This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
So where’s all the money going?
Whenever someone has a proposal for healthcare reform, the response is “actually that’s not the main driver of costs”. The money’s not going to insurers, their profit margins are slim enough as it is. It’s not going to doctors, they only make up 8% of the pie. So who’s actually getting paid? The money can’t be disappearing into thin air.
Not trying to do a gotcha here. I’m genuinely uninformed on this topic and willing to hear you out.
I mean, to start with, 8% is not nothing. And I think it’s quite reasonable to pay doctors like doctors, for the record. But there’s also everyone else’s salaries(hello, nurses), there’s admin expenses and capital costs, there’s profits for the hospital and the drug companies, there’s a bunch of healthcare that just doesn’t get paid for, etc. There’s no one culprit with a smoking gun.
More options
Context Copy link
A bunch of it is going to insurers. Profit margins are thin but if expenses are high from inflated salaries and the gross amount of money is hundreds of billions of dollars that adds up.
Clinical staff add value, most of the other salaries involved are siphoning value. Hospital and healthcare admin staff has ballooned. Practice managers. Billing staff. HIM staff. Midlevel mangers etc etc.
The system has a lot of room to be more lean but as with academia it's just expanded into an inefficient mess.
Many of the people who get paid unnecessarily essentially have the job of fighting other people who get paid unnecessarily (ex: hospital billing staff warring with insurance).
Comparatively little goes to insurers. On top of that insurers are obligated to pay out 80% of premiums.
This article has been litigated elsewhere so I won't belabor the point, but it's very easy to use loop holes for this sort of stuff. Non-profits do it all the time. Oh yes we didn't make any profit, but all the executives and their nephews have massive salaries...weird that.
(the insurance companies can likely be run a lot more lean).
Not really.
In any case, insurers are obligated to pay out a percentage of premiums, not profits, so the accounting tricks you described are not relevant. Indeed, UHC paid out 83% of premiums in the year shown. Since the most anyone could expect from them is to pay out 100% (and they obviously can't pay that much), there is clearly not a lot of room to maneuver.
Following up on this, some of the comments on the Noah Opinion article suggest that Hollywood style accounting tricks are involved but I didn't see enough in terms of details to really buy that.
More options
Context Copy link
Hmmmm, what's the explanation/incentive for their wildly shittier business practices then? They must be making money somewhere off of the sky high denial rates, no?
They make money off of denied claims, but the strategy can only go so far without falling afoul of ACA profit caps. They certainly aren't incentivized to pay out much more than 80%, it's just that even with high denial rates they can hit that target due to the difference in what they pay providers vs what they charge customers.
I mean I didn't realize it was premiums and not profits that's a my b, but there has to be some explanation for why their behavior is so much more obnoxious than providers and way their denial rate and so on is so different (30% more I think?)
Are you sure you don't find them more obnoxious because you are a provider yourself? I find it pretty obnoxious when nobody at the hospital can tell me what a procedure will cost, or when they charge me over $500 for some saltwater.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link