[tinokid]

Nice idea, but how realistic is it? Most patients are not scientifically-literate, some are flat out incapacitated.

For all the stories about heartless insurance companies denying to pay for things, perhaps they should actually be more strict. As in, refuse to pay for anything unless there is 1) rock-solid (i.e. double-blind, placebo-controlled) evidence that it helps 2) for a specific, objectively verifiable indication 3) when provided by a doctor whose track record is demonstrably non-inferior to that of other practitioners. But for all three of those things, no $.

I would be interested in buying insurance like that.

[maxerickson]

In the US system you agree to pay any bills the insurance will not cover prior to receiving treatment.

Which is an obvious opportunity for improvement. When a giant hospital and a giant insurance company get in a knife fight over whether a procedure is covered, the patient shouldn't be the loser.

(Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if insurance denies the claim)

[tinokid]

>Maybe some sort of system where if the provider states that something is medically necessary then they are on the hook if insurance denies the claim

Not only should a provider be legally prohibited from trying to collect payment for unnecessary treatment, they should be held responsible for complications. Even unnecessary x-rays can cause cancer.

[skadamou]

> "3) when provided by a doctor whose track record is demonstrably non-inferior to that of other practitioners"

This is interesting. I think there will always be a somewhat normal distribution of medical skill among doctors so how do we decide whose track record is good enough to preform which procedures? We probably don't need top preforming doctors to implement every procedure but then how do we decide which procedures warrant a top doctors time? And if there is a shortage of qualified specialists in a region or if something is particularly urgent isn’t an under achieving doc better than no doc at all? Maybe. Maybe not. I think there is a lot of gray area here. I guess ideally the hope would be that the distribution of skill among doctors is really narrow so the difference between top docs and bottom docs is not that pronounced. Even still, I think there are some interesting problems around ranking/rating doctors against one another.

[tinokid]

Right, it's not easy and there are adverse selection issues when you start incentivizing doctors to avoid complex cases that are more likely to involve complications. And the scientific basis for a given procedure is likely more important than minor variations in doctors' technical competence levels.

That said, insurers have better insight into this than almost anyone else. If they see a young person with almost no medical claims go in for an elective foot surgery with Doctor Lexus, and then all of a sudden that person is attending physical therapy and filling opioid prescriptions every month, that's a bad sign. If it happens more than once, insurers should feel empowered to go ahead and shut the good doctor down. But this does not happen.

[marze]

I wasn't claiming it was realistic or practical generally. Perhaps achievable for a well educated and motivated HN reader, certainly not for everyone.

Perhaps a startup could provide a service: should I [get some discs fused] (or whatever). Call it cybersecondopinion.com or something.