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United Healthcare CEO shot and killed

heelinhell said:
The high cost of health care in the USA compared to Canada and Western European countries is the result of relying on for profit insurers to cover Americans under the age of 65yo
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This is false, and I am 100% confident in that assessment. Insurance companies are not the main drivers of high health care costs. They are barely drivers at all. I mean, just look at the claims here:

1. For profit insurers deny claims too often and people die as a result;
2. For profit insurers are causing medical care to be too expensive.

These are contradictory statements. The only way that both can be true is for the effects to be quite small. And indeed, for-profit insurance's effects on overall costs is small. Administrative costs traceable to for-profit insurance adds maybe 5-7% of overall cost, at most (and that's before accounting for any savings generated).

A much more important source of administrative costs comes from the problems of a) the ridiculous inefficiency and non-interoperable EMR systems and b) procedure coding. So much money is spent in implementing EMRs that suck, so then they have to be replaced, and some companies build their own, which still suck, and nobody can talk to each other. And then physician practices spend a lot of time upcoding procedures to maximize reimbursements, and then the insurers want to fight against upcoding, so we get appeals processes, etc.

Neither of those categories of costs is traceable to for-profit insurance. I won't say that for-profit insurance doesn't in some cases aggravate them -- I wouldn't really know either way. But upcoding is a direct result of how Medicare reimbursements work, and I do not think a private insurance system would continue to use this technique if the entire field wasn't built around it. And I don't even know what to say about EMRs, the suckiness of which is almost incomprehensible to me, except that it seems to be a provider thing, and in particular large providers like hospitals.
 
superrific said:
This is a bad thing? I would think we would all want premiums as low as possible. That doesn't mean "deny every second claim so that people are paying not very much money for insurance that is worth even less" but it's odd to see this described as a negative.
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I think you misunderstood my point.

I said, “What UHC is doing goes beyond [controlling cost to controlling premium prices].”

I meant the part in brackets to be take together as in you control costs to control premiums which is good. I meant that they go beyond all of that. Maybe should have said “go beyond controlling premiums prices to maximizing profit for the company at the expense of member’s healthcare.”

Apologies if I wasn’t clear enough.
 
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superrific said:
This is false, and I am 100% confident in that assessment. Insurance companies are not the main drivers of high health care costs. They are barely drivers at all. I mean, just look at the claims here:

1. For profit insurers deny claims too often and people die as a result;
2. For profit insurers are causing medical care to be too expensive.

These are contradictory statements. The only way that both can be true is for the effects to be quite small. And indeed, for-profit insurance's effects on overall costs is small. Administrative costs traceable to for-profit insurance adds maybe 5-7% of overall cost, at most (and that's before accounting for any savings generated).

A much more important source of administrative costs comes from the problems of a) the ridiculous inefficiency and non-interoperable EMR systems and b) procedure coding. So much money is spent in implementing EMRs that suck, so then they have to be replaced, and some companies build their own, which still suck, and nobody can talk to each other. And then physician practices spend a lot of time upcoding procedures to maximize reimbursements, and then the insurers want to fight against upcoding, so we get appeals processes, etc.

Neither of those categories of costs is traceable to for-profit insurance. I won't say that for-profit insurance doesn't in some cases aggravate them -- I wouldn't really know either way. But upcoding is a direct result of how Medicare reimbursements work, and I do not think a private insurance system would continue to use this technique if the entire field wasn't built around it. And I don't even know what to say about EMRs, the suckiness of which is almost incomprehensible to me, except that it seems to be a provider thing, and in particular large providers like hospitals.
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What about liability and resultant malpractice insurance as a cost driver (a la John Edwards)
 
ColdBlueSteel said:
What about liability and resultant malpractice insurance as a cost driver (a la John Edwards)
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To a first approximation, this has no impact. Malpractice insurance doesn't affect prices, for a number of reasons (including that it's not a variable cost).

