Throwaway05
6mo ago
Anything that happens in a hospital involves scores to hundreds of people, the prices aren't inflated because of the drug, they are inflated because the drug needs to be tracked, stored safely, administered to you and so on. Those things are expensive a big piece of that is actual common sense stuff (making sure that expired ones are thrown out, that things that need to be in a fridge are kept at the right temperature), a good chunk of it is regulatory requirements (again some of which are probably good and helpful others are more questionable).
Because of the number of staff and safety standards and so on, the hospital is intrinsically super expensive which is why we try and keep people from going to the ED or hospital if they can avoid it.
We are also frequently basically forbidden by law or fear of tort from being cost aware.
Throwaway05
6mo ago
Yeah if your wood works just fine in other contexts it's almost always a psychological problem. What that can mean is super variable. Maybe you are stressed. Maybe you aren't getting enough sleep. Maybe you find your new partner intimidating. All of this can happen in the background without you realizing it, especially if you don't have good insight into how you function (common in people who don't need that most of the time!).
Still may be worth discussing with your doctor.
Something to consider is that you are getting older. Sometimes that means a mild decline in functioning that feels like a big decline in functioning which leads to a more "real" big decline in functioning.
Throwaway05
6mo ago
The short version is that it's the same thing happening elsewhere in the economy - economies of scale, regulatory burden, lobbying efforts. All these things kill small businesses.
Some examples in healthcare include the usual assaults on small business, the decline of competent secretarial staff (women have careers now! That's good but... (and doctors have stopped marrying people who can be there office manager for the most part)), requirements to have EHRs (easy for a big health system to implement and buy but not an individual practice), increased documentation requirements, and so on.
In the last few years private equity firms have come in and bought out many of the remaining private practices and physician groups. The owners are getting older and ready to retire so they sell it to PE, and that is one of the few ways to be profitable in healthcare (siphoning off physician pay).
The ACA is a complicated mess, I've heard to described in a million ways but probably my fav was "a poison pill that came with an antidote...but we didn't take the antidote.
Some of the stuff was expensive but ultimately the right call (like removing lifetime limits). Some of the stuff was expensive but actually likely efficient in the long run (forcing everyone to get EMRs/EHRs).
Yeah Epic made a ton of money along the way but its improved the doctor and patient experience (although the former don't always feel that way) and simplified billing greatly.
....but it was hugely expensive. And any time someone throws regulation in on healthcare it has a whole bunch of unforeseen side effects (and foreseen and lobbied for and abused side effects). Not that other regulation is too much better.
One thing we've seen from this stuff is the death of private practice - private practices are more nimble efficient, provide care more cheaply* and are more likely to do things like charity care, down billing and all kinds of other prosocial nonsense. Basically anything you hate about healthcare is probably something your doctor is forced to do because they are an employee.
Physicians were also banned from owning hospitals relatively recently, this was for a good reason - they were abusing that power in kickback schemes and other nonsense. However the replacement is business people, they are shit ton worse because they don't understand healthcare at all and can't make good decisions, and are just as interested in kickback schemes and so on but are much better at them because they are good at business.
Both of the above were massive own goals which probably made things significantly more expensive and didn't deliver the gains they were supposed to.
*granted some of the cheapness is generated by the environment allowing them to exist.
Edit: I thought I remembered the funding for EHRs coming from the ACA but fact checking myself I'm less sure.
Throwaway05
6mo ago
I find a good rule of thumb when it comes to anything is "if easy answers were to be had, someone would have done them." This definitely fucks me at times. I said no to Bitcoin in 2010. Many of my friends did not.
However usually most of the time the low hanging fruit is gone before we get there.
This is particularly important to healthcare - so much money is involved that you better believe that a ton of people have tried to get in and make some money or fix some problems. They almost always end up like Theranos. Google, Apple, Amazon, Microsoft, a shit ton of PE. At best most of them manage to come in and make a ruckus before the regulatory environment kicks them out for taking advantage.
