LinkedinLunatics

cost doesn't matter, I'd just give them my card and they can run it as often as they like.

Right.... But the point of this hypothetical is to explain how the billing process is detrimental to service. In this hypothetical, like with any time you visit a new Drs office, you have to go through a myriad of processes explicitly for billing. Hence why in this hypothetical the ordering process is specifically made to be labourus, so no, we won't hold on to your card. Please hand it to me for every item.

Right, and that's because the policy holder usually isn't the customer, the employer is.

Wouldn't there be even more options if individuals chose their plans instead of large employers?

Health insurance would likely be a lot simpler if the average policy holder could switch insurance,

I already explained that's not economically viable.....

No, there was no delay in care. Once I picked the option, I got the procedure done in the next week or two.

Your inability to choose an option is a a delay in care....... Any time between a prescribed written order and the fulfillment of that order is considered a delay in care.

give me the cash price, and I'll figure in the deductible and whatnot).

My dude, you don't understand what the cash price represents. Nor do you understand that it is of no consequence to you if you already have insurance. The cash price is simply the Medicare allowable, minus whatever internal policy they have for discounts for people paying in cash.

If you want to know the cash price, look up the medicare allowable for the procedure or item, then call the office and see if they offer cash discounts. If your office accepts Medicare, then it's against CMS guidelines to set billing codes for cash payers more or less than the Medicare allowable. You can apply discounts after using the Medicare allowable, but you must initially bill by coding guidelines.

However, if you already have private insurance then we have to bill for the specific pricing negotiated by the insurance and office. And like I said most of the times, unless it's a plan and operation the office does frequently, we won't know what your cost will be until we run a prior authorization.

You're right, the problem is paperwork, which is why we should give the insurance companies fewer options to reject claims. Eliminate or automate the authorization step. Care providers should never need to talk to anyone at the insurance company.

These are private companies...... What right does the government have over private industry to moderate them so closely? They would argue that it would risk their solvency as an industry. They would proclaim the same propaganda that has so effectively captured your own loyalty so well.

Higher risk just means higher costs. They can still collect some percentage of premiums, so why would they turn it down?

Did you even read anything I wrote about this? You aren't legally allowed to raise prices of individual coverage based on use. This isn't car or home insurance. And if they raised prices for everyone any more than they already have......people might start getting a little more excited about things like Medicare for all.

You're right, and those numbers are hard to come by since most studies/articles assume Medicare in retirement and focus on out of pocket costs.

No it's not......... It's all publicly available information on the CMS website. You can literally track where every single Medicare dollar goes, which is the benefit of socialized medicine, it's extremely transparent.

65+ insurance is indeed unique, hence why I mentioned an escrow system. Basically, you prepurchase insurance including end of life care.

Lol, people barely have the competency to sign up for Medicaid, a free service. The average citizen isn't going to be able to have the funding or the ability to plan that long into their own future. I feel like you have some misconceptions about public health, and who it primarily serves.

I'm guessing that escrow is something like $300-500k for basic EOL care, plus some extra for routine medical care. But I only have mediocre data to work from. If you have a good source, I'm interested.

Do you understand that the average person in my state would have to work 10 years to earn that kind of money? Just earn, not save. That's virtually impossible for the vast majority of Americans. That the average working male only contributes around 60k dollars to to Medicare in their entire lifetime?

Sure, and the same is true for education. And the problems with both are pretty similar:

Right but this was a response to the claim the providers were colluding with insurance companies to make more money, which is wildly false.

In many areas, the government has a near monopoly on education, yet the problems persist.

This is assuming the problem is inherent to government, and not the decades of declining funding, or the response of white communities to integration after the civil rights movement. Other governments do have a complete monopoly on education and they don't have these same issues. So I don't really think itakes much sense to just blame the government.

Why should we expect medicine to be much different?

Because we already have a socialized healthcare network that treats the majority of healthcare needs, it's just being weakened by private insurance stealing funding away from the system, and is kept artificially unavailable to younger healthier patients for the sake of private profit. And even surrounded by these parasitic corporations Medicare continues being the highest standard in the industry. Offering more coverage for lower cost than any other insurer in the country.

but socialized medicine certainly would.

