I’ve been on the selection side as an employer and several others will probably echo what I’m about to say.
Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable. United was quoted to me as almost 20% lower than current rate for our provider (before they are about to go up 20%).
On premium alone they will save some people close to $500 / month for what is…”on paper” the same coverage.
I’ve read all of the same stuff about United that everybody else has but the finances put employers in a very difficult position.
I feel people defend them by opposing any other approach to solving this. Politicians in particular say things like "preserving customer choice", which I think just means having the ability to select among all the terrible insurance companies who will treat you poorly.
That excuse doesn't even hold up because in places like the UK which have universal healthcare, private health insurance still exists alongside it as a "premium" option. That's more choice!
And shouting about "death panels" in public healthcare systems, as if the private insurance companies don't have people whose whole job is denying as many claims as possible
Yeah. The biggest difference is you can elect the public healthcare death panels, or call your senator or representative to lean on them. There's not a thing you can do about the private insurers' death panels.
Medicare may turn you down for an organ transplant because there are only so many to go around and you're not the best candidate. Private insurance may turn you down because "shareholder value".
Technically, they have the ability to choose whoever they want, they just have to pay full price with post tax income. If people accept their employer's choice, then they get to pay for a lower, employer subsidized premium with pre tax income.
That is one thing that would fix this problem fast. Let individuals tax deduct the price of their health insurance directly. There’s no reason it should only be up to your employer.
This is why we need to install National Health Care. Single payer systems get the best rate, and we can make a national decision over how much we can afford. The current system is insane and unsustainable.
Sure, I'll defend them, conceptually at least. I think most actors in this system are in some sense corrupt, and I don't think insurers are the most corrupt. Pull up the 2022 National Health Expenditure table, "National Health Expenditures by Type of Expenditure and Program: Calendar Year 2022" and look at combined hospital and physician expenses compared to insurer expenses; it's pretty black-and-white.
Your argument would be more convincing (well, not really because it’s typical bad faith contrarianism) if insurers weren’t also some of the largest hospital and clinic owners in the U.S. and use this to rob people blind on both ends.
> It’s no secret that UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. And thanks to a series of stealthy deals, almost 1 in 10 U.S. doctors — some 90,000 clinicians — now either work for UnitedHealth or are under its influence, more than any major clinic chain or hospital system.
They purchase physician groups... and then pay themselves higher rates.
> UnitedHealth Group is paying many of its own physician practices significantly more than it pays other doctor groups in the same markets for similar services, undermining competition and driving up costs for consumers and businesses, a STAT investigation reveals.
I take it then that we agree that for profit health insurance companies profiting from denying care is immoral. That there are other immoral actors is not germane to the discussion.
No, we don't agree. I think there are different values implicated in our system, in a system like the UK NHS, and a system like Australia's (for the record: I'd take Australia's over ours).
The UK does a good job of hiding economic concerns from its users, at a cost in availability of services, especially high-end and experimental interventions. The UK makes these rationing decisions knowing that some people are going to be denied life-saving care, but in exchange for that everybody else in the system will get predictable access to their care.
The American system does a good job of getting services delivered to customers; it does a better job of that than the NHS does, if you measure in interventions performed; it does such a better job at that that it's a real problem in our system: we overprescribe and overdeliver interventions that drive costs and decrease certainty as payers work out which things to cover and which not. The flip side of that is that everyone in that system can tell themselves that the system is doing what it can to gate delivery on whether care is truly needed and will be effective, and that it's not categorically denying care because of top-down mandates.
Neither set of values is totally benign. You can prefer one or the other.
I can go all 12 rounds on this topic, but if I keep writing about this I'm not going to write the work thing I'm supposed to write, so I'll leave it there.
It follows that providers should provide care for free. Anything else is profiting from denying care. I guess you're just a full communist? If that's the case, just come out and say it so we can agree to disagree and move on.
There are other options. Think about it a bit. Nonprofit insurance companies for one. National healthcare is another option that does not require communism. Don’t be a lazy thinker.
And billing us 4x more for it than Europeans, and, further: a lot of that work is wasteful and unnecessary (see: spinal fusion surgeries, back imaging). There were more MRI machines in Massachusetts in 2023 than there where in all of Canada.
No, they're billing insurance companies that much. For-profit insurance companies are incentivized to drive up the cost of care because of the cap on their profit margins. More expensive care equals more profits as a bigger pie means a bigger profit even if the percentage remains the same.
