Comment by brightball
3 days ago
Does anybody defend them?
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
They will also complain about waiting times - as if you don't wait with private insurance companies.
That is after you convince them that your procedure or exam is even needed, which can be a long protracted fight in itself.
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".
1 reply →
Most people don't even get the ability to select among all the terrible insurance companies - their employer chooses for them!
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.
1 reply →
> Politicians in particular say things like "preserving customer choice"
But that’s not shocking. Lobbyists and campaign donations make such behavior expected.
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.
One should not profit from denying care. All health systems ration care. Doing so in a way that people profit from denying care is immoral.
If you believe that, you should have a bigger problem with what providers bill, because that's the ultimate origin of the constraints.
6 replies →
And inefficient to boot!
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.
> look at combined hospital and physician expenses compared to insurer expenses; it's pretty black-and-white
I mean, yeah. They're doing all the work.
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.
10 replies →
> I don't think insurers are the most corrupt
Lol, nice defence
> $500 / month
What the actual f!?
That saving is double the total cost of my private health insurance in Australia!
This includes the “Medicare levy” tax I pay at the highest rate because I get an above average income.
Health insurance cost is something I just don’t think about.
My missus reminds me every few years to combine our plans because it might save us AUD 250 per… year. Maybe.
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)
1 reply →
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.
I was shocked to hear from an anesthesiologist friend of mine in Germany that an American salary could be 10x higher.
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.
[flagged]
>but the greater public ultimately felt he went too easy on them.
Not sure what exactly is meant by that, but most people did not think the killing was acceptable.
https://www.axios.com/2024/12/17/united-healthcare-ceo-killi...
”Survey of 1,000 registered voters conducted Dec. 11-13, 2024”
5 replies →
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.