other
| countries where drug manufacturers and hospitals and
| doctors are not allowed to negotiate, and have to accept
| what the government gives them.
|
| What would you do if you were the insurer and there was
| one hospital in an area or 1 patented medicine and the
| government forced you to cover it?
| jjoonathan wrote:
| No point?
|
| The point is that we should be doing what they are doing.
| When you're in a hole, stop digging.
|
| > WWYD
|
| I would get rid of private insurers and have the NHS
| negotiate prices.
| lotsofpulp wrote:
| This discussion is about insurers negotiating pricing,
| not about politicians enacting taxpayer funded
| healthcare.
| jjoonathan wrote:
| Nice try.
|
| It's a discussion about private insurers systematically
| sucking at their notional purpose. Which they absolutely
| do. They need to be replaced.
|
| "They're doing as well as could be expected" might be an
| exoneration of a company, but it's an indictment of the
| system.
| vkou wrote:
| No, it means that Obamacare is working as written[1].
| Insurer profit margins are set to the legally permitted
| ((medical bills) * 15%) - operating costs.
|
| If insurers want to make more money, they can either make
| medical bills more expensive, or reduce their own
| operating costs. Reducing the cost of medical bills does
| _not_ increase the amount of money they make, unless it
| means they are capturing market share from a competitor.
|
| The problem is that it's nearly-impossible to capture
| market share. Which insurer do I have? The one that work
| provides. Did I have any choice in it? No. Did I choose
| my workplace based on the insurer bundled with it? No.
| Will my workplace ever switch their insurer provider of
| choice? Almost certainly 'no'.
|
| How do you capture market share, when all of your
| customers, and all of your competitors' customers are
| captives?
|
| [1] Whether or not it was written well is another
| question.
| mypalmike wrote:
| I agree with many of your points. But in terms of
| employers switching plans, I've experienced such changes
| several times as an employee of different companies. It's
| not particularly inconvenient to a business to switch
| insurers, though it certainly can be to the employees.
| lotsofpulp wrote:
| It does if it results in them being able to sell policies
| at lower premiums than their competitors and hence earn
| more customers.
|
| > Will my workplace ever switch their insurer provider of
| choice? Almost certainly 'no'.
|
| Why not? I am an employer and we evaluate the cost of
| health insurance every year. It is a huge expense, so why
| would we not shop around?
| vkou wrote:
| > It is a huge expense, so why would we not shop around?
|
| Because switching to a different provider can be a huge
| pain in the ass to your employees, whose multi-year
| treatments/doctors/etc may suddenly become out of
| network?
|
| And it's probably not worth doing unless the cost delta
| is truly staggering?
| lotsofpulp wrote:
| That goes for switching any almost vendor. But it does
| give insurers an incentive to not runaway with pricing.
| xboxnolifes wrote:
| In the US, isn't there regulations that effectively cap their
| profit margins? Since they have no incentive to increase
| their margin through negotiation, their only incentive would
| be to lower their costs below competition.
| pishpash wrote:
| Wouldn't their incentive be the opposite? To get more total
| dollars so there is more profit at the capped margin.
| lotsofpulp wrote:
| Medical Loss Ratio:
|
| https://www.healthcare.gov/glossary/medical-loss-ratio-mlr
|
| It says 80%/85% of premiums have to go back out as payments
| for claims.
|
| > Since they have no incentive to increase their margin
| through negotiation,
|
| I do not see why this would be true. The less an insurance
| company pays for healthcare, the lower the premiums or can
| offer and win more business.
| 31835843 wrote:
| This would be true if there were a reasonable amount of
| market understanding by customers and the friction to
| switching were low. Neither are the case. Most of the
| time, it takes a qualifying life event or open enrollment
| (once a year) to switch. And then, understanding the
| trade offs between plans, which are difficult to
| understand on a good day, is another barrier.
| lotsofpulp wrote:
| Then why are insurance company profit margins so low? Why
| wouldn't they just jack up premiums irrelevant to their
| competitors and ignore negotiating pricing and see
| increasing margins?
|
| Low profit margins/multiple sellers indicates a highly
| competitive field, which means the businesses must be
| doing something stay in business.
| jjoonathan wrote:
| Yeah, but "something" could be advertising, kickbacks,
| cherry picking, lemon dropping, making comparison
| difficult, selectively optimizing visible metrics while
| balancing with dirtbag fine print, etc etc.