A stronger case can be made if you include "defensive medicine" in this category, if defensive medicine can actually be shown to exist. It still wouldn't make a big difference, but as a utilization driver, it would have some impact. To the best of my knowledge, economists and health policy people consider defensive medicine to be a subset -- a particular type -- of supplier induced demand.
 
ChapelHillSooner said:
I think you misunderstood my point.

I said, “What UHC is doing goes beyond [controlling cost to controlling premium prices].”

I meant the part in brackets to be take together as in you control costs to control premiums which is good. I meant that they go beyond all of that. Maybe should have said “go beyond controlling premiums prices to maximizing profit for the company at the expense of member’s healthcare.”

Apologies if I wasn’t clear enough.
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I see. I definitely read it as "goes beyond (controlling costs) to (controlling premiums)"

I'm not sure how to evaluate your statement. Health insurance is a competitive market (even more competitive than people usually realize, because many employers self-insure but turn to companies like UHC to administer their plans -- meaning that an insurer is in competition not just with other insurers but also large employers). The only reason for UHC to cut reimbursements to the bone would be to lower prices. In the short term, I suppose, an insurer can jack profits by denying care. But if it's not passing those savings on, their business will dry up. What employer wants to pay the same to UHC for a worse product?

A market should sort this problem out (unlike some other of the more difficult issues). To the extent that it doesn't, it's because we run health care payments through employers, as I noted on the other thread.
 
superrific said:
I see. I definitely read it as "goes beyond (controlling costs) to (controlling premiums)"

I'm not sure how to evaluate your statement. Health insurance is a competitive market (even more competitive than people usually realize, because many employers self-insure but turn to companies like UHC to administer their plans -- meaning that an insurer is in competition not just with other insurers but also large employers). The only reason for UHC to cut reimbursements to the bone would be to lower prices. In the short term, I suppose, an insurer can jack profits by denying care. But if it's not passing those savings on, their business will dry up. What employer wants to pay the same to UHC for a worse product?

A market should sort this problem out (unlike some other of the more difficult issues). To the extent that it doesn't, it's because we run health care payments through employers, as I noted on the other thread.
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I don’t know. I suspect it could be a combo of lower premium prices and greater profit margins. UHC rejects claims at twice the industry rate. That is hard to justify.

At some point, the insurance has to be pretty crappy before the employers care. Their first concern is the cost to them. They only care about the rest if they start to lose employees because the insurance is so bad. When a lot of your workforce is 22-40 year olds, insurance coverage isn’t the employee’s main concern. If the older people bolt, well some corporations might see that as a benefit.

Also for some large companies it’s the companies who pay out medical costs as the insurance provider only administers the plan.
 
tarheelbillie said:
Well, if true, maybe FBI does need a good review.
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A fair number of mass casualty events have seen the perpetrator talking about plans prior to the event. Not always clearly but sometimes hints are a bit more obvious than not.

Your suggestion that the FBI (and the other letter agencies) should not be monitoring message boards is surprising. If someone on this board were to make a credible and detailed threat against either Biden, Trump or their VP's, there is a decent chance they would get a once over from the FBI/SS and maybe even a visit.
 
superrific said:
This is false, and I am 100% confident in that assessment. Insurance companies are not the main drivers of high health care costs. They are barely drivers at all. I mean, just look at the claims here:

1. For profit insurers deny claims too often and people die as a result;
2. For profit insurers are causing medical care to be too expensive.

These are contradictory statements. The only way that both can be true is for the effects to be quite small. And indeed, for-profit insurance's effects on overall costs is small. Administrative costs traceable to for-profit insurance adds maybe 5-7% of overall cost, at most (and that's before accounting for any savings generated).

A much more important source of administrative costs comes from the problems of a) the ridiculous inefficiency and non-interoperable EMR systems and b) procedure coding. So much money is spent in implementing EMRs that suck, so then they have to be replaced, and some companies build their own, which still suck, and nobody can talk to each other. And then physician practices spend a lot of time upcoding procedures to maximize reimbursements, and then the insurers want to fight against upcoding, so we get appeals processes, etc.