Any evidence to support that statement, or even a theory on what kind of negative trade offs? You are speaking as if you are an authority on the subject, however based on prior statements you seem to have some great miscommunication about health care systems, billing systems, and the over all concept of insurance pools.

if care providers received the same amount from cash customers vs Medicare customers, and that amount is transparent and publicly auditable

How is that even a possibility? The amount of people paying for their healthcare upfront in cash is so small that it's not even trackable. You are talking about cash payment as if it's a common occurrence. I've been working in the field for over a decade and I've probably had 1 maybe 2 patients pay in cash upfront.

You are also assuming your own ignorance of the subject is due to some sort of colluding shadow group of healthcare providers working against you. In reality you're just unfamiliar with the inner workings of our healthcare system, and instead of just reading the literature available on the CMS website you've done your own "research" on YouTube.

Literally every single one of the claims you've made has been inaccurate. I have no reason to lie to you, I get paid the same no matter what I bill, or how many patients I see. I work at a state run children's hospital, specializing in orthopedics and rehabilitation. If I wanted to make more money I could easily take a job at a private clinic.

You do not know what you are talking about, I don't know how to say that in any simpler terms. The assumptions you have made are not idiotic ones, in fact private insurance companies spend a lot of money (often An illegal amount) to spread this misinformation to you.

However, what would be idiotic is to assume that you know more about a system than someone who has worked with it every day for well over a decade. I assume you have some specialized knowledge or skill you utilize in your career? What would you think of the person who tried to lecture to you about your career after a couple hours or even days of "research"?

Privatized insurance isn't the goal here, privatized medicine is.

Again....... The medical system is not profitable. There are some aspects that are profitable, but those profits are required to be cycled back into the system to help support the rest of it. If you simply privatizes the only aspects of the system that were profitable and socialized the ones that weren't, it would raise the overall cost of insurance for everyone.

You can't just keep repeating the same inaccurate claims when you haven't acknowledged any of faults ive previously pointed out.

They do it because it doesn't cost them customers. I can't vote with my wallet and switch my insurance, I can only beg my HR department to offer something different. I am not the customer here.

Yeah....seems to be a problem inherent to privatized insurance, which is my point. The reason you can't do this is because the insurance companies can't afford to let you do this. It would make apparent that private insurance only achieves solvency via careful control over their insurance pool.

I don't see why that should be any different for health insurance.

Because you have some inherent misconceptions about how insurance companies remain solvent, despite their cost exceeding their subscription fees. The only way insurance pools remain in solvency is by meeting a target subscription projection that would theoretically eventually cover their aging subscribers.

The way this projected growth is theoretically supposed to work is by adding multiple more young subscribers for every older subscriber they currently have. And for a while with the economic and population growth America has achieved in the past, this has been possible.

However, if the growth dwindles or if you get generations make less than their parents, the system starts to collapse. Which is why countries with disproportionately old populations have a hard time maintaining stable healthcare systems.

The reason we have the system we do is because government incentivizes company-provided health insurance. We should instead encourage people to select their own plans.

Wrong again..... The aca was simply a plan to get the uninsured rate down. They offered both incentives to companies and individuals to achieve this goal. Before the aca individual plans were not even offered by insurance companies. These individual plans were actually really robust, especially with medication cost, better than even my current private insurance. However, Republicans sponsored by the insurance lobbyist slowly ate away at the funding and requirements, making the individual plans basically useless, culminating with the abolishment of the mandate during the trump administration.

Auto insurance seems to work just fine with this. If I make lots of claims with one insurer, that slate won't just be wiped clean with the next one.

Are you a motorized vehicle? What makes you think insuring an entire population is similar to insuring a inanimate object? I've already pointed out that it is illegal to charge people a higher premium because of their preconditions or prior use. And if it was legal this would either lead to people being uninsurable, or would collapse the insurance pool.

