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PT6A posted:Well, they do in a sense. If I go to the doctor, they take my provincial healthcare card, provide me whatever service I need, and then the government pays them out for that at whatever the rate is for whatever they did for me. If my doctor says, "right, you need to get an ultrasound," they fill out a form, I take it to an ultrasound clinic, and again, somehow that clinic gets paid out by the government in a way that's completely invisible to me. LMAO at thinking a privatized industry won't immediately turn to profit maximization in a capitalist society with a weak government like the US.
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Jun 12, 2018 14:12
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Malcolm XML posted:They are required to maintain a loss ratio greater than 80% and also required to generate increasing profits for shareholders. Heath insurers have also been merging rapidly. Which is why they are focused on cost-saving measures. Economies of scale is another example of this, as it leads to higher volume which increases profits. How do you look at everything that health insurers do that you hate and come to the conclusion that "yup they don't care about costs at all"
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Jun 12, 2018 14:18
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Malcolm XML posted:LMAO at thinking a privatized industry won't immediately turn to profit maximization in a capitalist society with a weak government like the US. Is a single-payer structure with private providers inherently less likely than a trillion-dollar capital investment by the federal government to buy all medical infrastructure and employ everyone in the medical field directly? I'm just pointing out that there are many different ways that have been used to achieve the end goal of universal healthcare. Meanwhile everyone here in sitting in complete surrender to American exceptionalism: "it just can't work here!!!!"
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Jun 12, 2018 14:20
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esquilax posted:Which is why they are focused on cost-saving measures. Economies of scale is another example of this, as it leads to higher volume which increases profits. that the best available cost reducing measure is "not paying" is the part where things get complicated it is wrong to say they don't care about reducing costs, but ask how and things get real euphemistic real fast
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Jun 12, 2018 14:30
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esquilax posted:Which is why they are focused on cost-saving measures. Economies of scale is another example of this, as it leads to higher volume which increases profits.  youre agreeing with meHealth insurers do not give a gently caress about patient costs (I.e. premiums and they just cost recover the next year) since they have a fixed maximum margin. Any cost decrease on their end above a certain amount (that mandated loss ratio minimum) is turned into profit, not revenue reduction It's a perverse incentive designed to drive up costs amd as with most of ACA, it was written by the industry
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Jun 12, 2018 14:33
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Malcolm XML posted:
No I'm not agreeing with you. The fact that you can't see that is telling. They account for the expectation of cost-reduction activities to determine how to much to charge in premiums. Which allows them to charge lower premiums. Which allows them to increase the number of policies sold. Which allows them to increase profits.
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Jun 12, 2018 14:37
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esquilax posted:No I'm not agreeing with you. The fact that you can't see that is telling. OK then you don't understand how insurance works. It's not based on policies sold, it's based on loss ratio. I can sell a ton of policies and lose a gently caress load of money or sell a few and make a ton of money. But like, this is why insurance regulation is very hard and needs people who understand it deeply.
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Jun 12, 2018 14:40
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And health insurance is not price competitive so that canard won't work either
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Jun 12, 2018 14:41
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Being less glib: Since health insurers cannot have a loss ratio less than 80% they are incentivEd as a whole to pump up premiums. Individual insurers might wish to lower premiums to sell policies but shareholders will punish them for it. Internal cost reductions can be used to jigger the loss ratio since the aca loss ratio is not the classical one but even then it's a perverse incentive. Thus you see the collective skyrocketing of costs to the consumer.
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Jun 12, 2018 14:45
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Malcolm XML posted:Being less glib: They lower plan costs so that they can charge lower premiums and still be profitable and meet loss ratio requirements while increasing total volume. Cost reduction strategies are decided in advance, like premiums. Why are narrow network plans on the marketplace? Lower costs Why are high deductible plans? Lower costs Why do insurers negotiate provider discounts? Lower costs Why did they used to exclude preexisting conditions, including in states with loss ratio requirements predating the ACA? Lower costs Why did they used to do medical underwriting to make sure no high-cost people joined the plan, including in states with loss ratio requirements predating the ACA? Lower costs Why do they deny claims? Lower costs If your mental model of the health insurance marketplaces concludes that health insurers must hate making money, then you should probably rethink it. esquilax fucked around with this message at 15:28 on Jun 12, 2018 |
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Jun 12, 2018 15:26
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Malcolm XML posted:It's a perverse incentive designed to drive up costs amd as with most of ACA, it was written by the industry Oh is that why AHIP spent $100m on ads fighting ACA I remember this exact argument coming from a libertarian think tank. Maybe you could ask Trump to eliminate the MLR.
