What if this entire sector just didn't exist and the money paid out to health insurance secretaries and janitors who clean their offices and the people in the accounting department who handle their salaries just went into paying for actual healthcare instead?
Like isn't the entire sector just inefficient bloat? What value does it provide that can't be provided much more efficiently?
> What if this entire sector just didn't exist and the money paid out to health insurance secretaries and janitors who clean their offices and the people in the accounting department who handle their salaries just went into paying for actual healthcare instead?
What is the purpose of a medical license then, if insurance can step in and deny the procedure? Who is right? I think dissolving insurance altogether is extreme (I agree but don't want to waste time on pie in the sky ideas).
Why can't we start by removing insurances ability to deny anything from a licensed doctor? If doctors are padding their wallets or stealing, bring it up with the board of medical examiners or court just like any other malfeasance in any other regulated industry. If you are board-certified in X it means you are entrusted to do X. Insurance should never be involved.
You're still paying the same people the same wages to work for the government.
Or is your solution that we should pay health insurance workers less money?
You originally proposed eliminating all the jobs. Now you've moved all the jobs to the public sector. So unless you're paying them dirt, all that money is still going to people working to make sure healthcare fraud isn't 80% of GDP.
In a perfect world, you have 6% more money to spend on healthcare instead of corporate profits.
That's not going to change the picture that much.
And you're unlikely to arrive in a perfect world.
You'll probably get a 10% more expensive system that's 9% more inefficient and has 0 profits.
Canada isn't hypothetical. It is very easy to compare costs and outcomes.
I live in BC, Canada, and we don't have an entire industry built around claims processing, administration, etc. They still pay health care workers, but they don't have to have phone banks filled with people answering questions about claim denials. I'm not even sure if a claim denial is a thing here, or who I would call. We don't have healthcare insurance CEOs making 23mm per year. We don't have customer service reps, we don't have billing specialists in every medical practice, we don't have medical coding experts. These things kind of exist in a bare minimum way, but not anywhere at the scale that I have seen in the US.
I go to the doctor, they make a medical determination about what my needs are, and we proceed from there. There is almost no fraud because the doctor has no real financial incentive to overtreat me, and since it is a single payer system, malicious patterns get picked up quickly and efficiently.
Keep in mind that each province administers their own medical system, so there is no such thing as the Canadian health insurance system.
> They still pay health care workers, but they don't have to have phone banks filled with people answering questions about claim denials. I'm not even sure if a claim denial is a thing here, or who I would call.
The Canadian system may be much cheaper to administer, but it isn't magical. There is still a need for staff to administer and adjudicate claims, and you still have to ration limited healthcare resources somehow.
Notice how all of the things that you found represent a single department in the provincial government instead of a significant part of national GDP spread across multiple billion dollar conglomerates.
The first link you submitted is actually showing how the automated system processes the huge majority of claims automatically without people in the loop. So not a good argument that BC has phone banks of people answering claims questions.
Yes the claim process exists, and the various appeals parts exist, but that part of MSP is just not the patient's problem. If you read through the reasons for denial that you linked, almost all of them are requests for better paperwork or missing information. The level of administrative overhead just doesn't exist on the scale that I have experienced living in the states.
What I have never had happen, or heard of happening, is a resident getting a bill for seeking medical care (which would happen if a claim was rejected). Or someone not receiving medical care due to inability to pay. Or having to doctor shop for a place that accepts their insurance. In fact, most people I know have never even had to contact MSP.
>The Canadian system may be much cheaper to administer, but it isn't magical. There is still a need for staff to administer and adjudicate claims, and you still have to ration limited healthcare resources somehow.
But it isn't just the Canadian system -- it's every other system too.[0]
There is a unique form of corruption occurring in the American health system and it is absolutely tied to the insurance industry.
This corruption causes the misallocation of resources in ways that are detrimental to the health of American citizens.