Medicare's rates are about a half to a third of what private insurers have managed to negotiate. Funny how that works.
Doctors are not the problem with American health care, for-profit insurance is.
> Polyakova and her collaborators find doctor pay consumes only 8.6 percent of overall health spending. It grew a bit faster than inflation over the time period studied, but much slower than overall health-care costs.
> “People have a narrative that physician earnings is one of the main drivers of high health-care costs in the U.S.,” Polyakova told us. “It is kind of hard to support this narrative if ultimately physicians earn less than 10 percent of national health-care expenditures.”
Exactly. Even if you forced doctor compensation down to the level of other countries, that's, what, a 6% overall reduction, at best? Wow, so now when you get a surprise bill for $5000, it'll instead be $4700 instead! Hooray! We did it, Reddit/HN!
Does anyone think American healthcare was thereby fixed? I don't!
Now, FWIW, I'm happy to accept that US doctors are overpaid, and that there are feasible ways to make progress on that front. It's an important conversation to have. But it has virtually nothing to do with what makes US healthcare so brutal and kafkaesque.
Does that include the artificially bloated cost of care (compared to e.g. Medicare), the costs of Medicare Part D fraud, and the costs of having care denied and delayed (2–3x the claim denial rate of Medicare) or just the premiums?
Last time we did this song and dance you doubled down on incorrect assumptions about how Medicare functions. So, no, it's not likely I'll come to the same conclusions as you.
Yes, it is pretty silly to think American healthcare would no longer be a global laughingstock if surprise bills of $5000 were replaced with surprise bills of $4700.
Yeah, it's bad here. My health insurance premium (family of four) went from $3,000 US/month to $3,600/month on Jan 1. That doesn't cover everything, either - there's a deductible, and then there's copays, which means up to $9k/year out of pocket on top of those premiums.
Dear God. I pay a bit more than 400 EUR/mo, my employer pays a bit less than that, and my employer is delighted for me to take sick leave if I've got a cold because guess who pays my sick leave?
My health insurance.
(Germany, "public" insurance with one of the 150 or so "sickness funds" those of us in the 90% who have to be on public insurance can choose from)
Does your insurance also cover the rest of your family? As a single person I pay around $600/mo for insurance (a Kaiser silver HMO plan). Adding dependents will absolutely drive up cost here.
I haven't seen any defenses of insurance companies lately. In fact, it seems like insurance companies are the only safe target for criticism of US healthcare problems right now.
> Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable.
The elephant in the room is that healthcare costs are going up. Even if we waved a magic wand and eliminated health insurance overhead, profits, and executive pay, your rates would still be going up that same 15-20% per year.
This is the part that seems to confuse everyone. There's a common misconception that insurance companies are raking in huge profits and that prices would plummet if we could just eliminate those profits. You see it throughout this thread with phrases like "dancing on the graves all the way to the bank" and blaming "capitalism" or "corporate greed" with the implication that insurance companies are the purveyors of this greed.
Yet we have non-profit insurance companies. They're not appreciably cheaper. If you look at insurance company profits, they're actually relatively low for companies that large. If you map healthcare spending on a big pie chart, the slice that goes to insurance company administrative overhead and profits is not that big. Single digit percentage. Even companies with socialized medicine have some overhead in this same slice.
The problem is multifactorial. The challenge is that it's not politically safe to touch on some of the drivers of US healthcare costs. Everyone loves to point at insurance companies and drug pricing because it's easy, but things get much quieter when you point out that our doctors, surgeons, and providers are paid substantially more than their peers in other countries. Americans also love to consume more healthcare and many would be very upset if they were forced to accept the level of allowed care and delays in other countries. It's not just insurance companies who have decision trees about when and what care is allowed. Americans also consume medications at an extremely high rate. Again, they don't take kindly to suggestions that we limit prescribing or drug prescriptions (see outrage over the DEA limits on amphetamine production or complaints about hesitancy to prescribe opioids, even though we already consume far more opioids than most countries).
Many Americans also live unhealthy lifestyles which contribute greatly to healthcare costs, but it's taboo to mention that. Everyone has seen the life expectancy charts showing US lagging international peers, but fewer people have seen the per-state version that shows that life expectancy depends heavily on where you live (and therefore what you eat, how active you are, and the local culture). Instead, the only acceptable target of blame is our food. While we have some room for improvement, we're not going to solve the obesity epidemic and lifespan problems by banning red dyes. Lifestyles and diets need to change, but that's a difficult topic. Much easier to point the finger at insurance companies, "CEOs", and the food industry and pretend that those cover all that is wrong with healthcare.
