[HN Gopher] Medicare Advantage Popular with Seniors - But Not Ho...
___________________________________________________________________
Medicare Advantage Popular with Seniors - But Not Hospitals and
Doctors
Author : mooreds
Score : 52 points
Date : 2023-12-03 17:46 UTC (5 hours ago)
(HTM) web link (kffhealthnews.org)
(TXT) w3m dump (kffhealthnews.org)
| faeriechangling wrote:
| Well a more functional system is being displaced by the
| inefficient free market American Healthcare system. I can only
| imagine why doctors and hospitals are not chomping at the bit to
| deal with bad faith insurers fraudulently denying claims nonstop
| while never being punished for doing so.
| jws wrote:
| Around here folk call it the "Three D" strategy. Delay, deny,
| die.
|
| If the insurance company can put off your procedure long enough
| you might die and then they don't have to pay for it. Family
| friend who has lost so much hearing he can't participate in
| conversations anymore has been strung out for 6 months by his
| insurance on a cochlear implant. The final hurdle was them
| denying because of incomplete paperwork, that they did indeed
| have said paperwork which was part of the initial submission.
|
| If Americans find this unacceptable, they will need to adjust
| the laws to change the incentives to the insurance companies.
| toomuchtodo wrote:
| This might help your friend.
|
| https://www.propublica.org/article/your-right-to-know-why-
| he...
| pstuart wrote:
| That might help a lot of people ;-)
| novok wrote:
| The american system is also not a free market, it's a worse of
| most worlds situation.
| nobodyandproud wrote:
| The large hospitals (this includes "non-profits") are
| complicit.
|
| See https://news.ycombinator.com/item?id=38509774
| KittenInABox wrote:
| > The insurance industry's lobbying arm, AHIP, said in a February
| letter to the Centers for Medicare & Medicaid Services that prior
| approvals and other similar reviews protect patients by reducing
| "inappropriate care by catching unsafe or low-value care, or care
| not consistent with the latest clinical evidence."
|
| Reminder of the orthopedic surgeon whose recommendation for
| surgery was denied from insurance citing an insurance-paid doctor
| who is lifetime banned from doing surgery for _installing a hip
| in backwards_
|
| Edited to add:
|
| > Studies show that Medicare Advantage costs taxpayers more per
| beneficiary than the traditional program. But the plans enjoy the
| backing of many lawmakers, especially Republicans, because of
| their popularity.
|
| Ugh. _Ugh._ Of course they 're popular, the upfront costs are
| small, and the united states has literally over 10% more food
| insecurity in the past year alone[0]. Americans literally can't
| afford medicine, not because they just really really love
| Medicare Advantage!
|
| 0. https://www.cbpp.org/blog/food-insecurity-increased-
| in-2022-...
| gopher_space wrote:
| I wonder what sort of liabilities insurance companies open
| themselves up to by automating approval. Having a quack on
| staff isn't surprising, doctors who'd put their license on the
| line like this probably don't have too many options.
| shigawire wrote:
| Most do have automation in place. In fact, the big EHRs are
| now working with payors to help facilitate automatic
| interoperability for insurance claims.
|
| So the insurer can directly pull up the patient's chart and
| use discrete data elements for claims processing.
| jjk166 wrote:
| Odds are there's something buried in the insurance policy's
| terms that gives them permission to do stuff like that.
| sokoloff wrote:
| That insurance-paid doctor seems like they are a genuine expert
| on "unsafe or low-value care, or care not consistent with the
| latest clinical evidence".
| borski wrote:
| > Reminder of the orthopedic surgeon whose recommendation for
| surgery was denied from insurance citing an insurance-paid
| doctor who is lifetime banned from doing surgery for installing
| a hip in backwards
|
| Source? I believe you, I just really want to read about this.
| SoftTalker wrote:
| Almost every facet of health care and end-of-life care involving
| seniors is a scheme to drain them of whatever wealth they have
| before they die.
| FirmwareBurner wrote:
| We should probably fight to change it, since we'll all end up
| in their place, it's just a matter of time.
| EvanAnderson wrote:
| If you're rich enough you'll be fine. This seems like an
| another example of how expensive it is to be poor, but the
| "floor" for "poor" is elevated.
|
| Edit: I think we should do something about it, but money =
| speech so there's nothing to be done as long as the status
| quo benefits people with money.
| borski wrote:
| The status quo doesn't _benefit_ people with money. That
| they don't get a significant benefit from Medicare doesn't
| mean that shitty insurance somehow benefits them more.
| EvanAnderson wrote:
| It benefits people who are rich enough to have ownership
| interests in the shitty insurer market.
| FirmwareBurner wrote:
| Aren't a lot of those companies public? Meaning they're
| not owned by the stereotypical evil "Monopoly Man".