Medical bankruptcy and the cost that it has on a person's health isn't really a thing in Canada. Having to choose between paying for medical bills or healthy food isn't really a thing in Canada. People putting off minor medical issues until they grow into major issues because they can't afford routine checkups or treatments isn't really a thing in Canada.
This results in far less rationing of healthcare because people are able to make better choices that prevent the waste of medical resources.
Don't get me wrong, there are issues with Canadian healthcare -- the biggest being corrupt politicians and business people trying to import American healthcare practices for their personal gain but the issues that the average Canadian face in accessing healthcare are nothing compared to those that the average American faces.
> There is almost no fraud because the doctor has no real financial incentive to overtreat me
The vast majority of healthcare fraud does not come from corrupt dentists convincing you to get root canals you don't need.
The largest source is billing for services not rendered.
That is: some provider just makes up that you came to see them and charges the insurance company and you don't even know about it.
This is a non-trivial problem to solve.
Even in the NHS in the UK - where the entire system, including the providers, are public - there is STILL a large billing for services not rendered problem!
This seems trivially solvable. In BC, Canada, I had an old doctor renew a prescription over the phone. This must have triggered a fraud alert because my address was now in a different health management district. They sent me an automatic notice asking me to confirm that I had been helped by that doctor at that time. I believe I can also log onto a provincial portal and see activity related to my medical care.
Seems like a pretty low cost way to ensure that no fraud is happening. Set up triggers for confirmation like doctors treating people who don't live nearby, treating people who are concurrently seeing other doctors, or any number of other known fraud alerts, and follow up.
Since private practice isn't really allowed here, getting removed from the provincial insurance program means a career death sentence, so I think that it just isn't that big of a problem anyway.
I'm not a citizen of the UK so I can only speculate from a poorly informed position but I would imagine that it has to do with the starve the beast tactics that are being used to weaken the NHS to make it more susceptible to privatization.
I've proposed eliminating those jobs because they're bullshit jobs that have a net negative contribution to society because the American medical system is hopelessly inefficient and corrupt.[0]
It is a curious thing watching people defend the undefendable. What makes you so confident in this system that so many Americans loathe and feel betrayed by?
Because (1) most Americans are satisfied with their healthcare and (2) the CBO doesn't think that a public option would decrease costs much if at all: https://www.cbo.gov/publication/57125
"Hollywood accounting" only works because you're transferring the profits of one enterprise (ie. the movie itself) to something else (ie. the production/distribution company). Unitedhealth Group is a publicly traded company. Where are they funneling the profits to?
> The FTC’s administrative complaint alleges that CVS Health’s Caremark, Cigna’s ESI, and United Health Group’s Optum, and their respective GPOs—Zinc Health Services, Ascent Health Services, and Emisar Pharma Services—have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication. According to the complaint, these PBMs, known as the Big Three, together administer about 80% of all prescriptions in the United States.
What's the best way to solve the engineering issue of high load on any given system?
Reduce or eliminate the load.
Of course insurance will reduce their load with tactics such as deny, deny. But systemically, there's a better, good-faith way.
IMHO, without getting into all the nitty gritty details, the good-faith way to improve a ton of healthcare is to extend the efforts of fortification in common foods, expand people's consumption of healthier foods (more plants that provider fiber + minerals), improve people's abilities and motivation around healthier lifestyle choices (exercise, sleep), and significantly reduce or re-engineer illness-causing agents (plastics, VOCs) in our daily lives.
The challenge is how to implement these things in a balanced and sustainable manner, while keeping most industries relatively happy. Of course this would take a decade or more, but the knowledge is out there from some very competent healthspan PHds/MDs and a variety of scientists.
In my personal opinion, if all we did was increase consumption of sulfur, protein (especially collagenic sources), we would improve a tremendous amount of health outcomes drastically. Asian countries are a great example where the food actually has sulfur and collagenic sources built into their culture. Koreans consume cabbage 3x/day (cruciferous veggies with sulfur) and traditionally consume a bone-broth (collagenic) type of soup with 1-3 meals on the daily. I could outline the science here, but a huge amount of chronic illness, such as the shooter's mother may have seen some relief with some of my aforementioned efforts.