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Jun 12, 2018 15:49
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Malcolm XML posted:And health insurance is not price competitive so that canard won't work either Health Insurance is price competitive on the employer side. Companies leave insurance carriers constantly mostly due to price. A company's second largest expense(payroll being #1) is employee benefits. Of course it's price competitive. Malcolm XML posted:Being less glib: Also raising premiums would lower their loss ratio, not raise it. If I'm paying $100,000 a year in premium and only have $80,000 in claims, I'm running at 80%. If the insurance carrier raises premiums next year to $125,000 and my claims stay at $80,000 I'm now at 64% loss ratio. RisqueBarber fucked around with this message at 16:13 on Jun 12, 2018 |
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Jun 12, 2018 16:09
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Hospitals tend to run low margins. You know who doesn't run low margins? Non-generic Pharmaceutical manufacturers and Medical Device manufacturers. I looked it up one, medical imaging devices had the highest operating margin of any line of business at GE. Malcolm XML posted:And health insurance is not price competitive so that canard won't work either This isn't true. The vast majority if private insurance is employer sponsored which is incredibly competitive.
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Jun 12, 2018 16:10
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crashrat, that's terrible. I assumed most people were underestimating as far as they reasonably could to get the maximum subsidy, which was triggering all the really weird income verification issues that popped up this year as a back door to try to change the subsidy to last year's income instead of a guesstimate at next year's
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Jun 12, 2018 16:19
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The Phlegmatist posted:Oh is that why AHIP spent $100m on ads fighting ACA turns out they got value for money: in exchange for all that scaremongering, they not only got to write it, they got to guarantee the discussion going forward, in the minds of Rational Centrists, would be the precise amount of care given to the blowjob they were getting, and none of that pesky "patient outcomes" nonsense
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Jun 12, 2018 16:24
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RisqueBarber posted:Health Insurance is price competitive on the employer side. Companies leave insurance carriers constantly mostly due to price. A company's second largest expense(payroll being #1) is employee benefits. Of course it's price competitive. Ah but the issue is that health insurers are incentivized to raise premiums at the minimum loss ratio: namely they are 100% OK with higher health costs *as an industry* Reik posted:Hospitals tend to run low margins. And yet the secular trend is higher and higher premiums. You can change suppliers but if the costs of drugs and services continually increases costs increase, and since health insurers are not incentivized to reduce systematic costs, and cannot unless they choose to do radical changes to health delivery, you have costs increasing each year as is born out in practice The Phlegmatist posted:Oh is that why AHIP spent $100m on ads fighting ACA The MLS is great. It should be 100% and be paid by an NHS equivalent. But the libertarians weren't wrong here: health insurers are guaranteed profits, just not the crazy high ones pre-ACA. They also hate having to provide universal coverage and unlimited coverage since it sucks to be that one insurer covering the $10m patient. But they sure don't hate guaranteed money -- AHIP came out for the CSRs and individual mandate. Malcolm XML fucked around with this message at 03:45 on Jun 13, 2018 |
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Jun 13, 2018 02:26
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Crashrat posted:I think a major problem among wonks that think about the sliding-scale problem is that they're all economists or public policy people that have never spent a goddamned minute in the trenches of the social work field. I just wanted to personally thank you for this; it's very illuminating and a little shocking. I'd ask you for advice on my own horrible personal situation regarding America and it's contemptible system, but I don't feel that it would be within the spirit of the thread.
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Jun 13, 2018 02:51
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JustJeff88 posted:I just wanted to personally thank you for this; it's very illuminating and a little shocking. I'd ask you for advice on my own horrible personal situation regarding America and it's contemptible system, but I don't feel that it would be within the spirit of the thread. I appreciated his post because I spent half of my undergrad in the company of bowtie spinners who would drone on endlessly about their wonderful technocratic approach to fixing the problems of the poor. It took having a sociology professor who grew up on food stamps in the ozarks to shake me out of that kind of thinking. Designing complicated solutions with a middle class mindset that everyone trusts and loves the state to take care of them is intrinsically flawed. Many poor people grow up in margins of our political economy and get poo poo on their entire lives by a technocratic bureaucracy that doesn't care about their health, education, or future employment. So the idea that they should submit themselves to a humiliating and confusing ACA enrollment process is precisely the problem. The second half of the ACA debacle is that it was designed with employer dumping in mind. The employer mandate is not a real mandate but a backdoor head tax per employee dumped on the exchanges. Because the growth of the shared responsibility penalty is much slower than the growth of ESI costs on employers, they made the bet that the industry's benefit accountants would eventually all conclude en masse after an inflection point dropping ESI and dumping to exchanges would be the cost effective move. This was planned by 2020 so that by the time most employers stopped offering employer paid plans woke President Hillary or some other serious democrat could go in and tweak it to be less harsh on the little people with all that employer shared responsibility payment money. I remember Ezekiel Emanuel euphorically declaring that by 2020 employer paid insurance would be rare, and yet it's 2018 and ESI rolls have never been higher. The reality is that the law created such turds of plans and did nothing about the decades-old problem of individual market plans having narrow networks that companies literally could not dump their employees if they wanted to. Not if they didn't want their people running to the nearest competitor. So you end up with an incomplete medicaid expansion because it's optional and subject to state level barriers, a dysfunctional individual market that's spiralling out of control, and employers doubling down on ESI all the while benchmarking their plans so that the employee has barely a better than plan the target metal AV on exchanges. Good job democrats! CAPS LOCK BROKEN fucked around with this message at 04:03 on Jun 13, 2018 |
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Jun 13, 2018 04:01
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Malcolm XML posted:And yet the secular trend is higher and higher premiums. You can change suppliers but if the costs of drugs and services continually increases costs increase, and since health insurers are not incentivized to reduce systematic costs, and cannot unless they choose to do radical changes to health delivery, you have costs increasing each year as is born out in practice. Health insurers are incentivized to reduce systematic costs. They are trying to change health delivery via value based case reform. Keeping the PMPM cost of care down is like 25% of my annual bonus.