Healthcare in general is weird and American healthcare in particular is uniquely weird. There's a lot of confusion, myths, lies, and well intentioned people trying to fix a complicated problem. Sometimes it more or less makes things worse (see: the ACA) but that doesn't mean it's not well intentioned.
If you have a specific line item you want to dig into have it, it's entirely possible that I'm wrong about something or was right about it 20 years ago and the situation has changed.
Throwaway05
6mo ago
Price transparency everywhere. The IT solution already exists to make it trivially easy to see "cost of MRI in USA" instantaneously everywhere.
30-50 percent of healthcare spending is hospital based (therefore minimal choice) and a good portion of the population is severely limited in terms of choice by geography. Furthermore people would instantly be pissed when the posted price is not what the bill says, which would be extremely common since a lot of crap goes into caring for a patient and we don't know in advance what we are going to see.
Invent "Uber for treatment' - you can book a course of treatment at any provider within whatever geography you want. You should be able to book an appointment on your phone in a few seconds.
How would this work? You can schedule with whoever you want now, but that doesn't mean they have any spots for you any time soon, it doesn't mean they take your insurance, it doesn't mean they are the correct type of doctor for you. You see things like entitled people with basic hypertension demanding to see a cardiologist for management and then burning up all the spot that cardiologist had for actually complicated cases that require cardiologist expertise. Patient's will also lie about it because they insist they need the "best care." Some healthcare systems and providers have online booking resources already, but again wait lists, and how are you planning on making doctors take everybody regardless of insurance? If you try and mandate government insurance you'll see entire specialties like Psychiatry just choose to go to cash only. OB would die as a specialty without tort reform.
More doctors. We had a thread earlier this year about the number of doctors in the USA being essentially a cartel operation. Limited residency spots set by the AMA and not updated for 20 years and all that.
This comes up all the time here and is still incorrect. Federal residency spot funding was supposedly frozen decades ago, but state and hospital specific funding has been expanding spots for years. The AMA doesn't really bother with supply restriction, their primary lobbying aims at present are actually woke bullshit and expansion of supply (in the form of midlevels). I've been banging my drum in an attempt to correct this inaccuracy for years but it doesn't seem to stick.
More doctor-by-LLM for routine stuff. 50% of "disease" in America is diet, exercise, lifestyle. I'd venture a wild guess that another 10-20% is real but routine stuff; pneumonia, flu, skin stuff, broken bones without life threatening complications etc.
Generally you don't pay the doctor to manage routine disease, you pay the doctor to manage complicated disease yes but also to know what is routine vs. complicated. Ruling out things that look very close to other things is what the training is for and something that midlevel and other non physician staff constantly fuck up. People would be furious if their family member died a preventable death because of something that is an atypical presentation or a common mimic. Physician work also involves a side helping of preventing people from hurting themselves. This includes the obvious like suicidal ideation but also things like people pursuing risky treatments, not understanding "yes the bad outcome could happen to you" and so on. Algorithmic support is not good at managing these tensions.
People get to see and own their electronic health records. This feeds into the doctor-by-LLM. In fact, I could see a really awesome scenario in which people could (voluntarily) plug their electronic health records into a service, much like credit monitoring, that is always analyzing your data for deeper problems. And/or offering nudges for better health lifestyle choices.
Much of this is actually already available now in one form or the other, although with room for improvement. Your hospital has access to your outside records unless either hospital involved makes a choice not to (well more or less). Algorithmic support tools are under investigation current but are mostly pretty poor for now.
Pharmacy-by-mail for a lot more stuff. I can see this not being allowed for drugs that can have really bad interactions with other stuff, or painkillers because gestures to opioid crisis
Depending on your insurance company they are already doing this now and they like it a lot. The why for them is a complicated interplay between insurance companies, big Pharma, and retail pharmacies. It's more convenient for patients but is seeming to end up not actually being any cheaper. It also seems to result in an increase in intentional and accidentally overdoses, drug interactions resulting in morbidity and mortality, and a decline in retail pharmacies (especially independent ones).
Break down state-by-state insurance fences. People aren't magically more or less healthy in Colorado, Minnesota, Georgia, or Maine.