The way we can take for granted iodine deficiency because they added it to salt, we really need to do that for others. Omega 3s within milk these days is also a good path forward.
> If you take the CEOs salary and distribute it to healthcare patients, $50M worth of healthcare is not going to even minutely move the needle.
I have a hard time buying this. Really? You can't cover a few more cents of a few more claims if you reduce c-suite pay?
I don't pay my premium to just see it go directly to the c-suite and some retirement fund's coffers. I pay it to cover healthcare costs and to keep from being financially ruined by a chance illness or injury.
If the CEO is making a half-million a year and his company is coming to me telling me that there just isn't any money to cover my back injury surgery, they're negotiating in far better faith than if they're paying him ~5x the median lifetime earnings of the American male each year, every year.
>>$50M worth of healthcare is not going to even minutely move the needle.
>I have a hard time buying this. Really? You can't cover a few more cents of a few more claims if you reduce c-suite pay?
Nice job moving the goalposts from "moving the needle" to "a few more cents of a few more claims". UnitedHealth Group had 371.6 billion in revenue last year. $50 M means they can provide 0.01% more care to their customers. I think it's fair to describe that as "not going to even minutely move the needle".
The numerator might so up but so will the denominator, so it effectively cancels each other out. More to the point, I feel like this argument is over relative vs absolute. It might be noticeable" to a single person, but given that we're talking about the healthcare system as a whole, it's fair to say that it's not "noticeable".
Maybe instead of paying for the c-suite's bonuses, they need to be paying someone to air the dirty laundry of the health system that's charging $15 for an acetaminophen. When someone's f*cking both you and your customer like that, you go after them. But it's not about that, is it? It's about transferring value to shareholders, not reducing the costs of care. Hell, doing actual work to reduce the cost of care is expensive, and we can't possibly expect the retirement funds and major shareholders of America to pay for that.
> When someone's f*cking both you and your customer like that, you go after them. But it's not about that, is it? It's about transferring value to shareholders, not reducing the costs of care.
It's almost as if it's not an easy problem to solve, or some other health insurance company would do it and put all the other ones out of business.
It's not an easy problem to solve if you're not interested in solving the problem.
And they're not. Like I said, the goal of for-profit health insurance companies is not to maximize economic benefits for customers; it's to maximize economic benefits for shareholders. It's a lot easier to transfer value to shareholders by just denying the claim submitted by the customer for that pill than it is to actually (legally) beat the entity charging for the pill into permanent submission. So that's what they do.
> it's to maximize economic benefits for shareholders
Except health insurance is regulated, and you can only maximize profits to a small degree (which is the only reason UHC's profit margin is 6% instead of 40%).
This incentivizes health insurance companies to provide a good enough service that people want their insurance. Capturing a lot of the market is their ONLY way to make money.
They literally don't have the option to ask, "how do we just take more of our customers money and stuff it in our pockets?"
That's not really that terrible if the company is Apple and selling products that nobody NEEDS. It is terrible if you've only got a few choices and their selling something everyone needs - hence the regulation of profits.
It's almost as if our country isn't run by complete idiots.
Is it a perfect system? No.
Is there an obvious, far superior system? Also, no.
It's almost as if healthcare spending isn't the only variable that matters - and it matters how fat and sedentary your population is, and how much you pay doctors and nurses.
It's almost as if the world isn't so reductive complex issues can be reduced to cute little charts.
If the company was PERFECTLY run, you're still going to have tons of people getting denied claims. That's what happens with the law of big numbers.
And guess what. You're never going to have a perfectly run company.
If you take the CEOs salary and distribute it to healthcare patients, $50M worth of healthcare is not going to even minutely move the needle.
UHC revenue is $100B PER QUARTER. The CEO's pay is not even a rounding error on a rounding error.
Was the CEO a perfect, honorable guy? No.
Is taking his salary and spending it on patients going to do anything? In the large picture, also, no.