|
| Competition != Productive Competition
| lotsofpulp wrote:
| Then the competition who does not do that crap would
| offer lower premiums and steal business. Just like any
| other business that wasted money cannot compete with a
| business that does not waste money.
| 31835843 wrote:
| And this is only true in a markets that are easy to
| enter. Starting an insurance company isn't easy.
|
| Why are profit margins only 5%? Could be many reasons,
| including collusion. Insurance companies have teams of
| lawyers whose job it is to navigate existing regulation,
| lobby for new ones and to push for ones that hurt
| competition.
|
| Given how shady and complex the entire industry is, we
| don't really have a reason to believe that 5% is an
| accurate number.
| owisd wrote:
| There's no universal %margin on turnover that applies across
| all sectors that tells you whether a market is efficient or
| not. If I supply you widgets for $1000/ea and take a $50
| management fee that we assume is fair for the work involved,
| then if there's a shortage of widget materials that pushes
| the price up to $10000/ea, it's no extra work for me so the
| fair management fee is still $50. If I charge $500 to keep
| the % the same I'm adding no extra value for that extra $450.
|
| Building contractors are an example of an industry that runs
| on razor thin profit margins in % turnover terms, because all
| they're doing is passing on the cost of labour and materials
| from their suppliers and subcontractors onto their clients
| and just making their profit adding value in a thin
| management layer. Which sounds a lot more analogous to
| insurers than industries that earn 5% profit on their
| turnover.
| MrFantastic wrote:
| Private Healthcare is the Classic Agency Problem.
| hedora wrote:
| All they really need to care about is the average amount paid.
|
| Ten $100 brain surgeries and $2,000,000 for 1000 routine
| neurological screenings is a fine outcome. (Or would be, if not
| for price transparency)
| gnopgnip wrote:
| Health insurance customers are price sensitive
| jjoonathan wrote:
| Well, if they can negotiate a particular incident down then
| they pay less for it, but in the long run big picture you're
| exactly right. So long as they can inject noise into the plan
| shopping channel and so long as they aren't doing worse than
| their competitors by that noise margin, they'll do fine. Which
| in practice means that they just pass along the costs.
| nonrandomstring wrote:
| "Doctors hate this simple trick to reduce <illness>."
|
| That's the strange spam message I could never understand.
|
| Surely doctors would be delighted at any method to improve
| health?
|
| So I always assumed the "trick" to be quackery with dangerous
| side effects. After all, why else would "doctors hate it"?
|
| Eventually I realised these messages are exclusively US American,
| the only place on the planet where doctors could plausibly resent
| people improving their health at the expense of their profits (or
| at least that's the implication that seems to rest on an
| entrenched cultural cynicism).
|
| Am I totally wrong?
| kube-system wrote:
| You're overcomplicating your analysis. The purpose of ads is to
| generate attention. The message is effective for Americans for
| the same way that it is effective for you. It leaves the reader
| with multiple questions, which is more effective than an
| alternative phrasing which may leave someone with one or zero
| questions. Those ads are not posted by medical professionals,
| they're posted by scam operations.
|
| Healthcare in the US uses specialized labor just like any other
| developed nation. US doctors are not concerned with financial
| operations, they're focused on clinical duties. For any typical
| hospital, the people who do anything with finance or billing
| are not even in the same building as doctors.
| vorpalhex wrote:
| You are totally wrong.
|
| Quackery exists all over the EU and other socialized systems.
| The idea that you can fix issues by drinking water or vinegar
| instead of going through Chemo or surgery has always been an
| easy sell to the gullible.
| nonrandomstring wrote:
| So you're saying my initial interpretation is the correct
| one? "Doctors hate this" because it's fake and leads people
| to false hope and ineffective outcomes? But I'm still
| confused. Other than as an arresting "attention grab" (as
| another commenter says) why would someone advertise a product
| by denigrating it, even semi-ironically?
| fritztastic wrote:
| It's not that doctors resent people improving their health,
| it's that people are wary of their healthcare services existing
| in a for-profit system- these types of scams play to the
| paranoia and fear that people associate with medical
| establishments selling treatments rather than establishing
| preventative health. Basically it boils down to the sentiment
| people generally have that doctors benefit from sick people
| because they make money from people being sick.