Meh, no dog in this fight. Although it is worth noting that some states are healthier than others (chiefly obesity rates) and care is more expensive in some places for a variety of reasons.
Auto insurance considers your make and model and year. Medical insurance should do the same. Check-ups (for insurance purposes) annually. No survey or self-reporting. Height, weight, blood work, treadmill or other cardio fitness measurement. If you can't run, walk. If you can't walk (and aren't a paraplegic etc.) stand for as long as you can, or shuffle. Whatever. These reports go back to the insurance machine learning model to give you a quote. You pay it or you don't. If you can't afford insurance, you still know the price of the procedure down the road (see point 1)
Some insurance companies offer rebates to do this now and then will do things like sell your health data to third parties, and use nudges to say and avoid your prediabtes from becoming actually diabetes. If you very heavily peg insurance prices to health status then you'll rapidly price anyone with chronic disease out of the market. If only the healthy can get health insurance it rapidly becomes useless.
Throwaway05
6mo ago
Otherwise full price transparency and an easy way to look up prices for comparable services across all nearby providers.
This is viable for some services, but much of the expense in healthcare is unplanned and transferring between systems is hideously expensive and complicated. If you get hit by a car and end up in the ICU for three weeks and rehab for five months that's as expensive as thousands and thousands of doctor's visits, and price transparency doesn't help a lick. Even if you are awake and say "take me to the cheaper hospital" the ambulance is going to take you to the place you are triaged to, because if you die your family will sue the shit out of them and win.
Furthermore how do you want handle cost overruns. Let's say you get your appendix out and you shop around to whoever reports the lowest price (and it's urgent not emergent so you leave the hospital AMA to go to the cheaper place). Let's say 5k. What do you do when the surgery is a bit more complicated and expensive and the bill is 15k. What do you do when you have a major complication and the price is 1.5 million dollars? People would be furious! And if you want to just average out how much the hospital spent on all of those surgeries...well you've just reinvented general insurance again (since healthy/less complicated people are subsidizing the complicated).
Throwaway05
6mo ago
I think several of your comments center around "the current system has some huge gaping flaws" which...yeah no argument from me.
That's not what we are talking about though. Fundamentally United makes a ton of its money from fraud. Therefore I think any amount of profit is absurd. Stop committing fraud! They seem to have managed to dodge regulatory oversight somehow but that doesn't change that a lot of what they are doing is some combination of illegal, fraudulent, a breach of contract, or a scam. A higher percentage of stuff is deeply unethical but that is more questionable to criticize.
I have significantly less problem with them making money legitimately but until they do any amount of profit is absurd.
Some people (which may include you?) have a more winning focused attitude - if the system will allow the activity (illegal or not) than its fine, old school Sirlin stuff.
However if the system allows this kinda stuff you'll have gross negative externalities like the impending collapse of U.S. healthcare and the likely copy cat increase in violent populist activity.
I cannot tell you the number of times my interaction with an insurance company has boiled down to "yeah we were always going to cover this, as we were contractually obligated to, but I wanted you to spend 5-10 hours of your own time suffering to make it happen, maybe next time you'll just take the loss or tell the patient they are better off paying cash for their medication."
Throwaway05
6mo ago
Again, this is true for every commercial company.
Most companies can say, cut some labor, reduce the cost of manufacturing, remove some features. If the product becomes terrible people will stop buying it.
That doesn't apply here.
United's business model is:
-You are forced to buy eggs from us from your employer.
-You pay a yearly fee for eggs.
-When you ask for the eggs. 1/3 of the time you get an egg, 1/3 the time you get an egg that expired a month ago, 1/3 the time you get no egg at all.
-Sometimes if you complain long enough they'll give you an egg a year later.
-They were required to give you a fresh egg by law, they just didn't do it.
-The CEO's job at most companies is to reduce the cost of eggs, or provide lower quality eggs. The CEO at a health insurance company is finding new ways to not give people the egg they paid for, and trying to figure out how to do this without getting the government mad.
