[JoshGG]

Great article but the author is missing the fact that this is all designed on purpose. The insurance system is designed around a consistent strategy called “don’t pay out”.

The USA spends more GDP on healthcare than any country on earth and the insurance companies are immensely profitable.

Every company involved is making money off the status quo and wants to maintain the current system. when a patient comes along who isn’t desirable and profitable, they’re screwed.

This is all well documented in research about modern USA healthcare and health economics. None of this is an accident and the fact that this situation persists should be a national embarrassment.

[riffraff]

It was somewhat surprising to see the author come up with "we need standardized interfaces between actors" rather than "we solve this with public healthcare for everyone".

But to be fair, you can easily get lost in bureaucracy in public healthcare too, and private health insurance exists in countries with public health too.

[addicted]

Just switching to a public healthcare, or more likely, a public payer system won’t magically solve the problem. There’s a lot of work that needs to be done to ensure it works well.

The difference is that there is evidence from other countries that a public payer system allows for a better medical system to be built on top of it. There’s no evidence that America’s system of patchwork and arbitrary payments by different vested interests each trying to offload their expense onto some other entity allows for a decent system.

[garciasn]

Of course it won’t magically happen; other countries have been doing this for decades. It would take time to sort out, but the important difference is having a human-focused common goal of fixing the problem.

The common goal now in the US healthcare system is profit while a secondary goal is patient care. This causes individual healthcare systems to AVOID, AT ALL COST, interoperability. By forcing administration and bureaucracy challenges they can charge exorbitant rates for those largely unnecessary challenges while claiming patient care as paramount. Unfortunately, this also negatively impacts the patients and their care.

[riffraff]

Sure, but it would solve one important part which is determining who is paying and whether you can give services to someone, which seems to be the crux of the issue in TFA.

[JoshGG]

I should add that I’m glad the author wrote this as an account of their family experience and I have great sympathy for them, having seen similar experiences up close.

[thallium205]

Health insurance profits are capped by government. They aren’t immensely profitable in the strictest sense of the word. That’s why they had to refund premiums during COVID.

[l33t7332273]

A quick search shows they made more than 40 billion dollars in profit last year.

That seems immense to me.

[Wytwwww]

> That seems immense to me.

From an emotional perspective sure. Their revenue is more than 1 trillion, so while less than 4% lower prices would be nice it wouldn't really fundamentally change anything.

[wh0knows]

Profit can be manipulated. Creating a giant bureaucracy of overpaid administrators and middlemen can siphon off any amount of money while declaring no profit.

[Wytwwww]

> Profit can be manipulated

You mean costs can be inflated? Yes, the American healthcare system is extremely inefficient but that doesn't help the shareholders of those insurance companies at all.

[wh0knows]

Yes, I mean the amount that the cost is inflated by is much greater than 4%.

[smsm42]

> The USA spends more GDP on healthcare than any country on earth and the insurance companies are immensely profitable.

Yes, from the recent report of 2020 [1]:

The health insurance industry continued its tremendous growth trend as it experienced a significant increase in net earnings to $31 billion and an increase in the profit margin to 3.8% in 2020 compared to net earnings of $22 billion and a profit margin of 3% in 2019.

These humongous profit margins of 3.8% can no longer... Wait, what? Three point frickin eight percent? That's what passes for "immensely profitable", really? Maybe there's some other place we should look for greedy capitalists that stole our money than in 3.8% profit margins?

[1] https://content.naic.org/sites/default/files/inline-files/20...

[cwmma]

This is surprisingly not really the case a lot of the time, including this case, Anthem would have actually saved money had the mother been transferred out of the hospital.

Instead insurance are allowed to set premiums based on how much they payed last year plus a percentage. So the only way to charge more is to pay out more which sounds insane.

[qwytw]

> companies are immensely profitable

That's not necessarily true. If all the for profit insurance companies reduced their profit margins prices wouldn't go down that significantly. I think it's mainly the extreme inefficiency and much higher labor costs.

[specialist]

> extreme inefficiency and much higher labor costs

Which is mooted with single payer. Roughly 1/3rd of costs eliminated. Last time I checked (mid 2000s). Probably more now.

[qwytw]

> Which is mooted with single payer.

As in doctors, nurses, and other personnel will accept lower salaries because they won't have any choice? I'm not sure that would work in the US.

Also, there are relatively efficient non-single-payer systems in Europe (e.g., IIRC, Switzerland and the Netherlands don't have the equivalents of Medicare/Medicaid). Proper regulation, including price transparency and regulation, would solve most of the main issues and would probably be much easier to achieve than a single-payer system.

A federally imposed universal single-payer system seems to be totally politically infeasible. The best you could hope for is a two-tier system with the government continuing to subsidize for-profit healthcare (including insurance) companies (all extremely expensive treatments covered by the government, but most people who can afford it will continue having private coverage as well).

Wouldn't it be much easier (and possibly more efficient and equitable) to just adopt the Dutch system?

[yurishimo]

The Dutch system is largely private with a very reasonable out of pocket/copay each year. This year, it’s around 450€ per person. In a calendar year, you cannot, by law, be charged more than your premium + this out of pocket max per year. For minors, all coverage is completely free until they turn 18, including comprehensive dental.

Limiting the US spending per citizen to roughly $2k/year per adult seems impossible in the current climate. It should happen but it won’t. If current health spending trends are to be believed, the number of people using less than 2k/yr in services are less than 20% of the population. There just aren’t enough young people in the US to make up for it, and the feds will never get approval to cover the gap.

The only hope I see for US healthcare is to open government funded hospitals and clinics and offer it as another insurance option. They can compete in the market and hope they have enough funding to eventually convince people that they aren’t going anywhere. This will take a lot of capital to weather the first few years of insanity and shenanigans that we will see from traditional insurance companies. Anything less than competition will be lauded as communism (it will anyway, who am I kidding) but for some poor red states, opening a few clinics in rural areas might actually work for them come time for re-election.

I’m saying all of this as an American living in the Netherlands.

[specialist]

> open government funded hospitals and clinics and offer it as another insurance option

Agreed. This or/and some other variant of the public option.

I've been discussing this with local politicos and orgs. Socializing the notion. Most everyone is receptive once it's explained.

Some day I hope to muster the gumption to do my own lobbying.

[specialist]

The 1/3rd savings (off the top) is from eliminating administrative overhead that insurance (claims & billing) imposes.

Administrative burden (makework) on caregivers would be much reduced.

[gloryjulio]

> The USA spends more GDP on healthcare than any country on earth and the insurance companies are immensely profitable.

Even Buffet commented that he should have just invested in healthcare earlier on and he would make even more money

[figassis]

There are entities in the US that have the power to change this, and in the end, it’s congress and senators. But those to not act on something that apparently every soul in the US would benefit from, because politics, lobbying, etc. The power is there, it’s just not being wielded, and it seems that the reason is because these people are more afraid of vested interests than they are of you, the people. I would like to understand why and what would be a solution.