| borski wrote:
| Most of these companies are public, and you do not have
| to be rich to own shares. Also, tons of rich people do
| not own healthcare insurer interests. Tbh, they generally
| don't perform exceptionally well.
|
| "Rich people," as a group, do not somehow benefit
| significantly from insurance companies being garbage to
| those they insure.
| mschuster91 wrote:
| Yup. Elderly care in most countries - including Europe - is a
| scam designed to keep the poor classes poor. Assuming long-term
| care is ~3000EUR a month and ten years of life expectancy,
| that's ~360kEUR, or what most of us made in lifetime savings
| (remember, here in Europe we got actual pensions, so no 401k
| needed). However, a family that already _has_ 2, 3 million EUR
| in liquid assets? For them, even two or three people in elderly
| care won 't make much of a dent - the interest earned from
| these assets alone is enough to pay for their care. And for
| everyone above that it's not even a question.
|
| Now, the worse problem is there is no (ethical) way around the
| issue. Modern medical care as well as strict workplace safety
| regulations and the downturn of heavy industry (that caused a
| lot of people to die of silicosis, asbestosis and whatnot)
| allows for _far_ longer life times, even with mentioned severe
| illnesses that would have taken out earlier generations before
| they had even hit pension age, and there haven 't been wars to
| take out a decent part of the population either (which had been
| the norm prior to the end of WW2). At the same time, we can't
| just give poor elderly people a gun and tell them to off
| themselves out of ethical reasons, and we don't want to
| pressure them to "look for a way out" on their own either. We
| also can't rely on women to do the care labor as they did prior
| to the 70s, for both ethical and economic reasons (we need
| women in the work force). And we _also_ can 't import cheap
| labor from overseas to fill the gaps in staffing to drive down
| wages, because we already did that (good luck finding nurses
| and other care staff in Eastern/South Eastern Europe - all bled
| dry and burned out!).
| jackcosgrove wrote:
| I read the article and was nonplussed by the dichotomy between
| hospitals and doctors on one side and insurers on the other.
| First I'm not sure if hospitals' and doctors' interests
| necessarily align all the time, but maybe they do on this
| issue. Second I would be willing to sympathize with doctors
| much more than hospitals - those are the entities issuing the
| astronomical bills that bankrupt people after all, while
| monopolizing care in metro regions to control physician wages.
|
| I don't really see a champion for patients in this fight.
| coryrc wrote:
| It's also draining working people of wealth. We have all these
| tax breaks to keep old people owning their homes while they get
| free care, while working families pay all their earnings to
| landlords and our taxes go to elderly care instead of public
| services.
| anonporridge wrote:
| Tax burden is somewhat tangential to real root of the problem
| on working people.
|
| The deeper problem is that pushing so many resources towards
| old, retired people means that a huge chunk of the economy
| and jobs are forced to orient towards elder care. To be
| darkly blunt, elder care is a deeply depressing kind of work,
| especially when it's for strangers rather than family.
|
| A society with an increasing percentage of the population as
| old people who don't do anything interesting is an
| increasingly depressing society for young people to live in.
|
| It really seems like a downward death spiral.
| scarface_74 wrote:
| And this is why most cultures have multigenerational
| housing. Yes it's worse for economic growth and mobility.
| lapcat wrote:
| > A society with an increasing percentage of the population
| as old people who don't do anything interesting is an
| increasingly depressing society for young people to live
| in.
|
| It doesn't have to be this way, and the "solution" isn't a
| baby boom or Logan's Run.
|
| There are a lot of older people who are capable of working,
| but society presents many barriers to this: 1. Age
| discrimination; 2. Employers overworking employees; 3. Lack
| of flexibility in working conditions (part-time, work-from-
| home, etc.); 4. Lack of educational and job training
| resources for older people
|
| Society tends to push the majority of people toward
| retirement, both because it wants older people out of the
| workforce and also because working life tends to suck for
| the workers (hence the desire to retire ASAP). But a lot of
| retirees are actually bored and would welcome becoming
| useful again, if society provided better opportunities for
| them.
|
| Instead of "work hard until you retire", we could all
| perhaps "work easy until you die". Older people are forced
| to make the choice between working hard and retiring, but
| younger people are presented with similarly bad choices,
| for example, working hard or spending time raising your
| children.
| jewayne wrote:
| Would it make you happy to know that our life expectancy
| has been going DOWN since before the pandemic?
| anonporridge wrote:
| Life expectancy is a broke metric.
|
| Healthspan is woke.
|
| Living decades longer in a state of in incapacity and
| pain in a nursing home, lucky if anyone cares to visit
| once a year, is hell on earth.
| delfinom wrote:
| Life expectancy decreasing to the younger of society
| offing themselves with drug overdoses....
| Spivak wrote:
| You. Will. Be. Old. Care for society's elderly is literally
| the charge of the young and abled. You will eventually reap
| those benefits after having paid your keep.
