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PaperclipPerfector  12d ago (text post)   30516 thread views

Culture War Roundup for the week of December 9, 2024

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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.

if UnitedHealth Group decided to donate every single dollar of its profit to buying Americans more health care, it would only be able to pay for about 9.3% more health care than it’s already paying for. If it donated all of its executives’ salaries to the effort, it would not be much more than that.

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.

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.

I mean a 30% higher rate of random denials seems pretty assholish no?

There exists staff in the hospital who can tell you how much the "charge" (but not necessarily the "cost") is for a given thing but they don't interact with patients because our healthcare system is based around patients not paying for things themselves directly, these staff interact with the people who are paying (insurance companies).

Depending on the details of the specific complaint, your bag of saline costs a shit-ton of money because it was made and stored in a sterile setting with a restrictive expiration date and was handled by a large number of staff, all of which as per government regulations, or because the number is completely made up in a weird voodoo dance that exists to get insurance to pay for things.

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