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Noah Smith 🐇
@Noahpinion
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Before explaining why insurers aren't the big culprit behind health care costs, I thought I should demonstrate that I definitely understand why people hate them.
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Noah Smith 🐇
@Noahpinion
Insurance companies are low-paid middlemen who are hired to play the bad guy in the bloated U.S. health care system. The real people overcharging you are the providers themselves. noahpinion.blog/p/insurance-co
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David Watson 🥑
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Tony 🇺🇸
@TonyTsubasa
Wait, so can I blame doctors and nurses (and their related professional organizations) or do I have to blame the hospitals?
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Carter Williams
@jcarterwil
It is a business model issue. There are too many people to blame when it's a crappy unproductive solution. Obesity makes people unhealthy. Government and insurance subsidize the bad behavior. The fix is a new business model - food is health. PS: Life insurance is the only
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TIICANN
@TIICANN
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Why are more than 100 million Americans burdened by medical debt? One reason is because of aggressive tactics used by some large health systems, including nonprofit hospitals, to rake in higher profits at the expense of patients. Help us fight medical debt by taking our survey.
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From jotform.com
793K
Unsafe Block
@unsafebl0ck
I don’t really care that doctors are the culprit. The problem is the average American makes health purchases largely under duress and with little knowledge. You can’t negotiate anesthesia rates under a coma. My insurer should take care of it, and if they won’t pay, the clinic
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Printing Center of Excellence 🌐🇺🇸🇧🇩
@arnoblalam
My experience with front office staff of provider's has been horrible and chaotic. Meanwhile. my insurance co has off hours telephone support and I've never had issues as long as I follow their process.
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Steve Kerins
@SteveKerins
This all sounds about right, yes. It would be easier, and less terrifying and infuriating, if some regulator took care of all of this behind the scenes, and charged everyone roughly the same amount, in exchange for complete and comprehensive coverage. Because at the end of...
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Roger Seheult, MD
@RogerSeheult
We don't think you don't understand why people hate insurance companies we just aren't convinced that you've actually cracked a book on this one: Physicians are the blue arrow. Red = is that middle man you were referring to.
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JaMikeyMike
@JaMikeyMike
I’ve never been denied a claim, not a single person in my family has. Asked my group of friends the answer is 0… so is this really a thing or do I defy all the laws of physics?
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smiz
@__smiz
What’s interesting is that insurance companies typically model financial risk (well understood), but the harder problem is handling reputational risk, which is a lot harder to model. Esp because legislation/regulation is a big part of the puzzle.
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William Banfield
@BillyBamf
What’s infuriating is not just the denial, it’s that complete lack of leverage in the bargain. My insurance co recently changed their customary and reasonable rates for a provider I see. They did not inform me of this but suddenly covered about 1k less per visit. Nothing I can do
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Max Witt MD
@MaxWittMD
@Noahpinion
, You're missing a big part of how the system is functioning (maybe an optimistic description). We order tests, and the bill for those comes from the hospital. I send a separate, lower bill for my clinic visit ($100-400 ballpark).
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Max Witt MD
@MaxWittMD
Misconstruing "providers" as combining both physicians and hospitals, etc let this be one of @Noahpinion 's few bad takes. Very close to a good take though; Everything in medicine is hugely expensive, and doctors aren't always in a position to know what something costs. x.com/Noahpinion/sta…
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Tim Wells
@Sublimewasp
There are many reasons for high HC costs. Insurers are a key driver. We are overpaying $2 - $2.4T/yr. Insurance companies are $1T of that. They provide no needed service or benefit. They provide negative value. They are a cost with no value thus negative ROI.
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dreamz
@affe73
The author does not have an understanding of how reimbursement to "providers" is contracted by insurance companies and that sets rates. Providers can only collect what is contracted. Patients may have copays, coinsurance, deductibles etc.
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Mark Graham
@gram_krackr
That's the thing, though We have had first-hand experience with insurers doing scammy illegal things. Why would we assume that ostensibly 'good' changes, like the BCBS one, aren't just another example? Insurers need to gain our trust first, and I don't see any proposals for this.
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Derek Larsen
@DerekLarsen7
I just made some feelings get hurt on Physician Twitter for having the gall of calling them a Cartel, so thanks for the article, but don't envy your mentions!
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Tim Wells
@Sublimewasp
Not only are they $1T in unneeded costs but they create another $500B in negative externalities. And they are an anchor on economic growth and tax receipts. Hurt both sides of the Fed ledger.
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Rich Johnston
@rjohnston4
What do we make of the ‘UHC owns their own pharmacy, makes their insured people use that pharmacy, specifies the drugs and rates at that pharmacy’ setup? Because that looks pretty shitty without a single doctor or hospital being involved.
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Noah Campbell
@NoahProoval
I mean, didn't Germany do the utterly obvious thing and just make the insurers all non-profits? Seems like the totally stupid yet effective solution that doesn't involve a total overhaul of the entire system from top to bottom.
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Mark Graham
@gram_krackr
Insurers also need a rule to communicate exactly with patients why their coverage was denied If the AI denied your coverage, you need to explain its reasoning exactly. If it was a human, their whole decision-making process must be documented.
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TIICANN
@TIICANN
Ad
Why are more than 100 million Americans burdened by medical debt? One reason is because of aggressive tactics used by some large health systems, including nonprofit hospitals, to rake in higher profits at the expense of patients. Help us fight medical debt by taking our survey.
Learn More
From jotform.com
793K
David
@Bloke0791060507
In the UK we have massive waiting lists for the NHS because voters hate taxes. For all its faults, at least the US insurance-based healthcare system provides decent funding.
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Luís Dias
@lmldias
It's hilarious that in your writing you completely accept that these insurance companies are morally in the wrong, but then you argue they're not. Except that the problem is the system itself. The entirety of it. Does it really matter who's the face of it?
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Dr Murphy WeightLoss
@TakeWeightOffMD
No actually you do not. You undercounted the denial rates of some companies by quoting the average rather than the highest rates and lowest rates. Further, average doesn’t adjust for quantity of claims processed. $UNH
@UHC
is the MAJORITY claim processing insurer. Further you
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here
@0xPicasso
You missed Obamacare mandated minimum medical loss ratios - so the numbers aren’t actually super surprising
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Above The Gods
@AboveTheGods_
Insurance companies have to be strict with payouts to prevent the moral hazard problem that occurs with insurance. It’s similar to people spending more than they otherwise would have when they acquire a credit card. The hate for insurers is similar to the hate for Karens
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