|
| If you wouldn't say it's silly how much of society's expenses
| and taxes go toward child care and education another
| population that can't work to support themselves, then you're
| really just saying you don't care about old people because
| their "value" is already spent. This isn't even really an
| uncommon view, people will just openly say this about anyone
| with a disability that needs accommodation rather than saying
| it's our job to help them.
|
| God rugged individualism is such a cancer on society.
| Der_Einzige wrote:
| Based anti-natalists will also tell you to not have kids.
| scarface_74 wrote:
| Unpopular opinion, what's wrong with that? Who should pay for
| health care for people who can pay themselves and they get to
| leave their children an inheritance?
|
| While my parents who are in their 80s aren't rich, as an only
| child, I stand to gain _something_. I wouldn't be upset if they
| couldn't leave me anything because they needed it to be
| comfortable at the end of their life.
| buildbot wrote:
| Medicare Advantage is incredibly predatory and a misalignment of
| incentives. It pushes what should be a socialized program to the
| free market, which abuses it and rejects care in order to turn a
| profit.
|
| It's very funny people were worried about ACA "Death Panels". The
| insurers offering Medicare advantage basically have doctors on
| their payroll acting exactly as people feared, except it's the
| free market so somehow that's okay?
| Racing0461 wrote:
| It's the trolly problem.
| EvanAnderson wrote:
| I've observed that, too. "Death panels" conducted in public by
| parties appointed by accountable representatives are somehow
| repugnant, but having decisions made by completely
| unaccountable and inscrutable bodies is somehow okay. These
| decisions have to be made, why would we not want them made
| under some amount of public scrutiny?
| buildbot wrote:
| Exactly. The sad reality is in any (mostly) closed system,
| say, the USA or even earth, there are resource limits and you
| might be able to do more good by treating 4 patients with
| more simple cancer's vs. 1 patient with a very complex cancer
| that requires 10 doctors, 20 scientists, and endless support
| staff working over months to create a personal gene therapy
| for you. It's difficult and sad, but as a sibling comment
| said, it's literally the Trolley problem. Until we live in a
| utopia with nearly limitless resources, then the problem
| still applies, in both the public and private sector. I'd
| rather have it be public too.
| TehCorwiz wrote:
| You're assuming that the efforts don't feed back into
| knowledge and treatment for other people when in reality it
| does. But even outside that extreme example people are
| regularly denied treatment for existing easily treated
| ailments.
| fragmede wrote:
| That assumes the 10 doctors and 20 scientists and support
| staff are fungible resources. Which they are not. Those 10
| doctors have 10 different specialties and those scientists
| aren't going to suddenly become nurses that can administer
| the simple patient's therapies. Advances made in creating
| customized gene therapies will be used to help others,
| later.
| xkekjrktllss wrote:
| You're making an argument for a more organized society,
| not a less organized society.
|
| In your example, the solution is not letting 9 more
| people die but rather having a greater number of
| generalized doctors, in place of some specialized doctors
| if need be.
| fragmede wrote:
| my point is more that the less organized society that we
| have which lets people choose their own destiny leads to
| one where we don't have the generalists to save the 9, so
| it's less of a trolley problem because of the difference
| in urgency.
| xkekjrktllss wrote:
| You are failing to make your point. You think these
| people are choosing to die? What urgency are you talking
| about? You aren't making sense.
| konschubert wrote:
| That's why we need economic growth
| dragonwriter wrote:
| > but having decisions made by completely unaccountable and
| inscrutable bodies is somehow okay.
|
| They are accountable--directly and exclusively to capital--
| which is both why they are okay to the people funding the
| political propaganda in question and why the alternative
| (where that is not true, since there is, at least indirect,
| democratic accountability) is not.
|
| Capitalism and democracy are different, and fundamentally
| conflicting, systems of organizing power. This is often
| overlooked because capitalism is described as "economic" and
| democracy as "political", but those are different ways of
| describing systems of organizing power over others which is
| fungible between domains.
| phpisthebest wrote:
| >>conducted in public by parties appointed by accountable
| representatives are somehow repugnant,
|
| Well this where you find the problem, to me and many many
| others choosing a medical / insurance providers from an array
| of medical / insurance providers seems to provide MUCH MUCH
| more accountability then "parties appointed by accountable
| representatives " who are not really accountable at all, and
| whom elections are based on any number of issues very rarely
| would be the status of medical dealth panels, for the US
| currently would the "hot button" topics of the day (and for
| the last several decades) immigration, abortion and gun
| control
|
| This mythical idea that elections are how we hold the
| unelected bureaucracy in check has many many many examples of
| being completely and utterly false, unelected bureaucracy has
| ZERO fear of the election cycle most of the time. Meet the
| new boss, sames as the old boss, and almost none of them
| every leave.