|
| Anecdotally, I remember growing up in Brazil and we were taught
| in school about human anatomy and all sorts of health issues
| and how nutrition, immunization, proper hygeine, etc. helped
| prevent being sick... as well as home remedies for simple
| illness. But here in the US people seem to seek some authority
| to provide solutions, and these scam pseudo-medical ads play to
| this and fill the gap where state medicine and folk knowledge
| would otherwise be.
| fritztastic wrote:
| Simply put, it's a trust issue.
|
| I think in many places people establish a relationship with
| their primary doctor, where the Dr knows them and their
| medical history in detail. Growing up, my family doctor had
| treated my family for generations and was familiar with me as
| a person even though I did not have many appointments.
|
| But since I've moved to America most of my Dr. appointments
| are focused on the issue I am having as opposed to treating
| me for an issue. The Dr skims through my medical history to
| see if the issue relates to anything relevant. The
| appointments are hurried and impersonal.
|
| There is a business aspect to medicine in America- it's
| business more than it is healthcare, really. I have often
| felt more like I am going in for maintenance like a machine
| than going in to speak to someone who uses their knowledge to
| help me be the healthiest I can be.
|
| I know a lot of people here who also go to doctors and have
| their issues dismissed, minimized, or attributed to stress-
| and leave without any sense of what to do, besides grab a
| prescription or see a specialist. There is a helplessness I
| perceive in many people, and some end up with many
| prescriptions for different things and later find out there
| is an underlying issue that was overlooked all along. There
| are many many stories of people whose problems may not have
| persisted so long if their medical providers had communicated
| better- which perhaps most of them have no incentive to do,
| because this is time consuming and therefore loses them
| time/money. Whereas in a system where private doctors have to
| conpete with state provided healthcare, my anecdotal belief,
| they have an incentive to do better.
|
| Anyway, having an impersonal system leaves people feeling
| like they need to look for solutions themselves, looking for
| hope at a cheaper price than a stack of copays and possibly
| having to deal with waiting long times for referrals. This is
| also true of anyone anywhere feeling desperate and looking
| for some control in regards to their health problems. So this
| opens the door to a market of people offering miracle cures.
| Just happens to be there is a lot of distrust baked into the
| reality that healthcare in America prioritizes profit over
| people.
| ryandrake wrote:
| Yea, it appeals to the same brain matter that conspiracy
| theorists appeal to: "The mainstream is wrong, and only we
| few lucky people know the real truth! <Authority figures> are
| lying to you with their awful _complexity_ and _nuance_ so
| they can take your money, and hate our truth because it is
| simple and doesn't let them take your money."
| rglover wrote:
| Not at all. The solution in America is often to medicate, not
| change your own behavior or diet. If you watch regular
| television here (with commercials), every other commercial is
| for some new pill you need to take. When you go to a doctor's
| office, it's not uncommon to see a "drug rep" roll in a
| suitcase with samples of new drugs they want doctors to push
| (which inevitably comes with financial incentives).
|
| Being a doctor is a business just like any other. And just like
| any other business, some operate ethically while others don't.
| jcranmer wrote:
| Those messages come from the "health supplement" industry,
| which is basically a segment of the health industry that the
| FDA is prohibited by law from regulating. And it entirely feeds
| on consumer cynicism towards the health industry, despite the
| fact that the major players in "health supplements" are guilty
| of everything the health industry is accused of being.
| nonrandomstring wrote:
| What you're saying is a revalation to me. I did not realise
| the US medical science was split along economic/regulatory
| lines. Surely this is doing everyone a disservice?
| CogitoCogito wrote:
| > That's the strange spam message I could never understand.
|
| Well the message is likely untrue so maybe it's best not to try
| to understand it.
| nonrandomstring wrote:
| > Well the message is likely untrue so maybe it's best not to
| try to understand it.
|
| I hear you saying - don't give credence to idiots.
|
| But at the same time that's a strange philosophy as I've
| found some of the most interesting truths come from
| understanding the lies people tell, and why.
| CoastalCoder wrote:
| I'm curious if this is a first step towards hospitals being
| required to charge the same prices to everyone, insured or
| otherwise.
| 31835843 wrote:
| This seems so sensible to me that I'm curious why the hell it
| wouldn't work.
| treis wrote:
| Which price and who determines it?
| manquer wrote:
| Hospital is free to determine their prices, but they cannot
| give steep discounts to one channel of sales over other.
