[tptacek]

This isn't a response to anything I just said. I really don't understand why people collapse into all this handwaving when people point out the obvious: the money in our system is going to providers, and, in particular, it's going to practitioners.

[ceejayoz]

The insurers are buying the practices so they can eat at both sides of the trough.

(And the independent practicioners are having to use a significant portion of the money they take in to… fight the insurers!)

[tptacek]

What difference is that supposed to make? The money is still going into the pockets of practitioners. And: no, the claim you're making here about practitioners fighting insurers: closer to the opposite thing is true.

The idea that the problem with our system is health insurers is just slopulism. We have grave problems with our system! But they start with the providers, where the majority of all the funding in our system goes, not to the scapegoats they've stoop up in our insurers. The distinction is vitally important, because the most popular answer to this problem is to extend Medicare to everybody, and Medicare is just as victimized by this as everything else is!

We pay doctors too much, and we artificially restrict the supply of practitioners. Those doctors routinely overprescribe. Every other problem in the system is marginal.

[ceejayoz]

"The money is still going into the pockets of practitioners."

And by inflating that amount...

> Using newly available federal price transparency data, the researchers found that UnitedHealthcare pays Optum physician practices about 17% more than non-Optum practices in the same region. In markets where UnitedHealthcare holds a large share of the insurance business, that difference was even larger, up to 61%.

their capped-by-law 20% cut of premiums goes up, too. "Oh, those mean old providers we own charge so much! We have to raise premiums again!"

[tptacek]

Show me the more recent NHE table where this effect shows up and I'll be ready to have the conversation, but right now this seems like a dodge. Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023. I don't remember thinking that the health system in 2022 was good.

Fun thing about the NHE: you can project it as far back as you want. The data is there.

[ceejayoz]

> Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023.

What? Insurers have been playing this game far further back than 2023.

If an insurer doubles the time a doc has to fight over denials and has to hire extra billing staff to assist, where do you imagine that cost shows up?

[tptacek]

I feel like we've been in this argument before, and I like you just fine as a commenter, but do feel like you're tying yourself into knots to avoid a simple conclusion plainly supported by the data. I didn't post a trend story about what companies are doing or who they're acquiring; I posted the macro NHE table from last year. It simply refutes the argument you're trying to make.