|
| Of all the industries government bureaucracy has some of the
| longest tenured employees next only to education where once a
| person joins an agency they never leave until death or
| retirement. The Rare Exception is the regulatory capture of
| ruling making boards and committee's where there is a
| revolving corrupt door between the public and private
| sectors.
| WalterBright wrote:
| It's not a free market. The government funds it.
| jack_h wrote:
| I really don't know much about Medicare so I decided to visit
| the wikipedia page on this. Here is how it describes Medicare
| Advantage:
|
| > Medicare Advantage (Medicare Part C, MA) is a capitated
| program for providing Medicare benefits in the United States.
| Under Part C, Medicare pays a sponsor a fixed payment. The
| sponsor then pays for the health care expenses of enrollees.
| Sponsors are allowed to vary the benefits from those provided
| by Medicare's Parts A and B as long as they provide the
| actuarial equivalent of those programs.
|
| > Plans must be approved by the Centers for Medicare and
| Medicaid Services (CMS). If a MA plan changes some benefits,
| the savings must be passed along to consumers by lowering co-
| payments for doctor visits (or any other plus or minus
| aggregation approved by CMS).[2] Coverage must include
| inpatient hospital (Part A) and outpatient (Part B) services.
|
| > Original Medicare and Medicare Advantage pay healthcare
| providers differently. Original Medicare typically reimburses
| healthcare providers with a fee for each service.[5] This fee
| is often calculated with a standard formula (for example, the
| prospective payment system for hospital services). Providers
| either accept Medicare's reimbursement rates or opt out of the
| program.[5] Public Medicare Advantage plans negotiate payment
| rates and form networks with healthcare providers, similar to
| private health insurance plans that almost all Americans not of
| Medicare age use.
|
| Is it that last part that turns this into the "free market"? My
| lay reading of just the wikipedia page doesn't give me the
| impression that any part of this is subject to free market
| forces. What am I missing?
| borski wrote:
| Yes, it's the last part. Medicare has set prices it will pay
| [0], period, and Medicare is not prone to denying procedures
| that a physician thinks is necessary. This is a public
| socialized good.
|
| MA plans negotiate with providers, similar to a regular
| commercial insurance company, for different "deals." As you
| may be aware from commercial insurance, that typically means
| higher rates, since everyone along the line has to get paid
| across the providers and the insurance companies. Much higher
| profit motive than a socialized good.
|
| On top of that, MA plans have an incentive to deny coverage
| wherever possible, because as a for-profit entity they want
| to make as much money as possible, not get old people
| healthier.
|
| Young people have trouble fighting insurers on denials. I
| know this firsthand. But it's doable, because we tend to have
| more energy and less cognitive impairment; I'm generalizing
| here, but dementia is a thing that happens to a lot of people
| in old age, for example.
|
| For older people, fighting insurance companies is just about
| impossible. Often, this falls on their younger family members
| to help (ask me how I know, lol), but that implies their
| family or friends are _willing_ to help. Not everyone has
| that.
|
| And it shouldn't be that way.
|
| [0] There is a thing called Excess Charges that providers can
| charge, if they don't accept the Medicare fee table, but
| still accept Medicare generally. They have to tell you before
| the service, or you are not responsible. It is also capped at
| 15% of the service, and is illegal in some states entirely,
| and capped lower in others. Some Medigap plans also cover
| excess charges, but they are on the more expensive end.
| pdonis wrote:
| "Profit motive" is _not_ the same as "free market". In a
| free market in health care, the only way to make profits
| would be to provide genuine services that are of value to
| the patients who are paying for them. In our actual system,
| lots of profits can be made by specializing in working the
| system that has been put in place by the government, to the
| detriment of patients.
|
| I totally agree that it shouldn't be this way. I just don't
| agree that the way to fix it is more socialized control by
| the government.
| Tagbert wrote:
| A free market involves choices, information, and the
| ability to change choices based on that information.
|
| With health insurance the choices may be limited, you
| have very little information about what things cost and
| whether insurance will cover a given procedure. Most
| people are not educated well enough to be able to
| properly evaluate their options. You are only able to
| change your choice once a year.
|
| This is a free market in name only. But the impact of
| choosing incorrectly is very expensive.
| borski wrote:
| The US government did not invent insurance. If a company
| wanted to compete with an existing insurance company but
| do it differently, they can already do that; direct
| primary care offerings exist right now.
|
| Healthcare, when coupled with a profit motive, offers
| misaligned incentives, period. Getting people healthier
| for cheaper doesn't make a healthcare company money.
|
| That is why I believe basic healthcare _should_ be
| socialized. That doesn 't mean we can't have private
| companies offering countless other medical services or
| additional insurance, but nobody should be getting denied
| a cochlear implant because they are deaf due to
| 'paperwork issues' for months or years until they die.
