[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.

[ceejayoz]

> I posted the macro NHE table from last year.

Again: how will the “insurers force provider costs up” show up in said tables?

It’s caused by the insurer. It shows as a provider’s cost. But it doesn’t mean said doc is making any more money at the end of the day.

The insurer does, though! Their 20% cut got bigger, and the "computer says no" denials are cheap!

TL;DR: Where in your link does "doc spends needless hours on phone fighting insurer" show up as a cost?

[tptacek]

It literally breaks practice and net cost of insurance out!

[ceejayoz]

> It literally breaks practice and net cost of insurance out!

But it's not a "Cost of Health Insurance" item. It's an expense at the practicioner level! They have to factor that non-billable time into what they charge for the procedure!

Read their definitions: https://www.cms.gov/files/document/quick-definitions-nationa...

"Administration" is the insurer's side of it.

[tptacek]

This is special pleading.

[ceejayoz]

Oh, now who's dodging?

If an insurer manages to double a doctor's administrative costs for billing/appeals/etc., where does it show up in your tables, per your link's PDF of definitions?

[tptacek]

You have no evidence for this argument. It's just vibes. The numbers here are stark. It's not like it's close, between providers and insurers. Insurers are almost literally a rounding error.