-Things like PBMs and Medicare Advantage plans are flat-out scams somehow permitted by the government, likely through some form of regulatory capture that bring the system much closer to collapse. These are complicated but to briefly explain the latter, medicare advantages plans are when a private insurance company takes everyone healthy/cheap away from Medicare, gets paid to do so (as if they were unhealthy), doesn't cover their coverage when they do need it, and as soon as they actually get sick punts them back into the medicare pool. If that sounds ridiculous and like that couldn't be a thing....that's why it is a scam!
Throwaway05
6mo ago
LitRPG/Prog Fantasy Recommendations (other than 12 Below): Mother of Learning, Cradle, Dungeon Crawler Carl, The Perfect Run (anything else by that author), The Game at Carousel. I find those all to be a higher tier than the rest.
I find those all much better than the rest.
Re: clinical work. Don't feel bad about not jumping in, medicine and adjacent fields are some of the most interesting stuff there is, but the life is often awful, and it can be ultra draining. If you like where you are at, just read for fun and avoid the shit show.
Re: drugs and psychosis.
I suspect when we get more information and knowledge we'll find that most drugs (and I mean that beyond the ones that usually get fingered for this) can cause psychosis, temporarily, and rarely permanently.
And at the same time we'll find that most drugs can provide a second hit to a genetic and behavioral predisposition to psychosis (chiefly schizophrenia).
As it probably does both....who the fuck cares keep these mother fuckers away from drugs.
In my experience people who are predisposed to psychotic illness (outside of atypical situations like an otherwise normal college student go on a caffeine and sleep deprivation bender pre-finals) look like they could end up psychotic. Odd affect. Weird thoughts. Seems a bit off. Keeping these people away from drugs is probably reasonable harm reduction and prevents Jimbob Chad the tech bro from being annoyed at hearing "MJ bad" after we just sorted out that its totes fine.
I think we are mostly on the same page.
I think it would be helpful to know if you are steel manning or not, because it I can adjust the level of detail here, American insurance companies are comically evil, United even uses a company called "EviCore" to automate the fraudulent denial process.
Outright fraudulent (but difficult to fine and prosecute) activity is rampant and the lobbying arms have created some truly excessive vampirism on the American population (ex: PBMs, Medicare Advantage plans).
Sure, I could always explain how I would better spend somebody else's money. My point here was however that these profits have been characterized as "absurd". I don't see how it is appropriate.
They are absurd because any amount of profit or excess spending involves making healthcare more expensive, lower quality, or outright fraudulent activity. Everyone Agrees American healthcare is fucked and this is one of the biggest causes and the place to save the most money.
Every cent of all those CEOs multi-million dollar salaries is involved in not creating a higher quality product, but siphoning away money from taxpayers while providing the lowest quality product they can, knowing they can take advantage of regulatory loopholes and the lack of this environment functioning as an actual market.
I don't think you could seriously defend the premise that this is the only thing they are doing.
Let me rephrase this, any amount of money over replacement generated by an insurance company is fucking over Americans. When Apple saves 5 cents on an iPhone the American people are missing out on 5 cents, when United saves 500 dollars on a patient that is money they were contractually obligated to pay that they managed to weasel their way out of (again, frequently fraudulently!) that the taxpayer, hospital, or patient is now on the hook for. It's much more directly a zero sum game.
I thought it was properly fixed in 2010?
I don't know anybody involved who thinks that except maybe some Obama democrats.
is one of the most thoroughly regulated industries of all,
Absolutely not. It is regulated, but given the constant unmanaged fraud and all kinds of malfeasance it is either regulated ineffectively, or more likely the regulations were written by the lobby. That seems more accurate given the way they manage to skate by on practicing medicine without a license.
they are profitable in the sense that they help some people get rich at the expense of Americans
I've already made my zero-sum pitch above, but I'll note that these companies function more like defense contractors. They do something that is important and benefits Americans but the money and influence they have is totally de-tethered from the actual value they bring to the table, a lot of regulatory capture is involved, and billions of dollars are constantly falling off of trucks and not benefiting anybody.