| pdonis wrote:
| _> The US government did not invent insurance._
|
| I never claimed it did. My claim is that what we call
| "health insurance" in the US is not just insurance; it is
| a bundle of insurance (coverage for high cost unforeseen
| events) with other things that aren't insurance, but have
| to be bundled with it because the government says so.
|
| _> direct primary care offerings exist right now._
|
| Yes, they do, but they are hamstrung by the fact that the
| US health care system disincentivizes patients from using
| them. If _all_ primary care in the US was provided by
| such places, and patients paid the costs directly, _that_
| would be a free market, at least in primary care. But
| that 's nothing like what we have. It's certainly nothing
| like what Medicare Advantage, which is the subject of
| this discussion, provides.
|
| _> Healthcare, when coupled with a profit motive, offers
| misaligned incentives, period._
|
| Not in a free market. Health care in the US before WW II
| _was_ provided by private companies (or individuals like
| doctors with their own practices), for profit, and worked
| better, given the technology of the time, than what we
| have now. What ended that system was laws passed during
| WW II that fixed wages, which meant that companies could
| not compete for labor in a free market by offering higher
| wages. So companies looked around for other benefits they
| could offer to compete, and health care was an obvious
| one. And then after the war the government decided to
| regulate the company-provided health care instead of
| ending it and restoring a free market.
|
| What offers misaligned incentives is the bastardized
| system we have in the US, which combines the worst
| features of for-profit with the worst features of
| socialism. The for-profit part is not visible to the
| actual patients--as I have already pointed out upthread,
| patients have no idea what the services they are getting
| actually cost, so they have no idea whether they are
| worth what they cost. The socialized part is what
| patients see--the services available to them are
| determined by their health "insurance", not them--but
| decisions are made by third parties who have no skin in
| the game and suffer no consequences when they make bad
| decisions that cause harm to patients.
|
| _> nobody should be getting denied a cochlear implant
| because they are deaf due to 'paperwork issues' for
| months or years until they die._
|
| Of course not. And this would not happen in a free
| market. It happens because we _don 't_ have a free market
| in cochlear implants, we have a non-free market system
| with misaligned incentives, as I described above.
| IG_Semmelweiss wrote:
| Its not free market but its technically more choice.
|
| Basically its taking a subsidy (Medicare funding") and
| offering it to 3rd parties willing to offer equal value, but
| shuffled around so the benefits are "chosen" by patients who
| know what's best for them.
|
| Here is the secret: in almost all cases, regular medicare is
| better for most patients. You may pay more upfront (coins,
| copay) but there are fewer surprises.
| borski wrote:
| If they incentivize every insurance company the same way,
| and in the same amount, it is still a free market. The
| playing field is still level.
| CalChris wrote:
| Traditional Medicare pays most but not all of covered
| health care costs. So to cover the gap in coverage there
| are private standardized Medigap plans. Plan G has no
| copays, coinsurance or deductibles except for the Part B
| deductible ($240/yr). Love Plan G.
|
| I would argue that Traditional Medicare has much more
| choice; most doctors+hospitals and all ERs accept Medicare
| Assignment. You can also go to the Mayo Clinic, Cleveland
| or Cedars Sinai with TM but rarely with MA.
| CalChris wrote:
| Medicare Advantage is not more of a free market than
| Traditional Medicare. Both restrict their markets but in
| different ways.
|
| MA restricts your access to doctors and sets fees. Someone on
| a Kaiser Permanente Medicare Advantage plan won't be able to
| go to the Mayo Clinic but the Mayo Clinic and Cedars Sinai do
| accept Traditional Medicare. In addition, you'll need
| preauthorization ("Delay, deny, die") from the insurance
| company for many procedures.
|
| On the other hand, TM sets the fees to what is called
| _Medicare Assignment_ (and also allows something else called
| _Excess Charges_ ). But any doctor can accept Medicare
| Assignment. At UCSF, I need a referral for a colonoscopy for
| which Medicare pays Assignment but then I don't need a
| preauthorization from Medicare for that.
|
| My elevator argument for Traditional Medicare (A+B+G+D) and
| against Medicare Advantage (Part C) is: why
| would you want to spend the rest of your life arguing
| with an insurance company?
| jasode wrote:
| _> My elevator argument [...] against Medicare Advantage
| (Part C) is: why would you want to spend the rest of your
| life arguing with an insurance company?_
|
| It's an affordability issue so it's not as simple as you
| laid it out.
|
| Some corporate-sponsored health benefit plans for retired
| ex-employees _pay 100% for Medicare Advantage_ and not
| Traditional Medicare + Medigap.
|
| The UHC Medicare Advantage has some aspects of "Medigap"
| included in that plan and 100% of that total premium is
| reimbursed by the company.