Neither of those categories of costs is traceable to for-profit insurance. I won't say that for-profit insurance doesn't in some cases aggravate them -- I wouldn't really know either way. But upcoding is a direct result of how Medicare reimbursements work, and I do not think a private insurance system would continue to use this technique if the entire field wasn't built around it. And I don't even know what to say about EMRs, the suckiness of which is almost incomprehensible to me, except that it seems to be a provider thing, and in particular large providers like hospitals.
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With all due respect, you are wrong.

With a Medicare for all system, Medicare will bring in healthy younger cohorts which will lower health care costs under a system that will be a far more efficient delivery system than the mishmash of private for profit insurance companies.

There is a reason that Canada and Western European countries have embraced this system...and their citizens love it !
 
ChapelHillSooner said:
I don’t know. I suspect it could be a combo of lower premium prices and greater profit margins. UHC rejects claims at twice the industry rate. That is hard to justify.

At some point, the insurance has to be pretty crappy before the employers care. Their first concern is the cost to them. They only care about the rest if they start to lose employees because the insurance is so bad. When a lot of your workforce is 22-40 year olds, insurance coverage isn’t the employee’s main concern. If the older people bolt, well some corporations might see that as a benefit.

Also for some large companies it’s the companies who pay out medical costs as the insurance provider only administers the plan.
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1. I can't speak at all to UHC in particular. Merely rejecting claims at a high rate doesn't mean all that much in itself -- after all, someone has to be above average, by definition. I know you're saying more than that, that they are an outlier. Maybe? I can't speak to that.

2. I've never been involved in the process of a big employer crafting benefit packages, so I can't speak to that either. Obviously cost is a hugely important factor. But if the employers don't really care, then why aren't they all going with UHC? Why is UHC the worst? Employers, after all, do not have to offer insurance unless they have more than 50 employees -- yet most do. Or at least many do. Bad morale affects an organization before people start leaving, and employers offer benefits in part to keep morale up (and also to keep their workers healthy!). We agree on this, I think. I don't know how exactly companies cost gets weighed with benefits. I suspect there are a range of approaches, which is why there is a range (to put it mildly) of insurance plans.
 
heelinhell said:
With all due respect, you are wrong.

With a Medicare for all system, Medicare will bring in healthy younger cohorts which will lower health care costs under a system that will be a far more efficient delivery system than the mishmash of private for profit insurance companies.

There is a reason that Canada and Western European countries have embraced this system...and their citizens love it !
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1. There's a thread for this.
2. In a Medicare For All system, "bringing in healthy younger cohorts" is meaningless because it's a single-payer plan. At that point, there is no risk management at all because there is only one risk pool and it's co-extensive with the population.
3. I'm pretty sure the Brits hate their NHS. In fact, the state of NHS was one of the initial impetuses behind Brexit. That doesn't mean other European systems are bad. It means that there are a lot of complex policy questions that require answers, even for single payer systems, and if those questions are answered poorly (or ignored), the result could be a bad system.
 
doctor_octopus said:
Nope. Comparing American and British attitudes on health care in 2022 | YouGov
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I wasn't comparing the British and American attitudes. I was just commenting on the UK system. And that article suggests that I have exaggerated the British frustration with their health system. I don't follow it very closely and it's indeed possible I am conflating different things (e.g. frustration at striking nurses isn't quite the same as frustration with the system, although if the system makes it inevitable that the nurses will strike . . . ).

I think the larger point remains true, even if I chose a poor illustration: there are still policy questions to address within the category of "single payer health systems" and the way those policy questions are addressed have a big impact on the quality of the system and its citizens' perception of it.

I also suspect, though this is not terrible relevant, that Americans are just down about everything about America compared to other countries. Our president-elect rarely has anything good to say about the country, and shits on it with regularity. Trump shits on half of America with regularity; he tells invented stories of how bad it is; he calls America a Third World country or worse. So yeah, Americans are down on America. That's more or less unrelated to the point of your post.
 
Picked the guy up in Altoona PA

May be a very public fishing expedition

 
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