| They have to be consistent.
|
| Healthcare pricing should be based on cost+plus models for
| the hospitals rather than on value driven approach you see
| every else in any sales.
|
| We are not questioning their costs whatever they maybe, if
| the costs logically remain roughly same no matter how a
| particular patient came to them, then there is no reason
| for price to be different depending on type/ nature of
| insurance or lack thereof.
| CoastalCoder wrote:
| I would think that hospitals could create price schedules
| similarly to how other businesses do.
|
| Although I imagine this gets really messy when dealing with
| Medicare and with the mandate to treat everyone regardless
| of their ability to pay. I'd expect those arrangements
| would need to change to make this work.
|
| I feel a bit silly pontificating about this. Hopefully
| someone who really understands the topic will weigh in.
| [deleted]
| stevebmark wrote:
| This happened for hospitals too, and not much has changed.
| Cryptic billing codes will make this data hard to understand.
| daenz wrote:
| This is regulation everybody should be able to get behind. How
| are these markets supposed to function efficiently with healthy
| competition if critical information like this is hidden away?
| uoaei wrote:
| Libertarians ret-conned Adam Smith's definition of "free
| market" to mean "complete absence of regulation". And they use
| this appeal to authority (as well as the naturalistic
| inevitabilism that originates in evo-psych) as a cudgel to push
| for the permission of exploitative practices. We are becoming
| more and more aware as a society of the effects of this
| campaign, which is heartening, but reactionaries stand at arms
| to defend their ideological convictions to the death.
|
| For the record, what Adam Smith actually meant by "free" was
| "everyone is free to participate -- barriers to participation
| are controlled for and mitigated to the best ability". This
| requires regulation to discourage and ideally eliminate
| monopolistic behavior.
| zip1234 wrote:
| Those libertarians who have famously been in charge of the
| United States since it's founding and got the US into the
| current health care cost mess?
| tomrod wrote:
| Nah, not to be political but the parent commenter probably
| means the retconning folks in the GOP who claim
| libertarianism as a political ideology but are often
| anything but.
|
| Left libertarianism is summed up as: live and let live.
| Very different.
| sytelus wrote:
| I don't think this will lhave much impact on health care cost.
| The cost is high because it is paid through employer and
| therefore it is hidden from you. If the law was to force
| employers disclose lost wages for employees due to health car,
| that would have bigger impact. The real impact will come if
| employers turn off the medical insurence coverage entirely and
| everyone has to cut the checks themselves.
| IfOnlyYouKnew wrote:
| Employer-provided healthcare is a solution for the problem
| that health insurance, unless it is mandatory, will tend to
| attract a self-selected group of expensive customers and, in
| turn, make health insurance (even more) unattractive for
| healthy people.
| pastor_bob wrote:
| The free market produces the most efficient outcome
| tzs wrote:
| It produces a maximally efficient outcome (by some
| definitions of efficient) if various requirements hold about
| the market, the goods in the market, and the market
| participants.
|
| Almost all real markets deviate from those requirements.
| Sometimes these deviations aren't enough to prevent the
| market from producing close to maximally efficient outcomes,
| and sometimes they are enough to make the market produce
| outcomes nowhere efficient.
|
| This is one of the reasons why an economics degree requires
| coursework beyond Economics 101. :-) Economics 101 is the
| equivalent of Physics 101 where we mostly ignore things like
| air resistance and friction or Electronics 101 where we
| ignore things like parasitic capacitance and parasitic
| inductance of component leads and keep frequencies low and
| time scales long enough that we don't have to worry about
| speed of light delays between different sides of our
| circuits.
|
| It's the courses after the 101 courses were you start to get
| messiness that is the real world of economics or physics or
| electronics.
|
| Anyway, when a real world free market deviates from the
| requirements to produce a maximally efficient output one of
| the ways to make it work better is to use regulation to try
| to make it behave as if the missing requirement held.
|
| A good example is when you have a good that costs the maker a
| significant amount to make but that anyone can easily copy
| perfectly at close to zero cost. A free market will tend to
| not be efficient for that good because makers have trouble
| making a profit (or even staying in business). Consumers pay
| near zero for their copies and so can consume as much as they
| want, which makes them happy, but there will be much less
| variety available than consumers want.