|
| So choices are:
|
| - $0.00/month for Medicare Advantage
|
| - $2100/year out-of-pocket for Traditional Medicare + $$$
| extra for Medigap
|
| That's the tradeoff math that some seniors contend with.
| Some choose to hypothetically _" argue with an insurance
| company"_ because they don't have $2100 to spare.
| CalChris wrote:
| No, it's not an affordability issue and you're not
| getting something for nothing. First, you assign your
| Medicare benefit over to a corporation who then covers
| your health care costs _at their discretion_. Then you
| 'll pay your Part B premium ($174.70/mo) out of your
| Social Security benefit. So you will have the magical
| illusion of a $0.00/mo premium and the insurance company
| then makes a substantial profit to boot.
|
| I spend about $300/mo for A+B+G+D. My OOP max is the $240
| Part B deductible (except for drugs but I only take a
| statin). That will go up over time, Community Pricing. I
| have no preauthorizations, no copays, no coinsurance.
|
| And generally no paperwork. When I went to my UCSF PCP
| for a sprained MCL, I made an appointment a few days
| later. I showed up and said who I was. A few minutes
| later I saw the doc. After that I walked out. The wallet
| stayed in the pants and I didn't fill out a single form.
| A colonoscopy had a little paperwork, disclosures and
| actual ID. I watch the billing on MyChart, but it's a
| spectator rather than participatory sport. It's UCSF vs
| Medicare and it settles in a month or so.
|
| A+B+G+D is by far the best health insurance I've had in
| my life.
| pdonis wrote:
| _> Is it that last part that turns this into the "free
| market"?_
|
| No. "Having private companies do it" is not the same as "free
| market". Nor is "for profit".
| scarface_74 wrote:
| So how do you fully socialize a program and balance supply and
| demand?
|
| Don't get me wrong, as someone who saw first hand the shit show
| of the pre ACA, something had to be done.
|
| I was laid off right before the ACA took affect and couldn't
| get insurance at any price because of a non life threatening,
| no treatment needed then or in the future preexisting
| condition. I was healthy as a horse and had just run my first
| two half marathons.
|
| COBRA wasn't an option because the company I was laid off from
| went out of business. I had a well paying contract job and I
| could have afforded to pay out of pocket premiums.
|
| I ended up marrying my now wife six months earlier than we had
| plan to get on her insurance (her idea).
|
| But the challenge is end of life care and you will always have
| to make cost/benefit trade offs.
| pdonis wrote:
| I'm no fan of Medicare Advantage (or indeed of Medicare in
| general), but it is not a "free market" program. It has the
| same problem all socialized health care programs have: the
| people who are actually getting the care, patients, have no
| idea what it costs, so they can't judge whether the care they
| are getting is worth the cost. A free market program would be
| one in which the patients paid the costs directly and could
| shop around for the best deal, just like in the rest of the
| free market. If you want to help people who might not have the
| money to pay those costs directly, the obvious thing to do
| would be to subsidize them, the way we subsidize food purchases
| now for the poor with food stamps. Food stamps just give people
| a monthly sum they can spend on food; they don't go and
| negotiate prices with all the grocery stores and then argue
| after the fact about whether a particular food purchase was
| covered.
|
| It is true that in some situations, like emergencies or
| accidents, patients can't shop around. That kind of situation
| is indeed what insurance is for. But programs like Medicare,
| and indeed socialized health care in general, go way beyond
| insurance. Insurance is for high cost unforeseen events. Most
| health care is not high cost unforeseen events; it's foreseen
| events like physicals, shots, checkups and prescriptions for
| chronic conditions, etc., or low cost unforeseen events like
| getting an infection and needing treatment. If all of those
| things were provided in a free market, health care providers
| would be much more efficient, and it would be much easier to
| negotiate reasonable terms for insurance for the truly high
| cost unforeseen events that insurance is for. Medicare
| Advantage (and Medicare and socialized health care in general)
| is of course nothing at all like that.
| tcbawo wrote:
| It's very difficult to shop around when there are few options
| to shop around at. Also impeding the free market is a low
| supply of medical expertise. There has been a lot of
| consolidation in provider networks and systems. Many doctors
| and nurses have been leaving the profession due to stress,
| overwork, liability insurance, etc.
| pdonis wrote:
| All of the issues you describe, which are all valid issues,
| are consequences of the _lack_ of a free market. Medical
| expertise is not provided in a free market; doctors have to
| be licensed by the government. Consolidation of companies
| is due to the fact that there are economies of scale to be
| had when your company has to specialize in government
| contracting and lobbying (the consolidation of defense
| contractors over decades has happened for similar reasons).
| Doctors and nurses are stressed and overworked because
| their supply is limited (due to licensing, as above) and
| because limited time and tons of bureaucracy due to all the
| third party players involved (players that wouldn 't even
| have a say in the process at all in a free market) gets in
| the way of caring for patients.
| fastaguy88 wrote:
| > It has the same problem all socialized health care programs
| have: the people who are actually getting the care, patients,
| have no idea what it costs, so they can't judge whether the
| care they are getting is worth the cost.
|
| Let's imagine (unrealistically) that through some technical
| breakthrough, patients knew the cost before making their
| purchasing decision. They still do not know what it is worth,
| because they have no idea what the risks of not being treated
| are. There is a problem that your doctor also probably does
| not know the cost, but they are the only person in the
| decision making process with the information necessary to
| make a rational recommendation. (And, unfortunately, they
| usually have a conflict of interest.)
|
| Healthcare is different from buying cars or groceries - even
| if you know the relative costs, you are unlikely to know the
| relative benefits.
| pdonis wrote:
| _> They still do not know what it is worth, because they
| have no idea what the risks of not being treated are._
|
| I disagree; I think that in most cases patients do have a
| reasonable idea of the risks of not being treated. Where I
| think risk information is often not communicated very well
| to patients is in the risks of _being_ treated--what the
| actual success rate of the treatment being proposed is.
| That is because in our non-free-market system, doctors have
| a strong incentive _not_ to let patients know what their
| actual success rates are, and there is nothing that can
| counterbalance that. In a free market, they might still not
| want to, but they would have no choice, because that
| information is valuable enough to patients that if doctors
| don 't provide it, someone else will. (Other parties try to
| do that even in our current system, but they are limited in
| what they can do by legal restrictions imposed by the
| government.)
|
| _> [Doctors] are the only person in the decision making
| process with the information necessary to make a rational
| recommendation_
|
| I disagree with this as well. My experience with doctors
| has been that I usually know more than they do about my
| particular condition. (My wife, who has several chronic
| conditions, has had this experience even more strongly than
| I have.) I may have less overall knowledge of all medical
| conditions in general, but that's because I don't treat any
| patients other than myself, while they have to treat lots
| of them. But I have a strong incentive to learn about _my_
| particular condition that my doctor does not have, and that
| usually beats the doctor 's general knowledge.
| toast0 wrote:
| > Food stamps just give people a monthly sum they can spend
| on food; they don't go and negotiate prices with all the
| grocery stores and then argue after the fact about whether a
| particular food purchase was covered.
|
| Not taking away from your general argument, but only some
| food assistance programs are like that: an allowance you can
| use on any approved item; others are more like a coupon for a
| certain size container of (a specific type of) milk, butter,
| eggs, etc.
| pdonis wrote:
| _> only some food assistance programs are like that_
|
| As far as I know, food stamps, which work the way I
| described, are what the vast majority of people in the US
| who get a food subsidy at all have. I'm not familiar with
| the other programs you describe; can you give some
| examples?
| grogers wrote:
| > The inspector general's office found that 13% of the denied
| requests for treatment it reviewed and 18% of denied claims were
| for care that should have been covered.
|
| That is a lot lower than I expected based on the rest of the
| article. Maybe still a bit too high for false positives, but it's
| not outlandishly high. Those numbers make it seem like the
| insurers are doing a lot better job at avoiding unnecessary
| treatment than the doctors and hospitals are doing...
| Guvante wrote:
| Don't assume Medicare is denying zero claims. That is certainly
| not the case.
|
| 87% of denials aren't fraudulent does not mean they caught all
| of those and Medicare would have missed them.
|
| Also remember that counting claims is weird, they could
| literally be making their "profit" off these incorrectly denied
| claims.
| candiddevmike wrote:
| What's the difference between adjudicating unnecessary
| treatments and "death panels", especially for senior care?
| kmeisthax wrote:
| There is no difference. "Death panel" is just a scary
| sounding term for the institution that adjudicates
| unnecessary treatments.
| fragmede wrote:
| "Death panels" is a memetic phrase used by propagandists to
| get people worked up against "Obamacare". It's frustrating
| to see people not be able to see through their schemes.
| EvanAnderson wrote:
| "Death panel" is a term contrived by a small number of
| people, who have enough money that they will never be denied
| care, to scare people who might have enough political will to
| make the system based on something other than having money.
| WalterBright wrote:
| The rise in healthcare costs started in 1968, when the government
| instituted programs to reduce costs.
|
| The highest cost industries in the US are the ones that had
| reasonable costs until the government stepped in to reduce those
| costs:
|
| 1. education
|
| 2. health care
|
| 3. housing
| specialist wrote:
| You're referring to the Civil Rights Era and LBJ's Great
| Society.
|
| On the flip side, had we extended equal rights and
| opportunities from the drop, our GDP would have grown that much
| faster. IIRC > $1.5T per year.
|
| In other words, not paying up front cost us more long term.