Certain industries shouldn't be profitable because that leads to cost-cutting and therefore death. I want my air-traffic controllers to be inefficient but safe as hell because the government has their hands so far up those guys asses. Healthcare is largely the same, but Health Insurance is not.
I'm not asking for the government to get involved and have single payor, that's a recipe for its own separate problems. I want things like CEOs getting paid a few million max, because maybe then you'll get CEOs who are less efficient and finding legal ways to commit fraud.
EDIT: This post says it much better than I could manage: https://www.themotte.org/post/1287/culture-war-roundup-for-the-week/276661#context
Throwaway05
6mo ago
Profit as in profit margins is not egregiously high, but 4-6 percent of hundred of billions of dollars is a lot of money that could be spent elsewhere.
Moreover financial success can be spent on the company - inflating salaries for executives, finding no need to trim administrative fat, more general reinvestment.
I'm usually pro-CEO pay. Let people like Elon make a fuckton of money if they are bringing value, but the insurance companies are only bringing value by fucking over American citizens are further destabilizing an already fragile healthcare system.
So they are profitable in the sense that they help some people get rich at the expense of Americans, not profitable in the sense that they have excess profit margins.
Throwaway05
6mo ago
Fortysomething is pretty late in the game to develop schizophrenia
May not be relevant to this specific person, but one of the common teaching points for Schizophrenia is that most people develop it in their late teens to early/mid 20s. But there is also a big bump in the 40s - for women specifically, often associated with menopause.
Significant stressors seemingly can cause the illness, which altered consciousness or medical illness associated with advancing age can provide.
Clearly waxing and waning course is something a little unusual because we do usually see gradually worsening symptoms, but slow vs. fast onset is a thing that happens often enough to be labeled a prognostic indicator.
Sidebar: I tried briefly checking your posting history to figure out if I'm mansplaining at you and saw a post where you mentioned 12 Miles Below. Impeccable taste!
I mean, here's some examples from the Joe Rogan subreddit of all places.
https://old.reddit.com/r/JoeRogan/comments/1hb0c2d/i_dont_care_how_he_grew_up_he_right/m1co69q/
Is this kinda stuff "illegal?" Probably, but you have to be fined or prosecuted enough to make it unprofitable for the companies to stop doing it. United is ahead of the curve of unethical behavior, and the system tolerates it for now, but it is unethical and it is fraud, they are just good at getting away with it for the moment (ish, considering recent murder).
It's very much like companies who ignore environmental regulations and just break the rules. Does it make the company money to break the rules? Yes, the fines aren't enough.
Is it bad? Also yes.
Edit: I should clarify why I'm saying this -> I think it's important to say that rampant fraud is not business acumen, even if you can get away with it. It's just unprosecuted criminal activity.
Throwaway05
6mo ago
Weed appears to work a little differently from most other substances, most substances mostly cause drug induced psychosis - you take the thing, you act like a crazy person, you sober up, uhhhh whoops OR you get some kind of medical derangement that involves substances. People with bad alcohol withdrawal having hallucinations is the common example of that.
Some things appear to cause actual psychiatric illness. Marijuana and synthetic marijuana are the biggest culprits here. This can manifest as drug-induced psychosis that takes a long, long time to clear (or never does), or as generation of typical psychiatric illness (like Schizophrenia). In the former case the onset is rapid, you get high...and crazy and stay that way. In the latter you seem to have some element of increasing/worsening disease over a variable onset.
This is complicated by the fact that we know the psychiatclly ill like drugs of all kinds (which includes everything from nicotine to Marijuana). Are they treating early prodrome symptoms with weed and the weed is a sign of illness instead of a cause? Were they always going to become schizophrenic and the weed makes it happen earlier? Were they at risk of getting schizophrenia and then get it because of the weed? We don't know yet.
It's also possible that most or all drugs of abuse cause this and we are only having a clear picture with the weed because it's now popular and legal in most places in the U.S.
I'm sure their is some research out there somewhere that feels it has clarified some of this (maybe something like looking at schizophrenia rates in places with recreational weed and without) but I don't think we have an excess of clarity.
