People strike back at the "healthcare" industry

Off Topic Politics & World Issues
745

United Healthcare is a separate entity than United Health Group, and each are regulated by their respective laws. Conglomerates are a whole new can of worms to open but if anything it’s harder for United Health Group to operate with as much influence as they would like because of United Healthcare given additional scrutiny.

For example, they recently tried to purchase a home health competitor, and buy-outs & mergers are common in the business world - including in healthcare (which is what we are discussing here) but were denied under monopoly laws given their broader conglomerate status. More than likely a competitor who was not a conglomerate would’ve seen the transaction go through.

Optum is a response to high care costs. I’m not going to rehash the money in/money out conversation above but as discussed insurance companies work to negotiate lower healthcare costs for clients because it helps their bottom lines too. If they can pay $10k for a surgery vs. $20k that’s a big win across millions of clients, for example.

Optum is an effort to control costs, this is true. But the market forces being addressed are primarily competition and supply and demand. By owning production of sorts they can lower costs for clients, to a degree. They still have to pay professionals a competitive wage or they’ll just go somewhere else, but administrative overhead, fees et cetera can all be reduced through streamlined processes and care, with some control on cost itself as well.

This would be a problem if they wound up owning the entire chain industry wide because they could charge whatever they want then. But that isn’t the case. This would be more in line with a single payer system, ackshually, with complete reliance on government to keep everything in check appropriately. Here, we have govt control preventing monopolies as well as market competition keeping companies incentivized to drive rates down so they can offer competitive premiums and maintain/win clients.

Another creative avenue companies looked at was medical tourism. The general idea was that it would be cheaper to fly clients to inexpensive countries, board and feed them, have surgeries and therapy provided and then fly them home vs paying healthcare domestically. Liability became the issue. Although people agreed to the overseas doctors and insurance was paying for them, they still found a way to sue if anything in the surgery itself went wrong, and companies couldn’t fall back on US law so they were often stuck in abusive settlements and began losing money instead.

They did attempt to set up their own networks and build legal chops around them, but some pretty strong special interest groups prevented this. I’ll let you guess who. Hint, it was not the insurance industry.

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746

That was very interesting, especially the medical tourism part.

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747

Made an important edit. It was not the insurance industry blocking their own cost lowering initiatives in tourism.

748

I haven’t seen a convincing argument that our healthcare/insurance system is superior to the rest of the industrialized world other than our system is better with regard to making a profit. Not everything needs to be an industry and we’ve seen what that approach has done to our food supply.

And no, I’m not advocating for full blown socialism as I believe doctors should get paid relatively well and in family owned farms.

749

Yes.

I dropped health insurance when ACA came out. It became an administrative nightmare and wasn’t worth working with.

I own a regional brokerage with a few offices around Texas retailing both commercial and personal lines of property & casualty, life, annuities, series 6 level financial investments and also wholesale annuities to other brokers from a few banking institutions.

I have a general understanding of how health insurance works, however, and have held the licenses in the past. Insurance is risk mitigation and they all follow similar financial control methodologies at the carrier level, not to be confused with “market manipulation”, which seems to be the prevailing and incorrect assumption. But the whole money in vs money out thing, with legally regulated ratios at play.

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750

IMO…Insurance is required to live a secure life. It does, however, suffer from the same incentive issues that affect all segments of the economy.

Take a world in which houses are frequently struck by lightning. Householders all take out lightning insurance. The insures have no knowledge beyond the average rate and cost of lightning strikes, and all households pay the same rate for the policy. Then the insurers develop some nifty software from huge silos of meteorological and geographical data that allows them to identify with high reliability the small fraction of houses at high risk that account for 80% of the strikes. They split the market, and now sell cheap low-risk and expensive high-risk policies. As the software improves, they differentiate more and more. The upshot is that lightning insurance is sold to people who are not in fact at risk of suffering lightning strikes, and those who are at risk can’t afford it. If the problem is seen as “insuring the population of houses against lightning risk”, an efficient profit-seeking insurance market will find a way not to solve it. Similarly for health.

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751

Yes, and those people who live in other 1st world countries, don’t have to worry about it if they have to use their healthcare.as they are secure in knowing they won’t die

752

Most property insurance companies segment their own markets based on risk.

For example, I have offices in Houston, Austin, San Antonio and Dallas and they’re all contracted with the same companies.

Insurance in Houston is expensive as shit. Houston is in line for weather patterns that cause extremely expensive damage, and it shows in rates.

