site banner
PaperclipPerfector  10d ago (text post)   2619 thread views

Small-Scale Question Sunday for December 8, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

1
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

The bigger problem is that they are often below cost. You'll have to forgive me on the numbers because it's been a few years since I looked this up, but it's something like Medicaid pays .8, Medicare pays .85, and private pays 1.1-1.2 times cost.

[...]

If you see a doctor who is willingly taking Medicaid/Medicare (usually they are taking it because they are employees of a health system and the system takes it, often because of government funding or legal requirements) that means they are deliberately taking a pay cut to help people (which happens a lot because of martyr complexes) or have some way they are abusing the system (which can actually be legal and fairly harmless but isn't always).

I can see how in a certain system of ethics it's bad that UHC denies claims so aggressively. But in another system of ethics the fact that you can run a health care provider business taking UHC but not if you take Medicaid says something important, as well.

Interesting point. You know I haven't seen anything that breaks out UHC separately from other private insurance, it is possible that the barriers involved actually move it away from the rest of them.

My suspicion is no because a lot of what they do is more an externality creation than explicit costs. Most doctors will be willing to stay late to try and get things approved for the patient. Doctors are almost always on salary for the purposes of this, and can't usually bill insurance for admin time the insurance generates (well we can but they never reimburse it). Nobody pays for said admin time directly, and the doctor would choose not take United but we are almost all employed now and have no choice.

Instead that doctor quits, goes part time, burns out and retires early or whatever. Doesn't show up in the balance sheet but is a bad outcome.

Certainly if your goal is to maximize shareholder value and so on whatever United is doing seems to work best, but we've already decided elsewhere that we aren't okay with people doing that in healthcare and it seems sketchy to let one of the more profitable actors do it.

Nobody pays for said admin time directly, and the doctor would choose not take United but we are almost all employed now and have no choice. Instead that doctor quits, goes part time, burns out and retires early or whatever. Doesn't show up in the balance sheet but is a bad outcome.

It shows up on the balance sheet somewhere, no?

Somewhere up the chain of command is the person paying the cost of doctors (and the risks of burning them out) and who is also making the decision on whether or not to accept UHC. And that person often says "yes UHC but no Medicaid"

Unless we take as a given that the entire system is dysfunctional, and making exclusively bad choices, and implosion is imminent, I think this means UHC is actually good. Or, well, UHC is bad, but less bad than Medicaid.

It shows up on the balance sheet somewhere, no?

Well not really, no.

Something to keep in mind is that healthcare combines some of the worst parts of business, government, and the academy (also some of the best at times, but nobody wants to hear about that haha).

For example often we are forbidden by law to take steps to save money. If someone walks into the ED with an emergency and says "you can do whatever you want but I ain't paying for it" ...we do our best to save the guy's life. Ethical considerations often increase spending. Risk aversion too - nobody wants to see a bad outcome, nobody wants to get sued for a bad outcome so we spend more to prevent both.

One of the benefits of the oddity is that most people involved in healthcare are mission and martyr oriented. Physicians do a ton of free work and are expected to do this. Every year for the last thirty years or so pay has gone down, work has gone up (generally administrative tasks like what we are discussing here). Medical complexity has increased thanks to advancements in technology. A lot of problems in healthcare have been solved with "fuck it the doctor will take care of it." It is common for admin staff to quit or get fired and no replacement is hired, they just expect the doctor to do it, is a normalized thing.

However because the doctor generates value by seeing patients and billing for clinical responsibilities (and not typically by hours worked), and its just assumed that administrative responsibilities get done, these kind of things can easily not end up on a balance sheet in a meaningful way (at least to the hospital, I'm sure the insurance company has spreadsheets showing an advantage from sketchy behavior). Things that a lawyer or accountant would bill for? Nope, untracked and unpaid.

Successfully getting through medical school and residency requires an enormous ability to put up with bullshit, do nonsensical things, and work insane hours. We make do until we can't. People might take three days of vacation and spend the entire time catching up on paperwork. A family practice doctor might be done seeing patients at 3pm and spend the next 3-5 hours on paper work and other responsibilities.

It is very common in healthcare to see truly absurd things going on because healthcare doesn't (and to some extent shouldn't) function like a business. You see academy woke/DEI bullshit, spending hundreds of thousands to millions of dollars on unrelated politics. You see a posting for a physician that remains unfilled for half a decade because they are offering 80% of regional salary expectations. Even knowing that hiring the physician would bring in 5 times the salary in revenue. It doesn't make financial sense, but they just do it anyway because anyone with actual business acumen wants to shoot themselves dealing with medical horseshit and avoids it.

One of the biggest examples of the post-COVID era was travel nursing. During COVID a lot of nurses were like okay I need a pay bump from 1 to 1.1. Hospitals were like fuck off. So the nurses quit, or unionized and went on strike. So the hospitals decided to bring in travel nurses that were being paid 5. And then kept them. For years. At any point they could have gone back and paid 1.1 and gotten the original workforce back. Nurses would quit their jobs, sign onto a travel agency, and then work at the same hospital they used to work at and make more than a physician. It was hilariously dumb.

But that's healthcare.

It doesn't make financial sense, but they just do it anyway because anyone with actual business acumen wants to shoot themselves dealing with medical horseshit and avoids it.

And if they do have business acume, someone shoots them! Heyoo!

I mean, here's some examples from the Joe Rogan subreddit of all places.

https://old.reddit.com/r/JoeRogan/comments/1hb0c2d/i_dont_care_how_he_grew_up_he_right/m1co69q/

Is this kinda stuff "illegal?" Probably, but you have to be fined or prosecuted enough to make it unprofitable for the companies to stop doing it. United is ahead of the curve of unethical behavior, and the system tolerates it for now, but it is unethical and it is fraud, they are just good at getting away with it for the moment (ish, considering recent murder).

It's very much like companies who ignore environmental regulations and just break the rules. Does it make the company money to break the rules? Yes, the fines aren't enough.

Is it bad? Also yes.

Edit: I should clarify why I'm saying this -> I think it's important to say that rampant fraud is not business acumen, even if you can get away with it. It's just unprosecuted criminal activity.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats