this post was submitted on 09 Dec 2024
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Private insurance companies have earned the public’s distrust. They routinely put profitability above their policyholders’ well-being. And a system of private health insurance provision also has higher administrative costs than a single-payer system, in which the government is the sole insurer.

But the avarice and inefficiencies of private insurers are not the sole — or even primary — reasons why vital medical services are often unaffordable and inaccessible in the United States. The bigger issue is that America’s health care providers — hospitals, physicians, and drug companies — charge much higher rates than their peers in other wealthy nations.

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[–] assassinatedbyCIA 77 points 1 week ago* (last edited 1 week ago) (2 children)

Anaesthesiologist take over your breathing and control your physiology when undergoing surgery. I want them handsomely compensated.

~~Edit: also let’s be honest here. Anthem isn’t going to take the savings from paying physicians less and pass them onto you the consumer. They’ll take the savings and issue a stock buyback.~~

2nd Edit: Turns out that the ACA has a provision preventing the pocketing of premiums. Thanks FlowVoid for pointing this out and unironically thanks obama. My first point still stands though.

[–] FlowVoid 21 points 1 week ago* (last edited 1 week ago) (1 children)

They’ll take the savings and issue a stock buyback.

They can't do that.

The ACA requires large health insurers to spend 85% of their income on health care providers. If they don't (eg because they start paying less to anesthesiologists) then the savings must be used to reduce premiums or give rebates to customers.

[–] assassinatedbyCIA 2 points 1 week ago* (last edited 1 week ago) (2 children)

Hmm I didn’t know this. But is there anything stopping health insurers from spending the money on businesses they own (i.e. their own clinics, pharmacies etc)? If not I still fear they’ll run off with the savings.

[–] [email protected] 4 points 1 week ago* (last edited 1 week ago) (2 children)

United Health actually bought a bunch of health care providers, so they basically own a good chunk of the entire 'vertical' and somehow still ended up denying record amounts of claims.

What I don't understand is why Americans are still looking to the federal government to solve the issue, instead of getting together and building a non profit co-op to deal with health care. Do the insurance part, gain market share by being the ones that actually don't deny valid claims, start/take over hospitals, start making your own generic medicine, etc. If you don't have to make a profit and appease shareholders you can take over the entire market. Local/state governments could provide some of the seed capital for this and make it the 'public option' in that state.

[–] dogslayeggs 5 points 1 week ago (1 children)

What I don’t understand is why Americans are still looking to the federal government to solve the issue, instead of getting together and building a non profit co-op to deal with health care.

You're surprised that normal people don't just start up their own multi-billion dollar corporation with assloads of liability and assloads of government oversight?

[–] [email protected] 1 points 1 week ago

It's how it's done in many countries. You can bootstrap off unions, churches, etc.

[–] FlowVoid 2 points 1 week ago* (last edited 1 week ago) (1 children)

instead of getting together and building a non profit co-op

The Blue Cross Blue Shield insurers are either nonprofits or mutuals (the shareholders are the policyholders). So are many smaller insurers.

But nonprofit insurers are subject to many of the same pressures as other insurers. They need to keep premiums low, and they would go bankrupt if they paid every claim.

Likewise, the vast majority of hospitals are nonprofits. But nonprofit hospitals have to pay for medicines, doctor salaries, etc too. Most are barely scraping by and can't fund clinical trials into novel genetic medicines.

[–] [email protected] 2 points 1 week ago (1 children)

Why would hospitals need to run clinical trials? Just provide the basic health care.

[–] FlowVoid 1 points 1 week ago* (last edited 1 week ago) (1 children)

Oops, I read "generic medicine" as "genetic medicine". I thought you were suggesting that hospitals start competing with pharma over new mRNA designs!

Yeah, you don't need a clinical trial to make generic medicine. But you do need special facilities, which most hospitals probably would be unwilling to pay for.

[–] [email protected] 1 points 1 week ago

It initially said genetic because of autocorrect, I just fixed it. And hospitals wouldn't need to be making medicine, you need to start a corporation, like those guys that are trying to make a generic insulin. If you start selling those with even a small profit margin everything else would come down. The issue is that profits get extracted by every middle man in the system.

[–] FlowVoid 2 points 1 week ago (1 children)

Well, when you deny a claim from a clinic you own then it's very likely your "savings" are losses for your clinic.

[–] assassinatedbyCIA 3 points 1 week ago (1 children)

I was thinking more along the lines of deny claims for clinics you don’t own but approving claims for clinics you do own. Effectively shifting premiums away from outside clinics and into your own pockets all while staying under the 80/20 rule.

[–] FlowVoid 2 points 1 week ago* (last edited 1 week ago)

Insurers already divide providers into in-network and out-of-network. They deny or pay very little for out-of-network providers, because they want their policyholders to stay in-network. The reason they prefer in-network providers is that they negotiate reduced/discounted rates with those providers.

Sure, they could outright hire those providers as employees, but that means they would have to start paying their entire salaries rather than just discounted fee-for-service. And that's not necessarily a good idea, because health care clinics are not very profitable. Basically, this is the same question facing everyone who has to choose between hiring an employee and paying a subcontractor.

That said, some insurers do run their own clinics and hospitals, notably Kaiser Permanente.

[–] FlyingSquid 5 points 1 week ago (1 children)

Sorry, they don't get handsome compensation. Not when they have to pay back those student loans.

The era of the rich doctor is over. Medical group and hospital CEOs are the ones getting rich these days.

[–] athairmor 29 points 1 week ago (2 children)

Anaesthesiologists are not having trouble paying back student loans. It’s one of the highest paid specialties.

This article is BS as was Anthem’s policy. But, anaesthesiologists are doing just fine. If you want to feel bad for an MD, try pediatric oncologists or another specialty that isn’t in high demand.

[–] twistypencil -2 points 1 week ago

My cousin is one, he is not wealthy. He is solid middle class, not sure it's about putting workers against workers here