| jmyeet wrote:
| Pretty much everyone recognizes the exploitation, immorality and
| injustice in the brick kilns in India, Pakistan and Bangladesh
| [1]. This is called _debt bondage_. This is a harsher form of
| _indentured servitude_ [2]. Interestingly, such practices were
| made explicitly illegal (along with slavery) with the Thirteenth
| Amendment.
|
| Yet many of the same people can't reognize that the systems we
| live under aren't that different. As long as someone has a
| smartphone and a PS5, they seem to become oblivious to their
| chains.
|
| Every aspect of your life is designed to extract wealth from you,
| primarily through debt. Student loan debt, medical debt, end-of-
| life care, housing debt. Many of these things used to be free or
| very cheap.
|
| The US health care system is just wealth extraction and rent-
| seeking.
|
| [1]: https://www.antislavery.org/what-we-do/past-
| projects/india-d...
| romafirst3 wrote:
| Best healthcare in the world.
| cscurmudgeon wrote:
| It is though, if you have semi decent insurance. That's why
| even US-hating communists come to the US on tax payer money.
|
| https://english.mathrubhumi.com/amp/news/kerala/kerala-cm-sp...
| jewayne wrote:
| It's not, even if you have good insurance -- and almost
| nobody does these days, EXCEPT the elderly. Sure, we're
| world-class at a few high-profile things, but you'll note
| that things we are good at are immensely profitable. Because
| right now, the stated primary goal of our health system is
| profit maximization.
| cscurmudgeon wrote:
| I provided a link backing my point and you didn't. Sure,
| believe what you want lol.
| jewayne wrote:
| Oh, I clicked the link about the government official from
| India. It does a great job of illustrating my point. A
| wealthy cash buyer of specific health services is going
| to get world class treatment at Mayo or Hopkins. How many
| Americans does that describe?
| tzs wrote:
| On the other hand we also have a lot of Americans who go to
| other countries for medical care [1]. Destinations include
| Argentina, Brazil, Canada, Colombia, Costa Rica, Cuba, the
| Dominican Republic, Ecuador, Germany, India, Malaysia,
| Mexico, Nicaragua, Peru, Singapore, and Thailand.
|
| [1] https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-
| abr...
| Nifty3929 wrote:
| I think that has lees to do with quality of care and more
| to do with availability or cost of care. We may have
| regulations that make it hard for people to get certain
| treatments, or much more expensive.
| bradleyjg wrote:
| Of course doctors don't like it. Insurance companies are the only
| entities willing to stand up to their cartel. They want to
| continue collecting monopoly rents without anyone saying boo.
| qgin wrote:
| In what way are doctors a monopoly?
| Centigonal wrote:
| Insurance companies aren't their own even worse cartel?
| ars wrote:
| No, they are not. First their profits are capped by law, and
| second the entire reason these plans are so popular is
| because they are cheaper. And why are they cheaper? Because
| insurance companies are pushing back against doctors and
| hospitals.
|
| And since cheaper is a good thing, I don't think you can call
| them a "cartel", unless you mean a "cartel trying to lower
| prices".
| qgin wrote:
| >inappropriate care by catching unsafe or low-value care, or care
| not consistent with the latest clinical evidence
|
| Part of the issue is that doctors use clinical guidelines as
| baseline best practice document (but then have to care for
| patients who do not fall neatly within the parameters of the
| guidelines), while insurers use clinical guidelines as a ceiling
| for care (but then use the attributes of patients which don't
| fall neatly within clinical guidelines as a reason to deny
| coverage).
|
| Yes for 80% of situations, the effect is the same. But for the
| 20% of situations which fall outside of that it's a rough scene.
| medicare_senior wrote:
| I'm in Massachusetts, have been on a BlueCross BlueShied Medicare
| Advantage PPO for almost 2 full years now. So far I'm very
| healthy, only see the doctor 1x per year.
|
| For the same cost ($175/month) as traditional Medicare, I get the
| following extras: free tier 1 drugs, $1,000 in free medical
| supplies per year (everything from band-aids to heating pads),
| $500 toward fitness or weight-loss programs and $1,000 in dental
| care coverage. My out-of-pocket maximum is $5,600 if I do get
| something serious.
|
| If I go with regular medicare and want to limit the downside I
| have to buy a Medicare Supplement plan for an additional
| $196/month. The major benefit of this route is that I can be
| anywhere in the US (and internationally although I'm not sure
| what level of care that is) and get treatment without having to
| jump through hoops or travel back home.
|
| It's hard to turn down the Advantage program's $2,500 of free
| services and instead spend $2,350 to get the additional coverage.
| Yet the Advantage program costs taxpayers more, hurts providers
| and gives off an increasingly sleazy money-grabbing vibe. Ind the
| end it seems to me like the insurance companies are using tax
| money to pay seniors to help the insurance companies siphon more
| money out of the system.
|
| [edit: clarified that medicare supplement plan cost is additional
| to the regular plan cost]
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