A rebuttal that you have not acknowledged this entire discourse.

customers can easily switch, that should encourage insurance companies to lock in customers with longer term policies to spread out the risk.

Do you not see the internal contradictions of "customers can easily switch" and "lock in customers with longer term policies"?

The insurance company doesn't expect any particular individual customer to be profitable, they just expect that their customers will be profitable on average.

Which is not true with healthcare...... Not on a long enough timeline. Which is why insurance companies boot people to Medicaid or Medicare when they start to become a financial burden. If they are forced to provide coverage past the age of 65 then there is no possibility for a return. We all end up eventually receiving more healthcare than we pay for.

For an insurance company, it's like buying an index fund instead of individual stocks, and for individuals it's like buying an annuity instead of stocks

Again, you are ignorant of the fundamental differences of health insurance when compared to ensuring inanimate objects. At this point it seems like you are purposely being obtuse, so I'm assuming you lack the mental plasticity to change your mind regardless of any new information or perspective.

haven't run the numbers for a couple years (I compared ACA when self-employed vs new company), so things could have changed.

Aca self funded plans have significantly reduced their coverage and network size since the mandate went away. The original plans were actually a pretty decent deal, but they're pretty worthless by now.

Maybe. But that's also assuming healthcare costs stay stagnant. If we drastically reduce the complexity of dealing with insurance, we also reduce the costs to insurance, which may be enough to offset an increase in claims.

Again, if you are going to be standardizing these private organizations to the point where you dictate their operating procedures, what's the point of privatizes healthcare?

All the paperwork is waste, and it's getting to be a massive problem, but it suffers from a prisoner's dilemma-type issue (an individual company is better off complicating the process in the short term, but if everyone does that, net costs go up) so the current setup won't resolve itself.

Yes, it seems like every one of these "non profit" private insurance companies are prioritizing profit over service......Strange.

Insurance companies exist to cover extreme financial burdens, like developing cancer or other chronic conditions. Basically, things that could bankrupt you.

No, private insurance companies exist to extract public funds from the government at the expense of its citizenry. The entire point of a healthcare system, is to improve the health of the entire population, not individuals. Private health insurance damages the system, and does nothing to improve it.

The issue with ER is that it often goes against your will, and getting financial consent could be the difference between life and death.

Bahahaha, what? You don't have to take financial consent to treat someone at an ER. You don't need ID, or insurance paperwork, or even an address. What do you think we do with people who are unconscious upon arrival? We don't just stick them in the waiting room until they miraculously wake up.

As I said, you are making huge assumptions without a very basic understanding of healthcare. One of the reasons hospitals are inherently a natural monopoly nis because there is no choice often. You can't dictate where your ambulance goes, and we can't turn down a person in need.

There's just way too many weird cases to the point where we can't just expect insurance companies to take the hit here.

Lol, insurance companies do not take the hit, we do. The cost is covered by the hospital, and its burden is redistributed via raising price of healthcare.

Publicly funded ER solves those problems and can protect emergency care providers from lawsuits and whatnot so they can focus on providing care.

And again this would just lead to people using the ER more than they already so.

The ER would reject you and potentially fine you for nonemergency care. Just like calling 911 for non-emergencies.

First of all, this is once again illegal. But more importantly bits highly immoral and violates the Hippocratic Oath. No ER provider is going to turn away a patient in need of emergency medicine.

And of course you will say, that they can turn away non emergent care. But this just proves you lack of understanding of the healthcare system in general. Minor ailments that go untreated will eventually turn into actual emergencies. So it doesn't matter if you turn them away, or worse fine them, they will eventually come back in worse condition.

The only way to lower emergent healthcare cost is to provide affordable/free preventative care and education . Take for example the diabetic shoe program, every diabetic with peripheral neuropathy in America is eligible for diabetic shoes and custom inserts. At one point as a cost saving measure they cut this service, which ended up costing them hundreds of millions of dollars in the long run due to the increased incidents of wound care and amputations.

It's a much more complicated system then you would like to assume.