|
| A long time ago the approach to that was to just not have a
| market for that kind of good. Makers would find some rich
| patron who was willing to pay to have new goods made. Free
| copies might still be made for the masses, but the rich
| patrons gained social status among their peers by being
| patrons of famous makers so would keep patronizing makers.
|
| A regulatory fix is to make it so only the maker is allowed
| to make copies of their goods. You can then have a decent
| market in those goods. It's still not ideal because although
| it solves the problem of the market getting makers to make it
| does raise the price to consumers above the theoretical free
| market price which should be near zero.
|
| Another approach would be to have the government pay the
| makers, and then let anyone freely make copies. This is
| probably the way to get closest to maximal efficiency but it
| raises the problem of how to have the government decide with
| makers to support. One approach to that is to try to track
| which things consumers are actually using, and then pay the
| makers proportionally to that usage.
|
| Another issue with that approach is where should the money
| for the makers come from? It could come from general
| government revenues but then you have the problem of deciding
| how much should be used for this. Also you will have people
| who don't like these kind of goods and object to their tax
| dollars going to support them. Another approach is to tax use
| of these goods to fund the makers, or tax something that
| correlates well with use of the goods.
|
| Let's not overlook that an approach that requires tracking of
| consumer use might require surveillance that, in the hands of
| someone who wants to do something less benign than just
| figure out how to allocate maker pay, could be used for evil
| purposes. That might be too high a price to pay just to get
| the most efficient levels of production and consumption of
| this particular good.
|
| Real economics is complicated and messy.
| kibwen wrote:
| Sadly, no. Or it does, but only if one defines "efficiency"
| tautologically as "what a free market would do", which is
| sadly too common. There are many factors that contribute to
| inefficient markets, one of which is information asymmetry
| among the participants. Keeping markets efficient takes work,
| and, indeed, sometimes requires regulation.
| throw123123123 wrote:
| Because the obscurity of the prices is a result of regulation
| as well. We need less layers of control with "unintended"
| consequences.
| daenz wrote:
| Can you elaborate on the regulations that you are referring
| to?
| arwhatever wrote:
| Can't point to the source, but I think we all know that
| there is some sort of regulation requiring us to pay
| providers for services when those providers refuse to
| provide pricing information at before or during the time of
| service.
| IfOnlyYouKnew wrote:
| That sounds, among other things, like something entirely
| unrelated to the issue.
| AdmiralAsshat wrote:
| That would get in the way of unadulterated _profit_ , you see.
| ch4s3 wrote:
| Health insurers in the US have a cap on how much of premiums
| can go to profits.
| throwaway12245 wrote:
| It this a windfall profits tax?
| heavyset_go wrote:
| Premiums are not the only source of revenue insurers have.
| uoaei wrote:
| Would you like to provide a positive statement that
| coincides with this negative one?
| heavyset_go wrote:
| Copays, deductibles, revenue from providers, etc.
| coredog64 wrote:
| The copay goes to the healthcare provider, not the
| insurance company. That's why it's called copay: You are
| jointly paying the provider alongside the insurance
| company.
|
| A deductible is an amount of care that you're solely
| responsible for. None of that money goes to an insurance
| company.
| wccrawford wrote:
| Doesn't that just mean that they have an interest in
| keeping these costs _high_? The higher the costs, the
| larger that % is for the in absolute dollars.
|
| If all the costs come down, they are allowed to make less
| money.
| ch4s3 wrote:
| Yes, I agree that price controls set by the state are a
| bad idea.
| jjeaff wrote:
| In a vacuum, that would make sense, but most of these
| insurers still have to compete with at least one or two
| other big players.
|
| So while you could increase your costs so that you can
| increase your premiums thus getting 5% of a larger pie,
| that assumes that you can increase your premiums without
| losing customers to competitors.
|
| For the most part, on the ACA marketplace, all the plans
| are pretty similar, so price is really your main
| differentiator.
|
| Perhaps the obstacles of switching providers makes this
| competition less of an issue.
| nimish wrote:
| Bingo. This is why they loved the ACA. Only allowed one
| scoop of ice cream? Great I'll use an enormous scoop.
| lotsofpulp wrote:
| That enormous scoop results in 5% or less profit margins.
|
| Compare to tech companies' profit margins.
| CogitoCogito wrote:
| So? They're insurance companies. Why should they have
| high profit margins?