Throwaway05
6mo ago
It shows up on the balance sheet somewhere, no?
Well not really, no.
Something to keep in mind is that healthcare combines some of the worst parts of business, government, and the academy (also some of the best at times, but nobody wants to hear about that haha).
For example often we are forbidden by law to take steps to save money. If someone walks into the ED with an emergency and says "you can do whatever you want but I ain't paying for it" ...we do our best to save the guy's life. Ethical considerations often increase spending. Risk aversion too - nobody wants to see a bad outcome, nobody wants to get sued for a bad outcome so we spend more to prevent both.
One of the benefits of the oddity is that most people involved in healthcare are mission and martyr oriented. Physicians do a ton of free work and are expected to do this. Every year for the last thirty years or so pay has gone down, work has gone up (generally administrative tasks like what we are discussing here). Medical complexity has increased thanks to advancements in technology. A lot of problems in healthcare have been solved with "fuck it the doctor will take care of it." It is common for admin staff to quit or get fired and no replacement is hired, they just expect the doctor to do it, is a normalized thing.
However because the doctor generates value by seeing patients and billing for clinical responsibilities (and not typically by hours worked), and its just assumed that administrative responsibilities get done, these kind of things can easily not end up on a balance sheet in a meaningful way (at least to the hospital, I'm sure the insurance company has spreadsheets showing an advantage from sketchy behavior). Things that a lawyer or accountant would bill for? Nope, untracked and unpaid.
Successfully getting through medical school and residency requires an enormous ability to put up with bullshit, do nonsensical things, and work insane hours. We make do until we can't. People might take three days of vacation and spend the entire time catching up on paperwork. A family practice doctor might be done seeing patients at 3pm and spend the next 3-5 hours on paper work and other responsibilities.
It is very common in healthcare to see truly absurd things going on because healthcare doesn't (and to some extent shouldn't) function like a business. You see academy woke/DEI bullshit, spending hundreds of thousands to millions of dollars on unrelated politics. You see a posting for a physician that remains unfilled for half a decade because they are offering 80% of regional salary expectations. Even knowing that hiring the physician would bring in 5 times the salary in revenue. It doesn't make financial sense, but they just do it anyway because anyone with actual business acumen wants to shoot themselves dealing with medical horseshit and avoids it.
One of the biggest examples of the post-COVID era was travel nursing. During COVID a lot of nurses were like okay I need a pay bump from 1 to 1.1. Hospitals were like fuck off. So the nurses quit, or unionized and went on strike. So the hospitals decided to bring in travel nurses that were being paid 5. And then kept them. For years. At any point they could have gone back and paid 1.1 and gotten the original workforce back. Nurses would quit their jobs, sign onto a travel agency, and then work at the same hospital they used to work at and make more than a physician. It was hilariously dumb.
But that's healthcare.
Throwaway05
6mo ago
On an academic note we still aren't sure if the marijuana causes psychosis, reveals occult disease, or causes disease to manifest earlier etc (although researchers certainly have opinions).
We do see a TON of people who superficially seem to have driven themselves crazy (in the short term or permanently) with weed.
It's not a high percentage of people but a certain population absolutely needs to avoid it.
Throwaway05
6mo ago
He was pronounced dead in the hospital.
I didn't follow this part of the case closely so I'm not sure if this applies here, but it is very common for someone to be "dead" for all useful purposes, but we don't formalize that until they end up in front of the Trauma/ED team and they've given up.
I've seen the EMTs bring in someone on a LUCAS who was stiff and cold but until the doctor takes a look at them...other staff don't want the responsibility/documentation/risk of getting it wrong.
Throwaway05
6mo ago
If you're going to lie about which numbers I'm asking for, we're going to sit here all day, and your final argument will be, "If I lie about what numbers you're asking for..., then..." We will just leave it there for posterity.
I did not lie about the numbers, all numbers you have asked for do not apply to the amount you pay and cannot be used to make decisions for that reason given your initial conditions.
If you would like to you change your initial conditions you can. For instance if you do not have insurance, you may be asked to pay an amount of money, which is mostly unrelated to the numbers you were asking for at most hospitals (but not always!).
