[codegeek]

"using each patient's insurance...."

I usually commend anyone trying to fix our Healthcare system in America but every time I see a startup in this space, no one can dare to fight against the main culprit: the middle man Health Insurance Mafia. I wish someone could do something where Health Insurance mafia is no longer in picture except for catastrophic insurance. Watch how prices drop for everything when Doctors/Hospitals can bill patients directly in cash.

[lotsofpulp]

No one is forced to use health insurance. Everyone is able to try to negotiate with healthcare providers.

This is a surgery center in Oklahoma that offers pricing without insurance.

https://surgerycenterok.com/

[codegeek]

Yes there is that 1 center or may be a couple like that. But are you really arguing in good faith that people can just live without Health Insurance in America ?

Btw you are forced as well because of Obamacare but even if you were not forced, you would still need it unless you are an excellent salesperson/negotiator where you go a Doctor's office and negotiate Cash Price.

Tell me what's the first question you are asked when you call a Doctor's office other than your name ? It is "What Insurance company do you have" ?

[atonse]

Also you're then making a tradeoff between time and money.

Do you want to spend hours calling and faxing various places to save $50 on a bill? The people on the other end of the line are getting paid to talk to you, they'll happily talk to you for hours. But you have other things to do.

[codegeek]

Exactly.

[lotsofpulp]

The root problem is most people cannot afford the healthcare they need/want. That cannot be solved by simply getting rid of health insurance. Absent taxes, it is the mechanism by which you get other people to pay for your healthcare (at a certain point in time).

You are correct that prices should fall if demand was reduced, but that would mean a period where people go without healthcare. And you are correct having a middleman does increase prices. But in this case, you also have the high cost of highly specialized people doing difficult work, medicinal patents, and extremely high liabilities involved.

[codegeek]

I pay $24,000/Year Premium + $5000 deductible for my family before Insurance will pay anything. So I am almost out of $30K out of pocket before Insurance pays. My point is that if we can get rid of that $30K, I am sure the doctors and hospitals bill will be less than than and this is just for 1 year. Now, if something catastrophic happens like a cancer surgery, let Insurance cover that but it shouldn't cost me $30K/Year in premiums/deductibles.

Now I know you will say "Oh get a better insurance through your employer". If You don't see the problem with that, I have nothing to add. I should not be dependent on an Employer to provide a good neogitated Health Insurance Rate. The job of an employer is not to provide Health Insurance. It adds overhead for them and employees as well.

This is purely on the cost side. NOw let's talk about the inefficiences that are added due to Insurance middle man mafia. I had a Doctor's office bill incorrectly and it took me days to fight with them and the insurance company just to correct a bill. I know I am not alone in this.

We need to get rid of Insurance companies and rethink the concept of Health Insurance. Thats my opinion and if I had the power, I would do it today.

[lotsofpulp]

>My point is that if we can get rid of that $30K, I am sure the doctors and hospitals bill will be less than than and this is just for 1 year.

Your assumption is incorrect. You are not paying for your doctors and hospital bills, and you are not paying for just the 1 year. You are paying for the NICU baby that costs $1M, or the anemic person that needs medicine that costs $100k per month, etc. And the chance that you might be one of those people.

>Now I know you will say "Oh get a better insurance through your employer". If You don't see the problem with that, I have nothing to add. I should not be dependent on an Employer to provide a good neogitated Health Insurance Rate. The job of an employer is not to provide Health Insurance. It adds overhead for them and employees as well.

No, I will not say that. Employers are involved in health insurance because it gives big employers an advantage over small employer by being able to compensate employees with pre tax dollars, and it helps prevent people from being able to compare compensation from different jobs so it incentivizes employees to stay put.

A further benefit is that employers with relatively healthy and young employees such as higher paid desk job firms can sequester their health risks into a healthier pool of lives so that they are not subsidizing healthcare for older/less healthy people.

>This is purely on the cost side. NOw let's talk about the inefficiences that are added due to Insurance middle man mafia. I had a Doctor's office bill incorrectly and it took me days to fight with them and the insurance company just to correct a bill. I know I am not alone in this.

Absolutely, there is inefficiency. But doctors are among the smartest, most well paid people in the US, and have been for a long time. There is a reason that most agree to the terms of insurance companies, and that is because they know their customers cannot afford to pay them as much as they get via insurance companies.

See also this comment.

https://news.ycombinator.com/item?id=36972991

[smcl]

According to this same user you should be individually negotiating with your healthcare provider (or going to like one center in Oklahoma). You're talking to someone who is probably insulated from the worst of this (i.e. is young and/or well paid and insured and/or hasn't had a major healh scare) and therefore does not see what all the fuss is about.

[lotsofpulp]

I see perfectly well what the fuss is about. I am simply trying to elucidate that eliminating health insurance companies from the chain is not the panacea that many people think it is, which is due to people not being able to afford the services they want/need, and hence being subject to a mechanism of cost sharing not unlike taxes.

In order of descending profit margins in the healthcare chain, you have:

Pharmaceutical companies, medical software companies, medical hardware companies, hospital companies, nursing home companies, doctor companies, individual doctors, nurses/other staff, pharmacists, health insurance companies, and pharmacies.

Somewhere in there is also costs due to liability due to tort laws, probably reflected in liability insurance companies. But let us say you got rid of the health insurance companies, who have medical loss ratios of 80% to 90%. Which means you are still left with quite a bit of the current system's costs.

[blastbking]

Yeah, it's really hard to go head up against companies with 100B+ revenue (united healthcare etc) who essentially write the laws.

I think this is a good space for the government to step in with progressive policies, and there are a lot of supporters that aren't as easily influenced by lobbying and under the table bribery.

Our approach is to make something that makes the existing system easier to use for patients, under the assumption that that system continues to exist as-is. We do think there is bipartisan support for price transparency. Something like single payer healthcare is much less likely to get passed and health insurance companies would fight for their lives to prevent it from happening.

There is a ridiculous amount of overhead that the whole insurance dance adds to providers and I think it's unfortunate how much that inflates pricing for everyone.

[mbesto]

> I wish someone could do something where Health Insurance mafia is no longer in picture except for catastrophic insurance.

This is not a technological/startup problem to be solved, but a regulatory one.

[codegeek]

Agreed. But our politicians are too much in bed with the Health Insurance mafia and the only alternative is people like Bernie Sanders advocating for things like Medicare for All which I am not quite sure about. Best solution would be for Doctors/Hospitals to work directly with Patients without requiring Insurance company contracts.