An identical home in Houston and Austin would cost 1/3 to 1/4 to insure in Austin, by the same insurance company and under the exact same policy.

Risk is distributed around the Houston market, however, and even then many companies divide the market by distance from the gulf coast. Inside of 90 miles, or 45 miles or whatever the particular underwriting guideline is, rates are even higher than the rest of Houston, and some companies won’t even offer coverage because the risk is so high in their money in/money out formula they can’t do it without spiking rates beyond market prices, so they ignore entire markets vs losing share through exorbitant costs.

And, similar to health insurance, they negotiate with contractors, suppliers et cetera to keep things down.

Lots of misconceptions out there.

Risk pools are real, but not applied how you’re describing.

Edit, misread your post. We are sort of saying the same thing. Risk bands are used to levy cost of insurance. Same concept as health insurance risk banding.

Also, the material suppliers and labor are the cost drivers. Insurance is a voluntary service. You could always self insure if you don’t like what they offer. See how far you get with a general contractor to make a repair or rebuild after lighting burns your house down affordable.

One caveat is if you have a mortgage, banks will require you to carry a policy as long as they hold a lien, because they know you can’t afford to rebuild given the cost of labor and supplies.

Risk ultimately belongs to the homebuyer. You can’t build a home on the rim of an active volcano and realistically expect a company to cover you, for example. At least not for fire damage. An extreme example but follow the concept. And Castoli would expect you to pay for his volcano house, via taxes from your labor. So that’s exciting.

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753

Made it incredibly abundant and inexpensive?

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754

I wonder if he knows he can homestead and contend with nature himself?

755

Its an interesting conundrum. Pittsburgh is the world capitol of transplants. They’re really good at solving the high level problems, and Pitt is a medical research and development powerhouse. Part of my buddys thing, aside from teaching and working in surgery was traveling to other universities around the world to teach new techniques and applications to other universities and health systems around the world, along with hosting groups that came to learn. Our medical universities are massive holders of intellectual property, and other countries have to pay a really pretty penny to use it. Thats sort of a less public facing method of generating income other than tuition and billing.

So I think where a lot of the elevated status in medicine that the US enjoys comes from is in the innovation of new & better technologies.

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756

To follow the concept, if a company offers me home volcano insurance, I naturally assume fire damage is part of that. If they say “Yeah, that’s a stupid place to build a house, it’s all on you man,” that makes sense.

But if they sell a policy that someone pays years for, and then the volcano explodes and the house gets fire damage, why sell it in the first place, except to make a sales quota and then never pay out when insurance is needed?

757

And poisonous. There are reasons why the US is a fat and unhealthy nation.

758

I don’t need to because I have local farms I can buy from. I also don’t need the hassle of dealing with Monsanto.

759

Read the fine print. It’s all in the contract.

760

Your first paragraph is exactly what happens. Every policy lists exclusions under the insuring agreement, which is exactly what it sounds like.

This is true for health insurance too, tying back to the original topic.

It’s exceedingly rare for claims to be denied erroneously, also already discussed and showcased with linked sources.

And the ramifications are massive if it does happen.

I actually want a health insurance company to deny a claim that my agreement shows should be covered one day. It would be like hitting the lottery.

In any case, assumptions on behalf of the consumer aren’t binding. Your agreement is.

Let’s be honest, you’ve never really taken the time to understand what your insurance policies do, have you?

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761

Assuming you don’t die first.

762

I have, navigating family illnesses for years makes it a necessity, and I have good insurance.

I’m just bitching about a whole system that seems inefficent and broken.

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763

Ok, I’m going to go ahead and engage you but I’m not going on an Alice in Wonderland twist.

This is another misconception turned bullshit story line.

A) Healthcare providers are the ones who offer treatment. If they let you die because you can’t pay them, the death is very literally on their hands.

B) Medical professionals cannot ethically turn down life saving care in an emergency situation. I don’t know the ins and outs of legality here, so I’m not going to go deep, but you don’t just get left to die by an insurance company. I would personally recommend paying out of pocket if it turns out your care wasn’t covered, which is exceedingly unlikely as discussed. Or be the piece of shit who walks and lets collection fees raise the cost for everybody.

You can research concepts like terminal illness & futile treatment, informed consent & patient wishes et cetera on your own. But they’re healthcare problems.

764

And I think that’s healthy. It is a broken system. But you can’t fix it if your aim is off.