In fact let us explain health insurance.
Health insurance is not like most bills you receive in your life. The numbers only peripherally matter to the hospital and the insurance company and don't matter at all to you.
You pay an amount (typically zero in the situation you proposed) but may include a small fee called a copay instead.
Your insurance pays the rest. The hospital charges a functionally arbitrary amount. The insurance company gives them a functionally arbitrary amount back.
If you have bad insurance they may try and make you pay some amount and claim it is not covered. This number has nothing to do with the health system and the health system has highly limited ability to know about this in advance. If your plan is very bad this number may be rather high. This is the gamble you play if you have a bad plan, but how bad your plan is between you and your health insurance company.
It occurs to me now that you may be complaining about high deductible plans. If this is the case you should have just asked that. If you are getting a surgery done and the question is "is this going to fuck my deductible" the answer is almost always going to be yes. This is a reasonable question to ask and I invite you to ask your surgeon this. The answer likely be "I am not in charge of your insurance plan, but yes." It does not require an exhaustive breakdown of anything.
Throwaway05
6mo ago
You can't even identify the numbers we are talking about without lying. We can't get to relevance if you're that clueless/nefarious.
If you think I have misunderstood what numbers you are asking for then it is your obligation to correct me and say "I was asking for this." I may then argue that you have changed what you are asking for (and you have), or that you have misunderstood what you are asking for (which is now my argument).
Accusing me of being wrong is reasonable and acceptable. Deciding this discussion is no longer worth your time is reasonable and acceptable. Accusing me of lying is not. If I am wrong, correct me instead of shouting "liar."
Throwaway05
6mo ago
I am not lying about which numbers you are asking for. I have responded to the numbers you have asked for, and explained that they don't do what you think they do and gave you a chance to correct my understanding with an example, were you able to furnish one. I even talked about numbers you didn't ask for, and explained how those might be more relevant.
I also tried to make it clear using a metaphor you have used in the past (automotive repair) and with a simplified scenario (the oranges discussion).
In both cases you accused me of "incoherent babbling."
You should not accuse someone of lying when what they are asking for is for you to explain what you mean, and to be clear what that is "explain what relevance the number you are asking for has to your decision making."
Throwaway05
6mo ago
You have asked for a number of representations of "price" none of which impact your personal bill. I don't think you understand how health insurance works.
I'm not lying about what you've asked for, but I don't think you understand what you asked for.
Throwaway05
6mo ago
The number you pay is zero, or some other number chosen by your insurance company and not the hospital. Great I've given you the number that is relevant to you.
The numbers you asked for are not zero, are not what you pay, and are not what your insurance pays. Those are not relevant to you because neither you nor your insurance pays them.
Throwaway05
6mo ago
Interesting point. You know I haven't seen anything that breaks out UHC separately from other private insurance, it is possible that the barriers involved actually move it away from the rest of them.
My suspicion is no because a lot of what they do is more an externality creation than explicit costs. Most doctors will be willing to stay late to try and get things approved for the patient. Doctors are almost always on salary for the purposes of this, and can't usually bill insurance for admin time the insurance generates (well we can but they never reimburse it). Nobody pays for said admin time directly, and the doctor would choose not take United but we are almost all employed now and have no choice.
Instead that doctor quits, goes part time, burns out and retires early or whatever. Doesn't show up in the balance sheet but is a bad outcome.
Certainly if your goal is to maximize shareholder value and so on whatever United is doing seems to work best, but we've already decided elsewhere that we aren't okay with people doing that in healthcare and it seems sketchy to let one of the more profitable actors do it.
I do think we have some low hanging fruit. Tort reform would dramatically reduce the instances of expensive low value care and could be done while still allowing patients to sue.
I don't have the states on me at hand right now but administrative bloat is something absurd, like 1:1 (with physicians) 50 years ago to 1:16 now.
A lot of this is driven by bedside nurses being burnt out and wanting a different job, we also have a bedside nursing shortage right now. One fix fixes another.
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