| lotsofpulp wrote:
| I never wrote they should. I am disputing the notion that
| they earn huge profits ("enormous scoop"). Which is
| trivially disproven by looking at their financials.
| corrral wrote:
| The "enormous scoop" refers to their incentive to drive
| prices higher so their "scoop" (the 5%) is bigger in
| absolute terms, I believe.
| CogitoCogito wrote:
| How is it disproven exactly? Are you saying 5% is not a
| lot because it's the number 5 or something?
| jcranmer wrote:
| S&P 500 average profit margin is typically around 10%.
| So, yes, 5% _is_ low profit margins.
| CogitoCogito wrote:
| I already said it elsewhere, but I think blindly
| comparing profit margins across totally different
| industries is kind of dumb. But continue to compare
| insurance companies to Apple if you'd like.
| lotsofpulp wrote:
| From experience operating businesses and reading
| financials of various companies, 5% profit margin is on
| the low end. Walmart and other retail play in the 2% to
| 5% range.
| CogitoCogito wrote:
| Why would you compare such different businesses profit
| margins?
|
| Anyway I just think saying a 5% profit margin is small
| because other businesses have larger profit margins is
| kind of naive. I mean if through competition insurance
| companies' profit margins dropped to 2%, then the current
| status quo of 5% would seem crazy.
|
| It's all just a matter of perspective. Saying 5% is low
| because other businesses have higher profit margins
| doesn't make much sense since the businesses are totally
| incomparable.
| magila wrote:
| Yes, this is one of the more unfortunate unintended
| consequences of the ACA.
| heavyset_go wrote:
| Insurance costs were increasing at a higher rate each
| year before the ACA was passed or went into effect.
| ch4s3 wrote:
| The rate of growth didn't go negative or to 0, it just
| slowed down.
| vanattab wrote:
| It may have been unintended but it was defiantly not
| unknown, I remember people pointing out this exact
| problem during the debate around ACA.
| tryptophan wrote:
| "unintended"
|
| Insurance companies wrote the bill.
| ch4s3 wrote:
| Parts of it, but it's not clear that MLR was one of those
| parts or even a net positive for insurers.
| mypalmike wrote:
| Are you implying that before ACA, insurers had an
| incentive to keep costs low?
| Spooky23 wrote:
| Yes. Although painted by reactionaries as a communist
| plot, ACA was modeled after Massachusetts' "Romneycare".
|
| It's typical old school GOP policy of leveraging private
| sector actors with public sector dollars. It's not awful
| policy, but did create bad cost incentives and encourages
| cartel like health networks.
| coredog64 wrote:
| It's called Romneycare because he got it implemented as a
| lightweight alternative to a pending proposal for more
| universal coverage.
|
| It's also similar in nature to the Swiss system. Not a
| lot of GOP voters in Swiss cantons.
| ch4s3 wrote:
| You don't need to be a reactionary to see that it was
| very poorly written and that the implementation was even
| worse.
| NaturalPhallacy wrote:
| IIRC, it's 15%, meaning that they can only have
| $675,000,000,000.00 in profits.
|
| That is $675,000,000,000.00 they can take from us and
| instead of using for healthcare or even healthcare
| administration, it's just additional money that they took.
| lotsofpulp wrote:
| > it's just additional money that they took.
|
| When did they take it?
|
| All the 10-Ks are showing me 5% or less profit margins.
| nicoburns wrote:
| They have low profit margins, but they massively overpay
| for the care, meaning that it's still incredibly
| inefficient.
| daenz wrote:
| It seems like the cap should be unnecessary in the near
| future if we have full price transparency.
| jjav wrote:
| That's a meaningless cap because you can decrease profits
| at will by increasing inefficiency and unnecessary costs
| inside the company.
| coredog64 wrote:
| It's called medical loss ratio (MLR), and insurers are
| required by law to spend 80-90% of premiums on medical
| care.
|
| They can get there by overpaying for care or by refunding
| money/charging less. But they can't get there with
| increased internal administration spending.
| lotsofpulp wrote:
| Also why wages and other transaction data (like it is for real
| estate in most states) should be public.
| ledauphin wrote:
| i don't follow this argument.
|
| thr salient point for me is that people should be able to see
| prices before they commit to contracting to pay them (e.g. by
| receiving healthcare).
|
| With wages, employees (and employers) get to see their price
| before committing. So the need for transparency seems like it
| would need a different justification.
