[jmyeet]

I'm honestly not sure if I should attribute this comment to disingenuity, ignorance or just bad faith.

> pushing back on anesthesiology pay on the East Coast.

Not even close. BCBS was just pushing extra charges onto patients.

> insurers working to make surgeries cost less

This is laughably ill-informed, I don't know where to begin. The only thing insurers are doing is increasing the gap between what they collect and what they have to pay out. They do this by denying claims. Making the service cheaper has nothing to do with it.

> where medical staff are paid 2-3x more than they are in other countries

Because medical school is so expensive. Also, doctors spend 3-8 years working for minimum wage (ie medical residency) and the cost of billing and administration is enormous. One study showed a primary care doctor spent $99,000 a year on billing and roughly 25% of ER income spent on the same [1].

The US spends the most per capita on healthcare than any other OECD country, by about 50% (Switzerland is #2) [2] for less coverage, worse outcomes and lower life expectancy.

Medicare spends almost all (~98.5%) of its funds on patient care and ~1.5% on admin, compared to 15-25% on admin for private insurers (including Medicare Advantage).

It amazes me how concifently wrong and ignorant about a subject can be while having such strong opinions.

[1]: https://www.fiercehealthcare.com/finance/study-billing-for-m...

[2]: https://www.oecd-ilibrary.org/sites/7a7afb35-en/1/3/7/2/inde...

[tptacek]

Anthem proposed to apply the precise guidelines Medicare uses to pay for anesthesiology, including references to those CMS guidelines. Billing for anesthesiology has been a hot button issue: the search you want is [anesthesia surprise billing]. Anesthesiology is one of the highest-paid specialties in American medicine.

You cannot reasonably support Medicare and claim that Anthem was doing something unconscionable, because Anthem was adopting Medicare's own policies.

Medicare's admin cost ratio is a function of who it covers. Somewhere in the comment history on HN, there's a short writeup I did of how the math works out if you extend Medicare to the whole population; the admin overhead, for obvious reasons, shoots up --- people pay the same amount of money but require far fewer services, reversing the "advantage" Medicare has in the metric currently.

[jmyeet]

Insurers use the Medicare schedule as a weapon to simply reduce how much providers get paid and/or increase how much patients have to pay out-of-pocket.

The Medicare schedule is generally low because of the negotiating power of the Federal government so when Anthem (or whoever) says something like "we'll pay Medicare rates" or "we'll pay 120% of the Medicare rate" they're really just cutting payments and increasing patient costs. Nothing more.

In the recent BCBS case, all they were doing was saying "it may take 8 hours for the surgery but we're only going to pay you for 3". They haven't made the surgery cheaper to provide. They just wanted to pay out less.

Also, if we're going to simply do everything based on Medicare, why exactly do we even need private insurers? Just expand Medicare to everyone if the schedules are good, right?

[tptacek]

You're saying "the Medicare schedule" as if it's an abstraction, but it is literally the payment process used by the largest buyer of medical services in the country. What Medicare pays matters more than what anybody else pays, because most medical services are performed for Medicare patients. So I'll ask directly: how is it unconscionable for Anthem to use those policies, but not for Medicare to use them?

You are exactly right that Anthem is demanding providers charge less for surgeries, not for surgeries to take less time. Providing "less anesthesia" is not a thing. This is entirely about preventing health providers from charging more money to Anthem and, in turn, their customers. That's why Medicare does the same thing.

[adgjlsfhk1]

The fundamental difference between Anthem and Medicare is that when Medicare cuts reimbursement, that cost isn't passed on to patients, but when Anthem does, it is. Medicare's rates are arguably too low, but low Medicare rates are getting a good deal for the country. Low Anthem rates are passing costs onto consumers and profits onto shareholders.

[tptacek]

That is not how any of this works. Insurers and health chains are in a continuous process of rate-sheet negotiation, and the result of that negotiation is reflected in your premium costs. Most people's out-of-pocket costs are capped, and even the most routine surgeries (like a tonsillectomy) exceed the out-of-pocket cap (I checked! This is a number people report.)

This is about the trade association for anesthesiologists deputizing angry people on Twitter to go to bat for them overcharging for their services.

[emeril]

Us republicans here don't like them facts and prefer alternative facts

we like to think we are just da best at everything

after all, I sometimes read about people coming to the US for care so it must be better?