This is why it's politically difficult to accomplish anything in the United States. If anyone tried to copy and paste the health care system of a European country, from doctor pay to allowed procedures to more limited prescribing practices, there would be riots. People want all the healthcare, they want it now, they want it how they decide, and they want someone else to pay for it.
The medical costs are skyrocketing because insurance companies inflate the price of medicine. The slice of the pie that goes to the insurance company is small compared to the pie, so they make the pie bigger to make their slice bigger. The other parts of the pie, many of whom are owned by the same insurance company, aren't complaining. They are horribly inefficient. The cost of hospitals processing payments to insurance companies alone (and note this is typically one company sending itself a bill) is nearly $400 Billion per year. That's about 8% of all US healthcare spending, and it generates no value.
What isn't happening is increasing cost because of either more or improved care. As time goes on it should be easier to make drugs, meaning that prices should go down. Instead the cost per gram of even very simple drugs like epinephrine and insulin are going through the roof. Doctors are paid well, but they've always been paid well, and in fact while physician pay over the past 70 years has kept pace with inflation, it has been far outstripped by the price of education needed to achieve that salary, meaning doctors today are generally worse off financially than they used to be. other medical professionals like nurses are seeing increasing workloads without commensurate increase in pay. American life expectancy is decreasing, as are numerous other measures of healthcare efficacy. While we are paying more, we are getting less than we used to.
Then there is the common argument - our high drug prices subsidize new drug development. Only issue is that new drug development has been steadily slowing down. Most drug development is in the form of minor changes to existing drugs that serve little purpose beyond resetting the clock so cheap generics don't come on the market. Where new drugs are developed, they tend to be focused on profits, for example new pills to help people maintain erections rather than treat rare diseases. When the stars align and a new drug is developed that genuinely helps people, it tends to be insanely expensive, such as the cancer drugs TFA is talking about. This is not to say that nothing at all gets done, but it's less than it used to be.
Is insurance the only problem in America? No, obviously not. But at the same time, healthcare prices dramatically higher than anywhere else in the world that are also rapidly increasing is not an inescapable fact of life. Our healthcare can be both substantially cheaper and higher quality than it currently is by eliminating purposefully inefficient systems that use anticompetitive practices to jack up prices. When the dust settles US healthcare might remain a bit pricy per capita - part of having a country with very high wealth per capita is that everything is expensive per capita - but our money will be going towards paying skilled people to do useful work for our benefit.
Again, not sure what you're trying to say but given how it's overwhelmingly against "killing was acceptable or somewhat acceptable", it's unlikely that polling error would significantly change the conclusion.
> Young voters were far more split: 41% found the killer's actions acceptable, while 40% found them unacceptable, per the poll. About 24% found them "somewhat acceptable" and 17% "completely acceptable."
It's easy to just blame the insurance providers, but keep in mind:
Everybody expects a higher standard of care, because now we treat things that we didn't even know about in the past. For example, I have a CPAP and went through surgery for sleep apnea. 50 years ago, who knows what would have happened to me?
Medical providers are incentivized to "find" things to bill for. For example, I went to a podiatrist for foot pain, and she tried to figure out how to have me visit monthly.
Likewise, end-of-life issues can get very expensive, because it's hard to say "no" when loved ones' emotions are fragile.
I have a CPAP too, and the insurance paid for part of the cost, but most was still paid for by me. I investigated the price of buying it directly, for cash, and it was only a few hundred dollars more.
The point is that other countries are realizing the same or better (generally better) levels of care while confronting the same issues.
Privatization and ineffective/lobbyist-written regulation is and has been the problem from the beginning.
Adding "but before all those complex concerns, our number one priority is making a profit" is literal insanity.
Add to the mix that employers are only incentivized to provide care for accute conditions that jeopardize productivity (rather than things that improve longevity and quality of life), and I mean... what did anyone expect?
Healthcare is complex but understanding why we're living in a failure mode isn't. The fundamentals are completely incorrect.
I’ve been on the selection side as an employer and several others will probably echo what I’m about to say.
Virtually every insurance provider is going up 15-20% / year to the point that it’s completely unsustainable. United was quoted to me as almost 20% lower than current rate for our provider (before they are about to go up 20%).
On premium alone they will save some people close to $500 / month for what is…”on paper” the same coverage.
I’ve read all of the same stuff about United that everybody else has but the finances put employers in a very difficult position.