| heavyset_go wrote:
| It's because information asymmetry allows for maximum profits.
| tomrod wrote:
| I view healthcare as a service, like utilities. There is a
| reason the PUC exists in so many (all?) US states.
| april_22 wrote:
| George Akerlof's work on information assymetry, especially
| his 'Market for Lemons' is super interesting and I can only
| recommend reading about it. He won the Nobel price 2001 for
| it.
|
| https://you.com/search?q=George+Akerlof+information+asymmetr.
| .. https://www.investopedia.com/terms/g/george-a-akerlof.asp
| epgui wrote:
| IMO, as a non-affected Canadian, this is one of the (very few)
| good outcomes of the Trump presidency.
| pkaye wrote:
| Next step is pharmacies. Find out which step in the chain is
| overpricing. The manufacturers, PBMs or local pharmacies, etc.
| uoaei wrote:
| I think we all already know it's all of them.
| quarantaseih wrote:
| Agreed, but admin is probably the greediest and while adding
| the least value.
| corrral wrote:
| I've been reading about healthcare systems off and on,
| sometimes fairly seriously, for over 15 years, and my
| conclusion about the entire US system is that "the problem"
| is "literally everyone involved".
|
| It's why various schemes that target one thing (say,
| excessively-expensive doctor liability insurance, which gets
| talked up as some super-big deal and a huge part of the
| problem in certain circles) are typically expected, on sober
| analysis, to have only a tiny effect on prices-- _everyone_
| is taking too much money, at every level, so at most steps
| the % increase over what 's reasonable isn't huge, but by the
| time you filter through a few layers of that with everyone
| piling atop the other layers, sure enough, it's a solid
| 30%-40% more expensive than it has any reason to be. But
| there's no one, or two, or even three things you can point at
| and say "if we fix this, we fix almost the entire problem".
| _Every part_ of it needs a shake-up. It 's like 20 different,
| though interrelated, problems, contributing to the bad result
| we see. Addressing most or all of the problem will take tens
| of measures, or else one big, sweeping, fundamental overhaul
| (M4A or what have you)
| fragmede wrote:
| Hopefully this approach will help the situation:
| https://costplusdrugs.com/
| imperio59 wrote:
| Not to get political, but pretty sure this is thanks to one of
| Trump's last executive orders while he was in office. Correct me
| if I'm wrong
| [deleted]
| macksd wrote:
| I've lost count of all the problems I've had with medical
| billing. I can't understand an argument against public pricing
| because it seems like a clear win if you believe in free market
| dynamics or progressive reformation of the health care system.
| But it seems to me the system is just rotten to the core anyway.
| It makes even my Libertarian self want single-payer healthcare,
| but I have no expectation the set of people currently working in
| the system would do anything but keep it rotten.
|
| In the most recent case I tried to get a written quote for
| procedures because of past problems. I was given the run-around
| until all I could get was a verbal quote over the phone. But if
| that wasn't good enough, my only recourse was to delay getting a
| suspicious lump examined. I was then charged more than I was
| quoted, and I was even billed for procedures they didn't do. I
| actually heard one of the employees say "I added that because I
| thought he was using insurance". Still - hours of phone calls
| over several weeks before they would even bill me correctly
| without adding tests that they had no results from. And even then
| - more expensive than they told me because the person I was
| transferred to over the phone was in a different state than the
| clinic I called in the first place.
|
| Absolutely rotten.
| bushbaba wrote:
| Don't forget all that time spent on the healthcare side. Easily
| 10%+ of the cost of operation.
| BryanBeshore wrote:
| Now tell me about the relationship between health insurers and
| hospitals, and how they engage in pricing.
| bushbaba wrote:
| This will be huge! I've found that self paying can be 1/nth the
| cost of paying through my insurance. But you need to request self
| pay up front.
|
| Being able to better understand prices before hand will
| drastically help people reduce their healthcare costs.
| dwringer wrote:
| I've seen the exact opposite of this - the self pay option
| would cost (for example) $300 while insurance would only get
| billed $150 for the exact same procedure. In the case I saw it,
| that meant the insurance paid out something like $12 and I was
| on the hook for the remaining $138. Which is roughly the same I
| would have owed if insurance had been billed the full amount
| and paid out the remaining $162.
___________________________________________________________________
(page generated 2022-07-01 23:00 UTC)