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Jun 13, 2018 15:16
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Reik posted:Health insurers are incentivized to reduce systematic costs. They are trying to change health delivery via value based case reform. that the highest value-add you can provide is a list of customers unlikely to fight it if you refuse to pay their bills is, admittedly, a bit of a wrench in that premise
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Jun 13, 2018 15:49
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Reik posted:Health insurers are incentivized to reduce systematic costs. They are trying to change health delivery via value based case reform. Ze Pollack posted:that the highest value-add you can provide is a list of customers unlikely to fight it if you refuse to pay their bills is, admittedly, a bit of a wrench in that premise ACA adjusted MLR will take into account efforts to increase care quality so this poo poo pays for itself, but on the whole if the cost of a procedure or drugs increases 10% that cost is directly recovered from premium payers, and causes an increase in revenue as premiums increase. LMAO at "Value based care reform" i.e., how can we deny more claims?
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Jun 13, 2018 16:53
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Malcolm XML posted:ACA adjusted MLR will take into account efforts to increase care quality so this poo poo pays for itself, but on the whole if the cost of a procedure or drugs increases 10% that cost is directly recovered from premium payers, and causes an increase in revenue as premiums increase. But when they deny claims it reduces their costs, and they wouldn't get their 1/80% load on that so by your reasoning denying claims leads to less profit for them so why would they ever deny claims?
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Jun 13, 2018 17:12
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Reik posted:Health insurers are incentivized to reduce systematic costs. They are trying to change health delivery via value based case reform. Are you guys trying to move to upside/downside on everything or do you view upside-only or downside-only as desirable models long term?
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Jun 13, 2018 17:32
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Malcolm XML posted:ACA adjusted MLR will take into account efforts to increase care quality so this poo poo pays for itself, but on the whole if the cost of a procedure or drugs increases 10% that cost is directly recovered from premium payers, and causes an increase in revenue as premiums increase. If medical costs goes up by 10% after you set premiums, you're going to lose a lot of money. Premiums are set prospectively, so if costs are always going up you're always going to be playing catch up and losing a lot of money. Now, if you set premiums according to past experience, and properly manage costs to bring medical expenses down 10%, you're going to make more money. Maybe you should try Googling value based care before shitposting. esquilax posted:Are you guys trying to move to upside/downside on everything or do you view upside-only or downside-only as desirable models long term? I don't really touch that part of the business, but it seems like it's very difficult to get providers to take up anything not fee-for-service. Reik fucked around with this message at 17:48 on Jun 13, 2018 |
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Jun 13, 2018 17:43
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esquilax posted:But when they deny claims it reduces their costs, and they wouldn't get their 1/80% load on that so by your reasoning denying claims leads to less profit for them so why would they ever deny claims? You deny claims to the 80% mandated MLS then hope that the systematic costs (so you can ratchet up premiums) rise. Claims are costs, revenue is premiums. Turns out that this is exactly what happens in practice with every large insurer clustering around 80% and yet having large revenue increase each year Your job is to turn that revenue into profit, not reduce revenue.
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Jun 13, 2018 17:47
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Reik posted:If medical costs goes up by 10% after you set premiums, you're going to lose a lot of money. Premiums are set prospectively, so if costs are always going up you're always going to be playing catch up and losing a lot of money. Now, if you set premiums according to past experience, and properly manage costs to bring medical expenses down 10%, you're going to make more money. if only there was some way to avoid playing catchup... to proactively set premiums at the costs you expect them to be, while simultaneously doing your best to identify people you can safely refuse to provide the service they pay you for... as an analyst, of course, you have no familiarity with any such technique as "drawing a trendline," right Reik
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Jun 13, 2018 17:48
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Malcolm XML posted:You deny claims to the 80% mandated MLS then hope that the systematic costs (so you can ratchet up premiums) rise. Claims are costs, revenue is premiums. When you say large revenue increase each year, are you referring to the exchange rates?
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Jun 13, 2018 17:49
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Reik posted:If medical costs goes up by 10% after you set premiums, you're going to lose a lot of money. Premiums are set prospectively, so if costs are always going up you're always going to be playing catch up and losing a lot of money. Now, if you set premiums according to past experience, and properly manage costs to bring medical expenses down 10%, you're going to make more money. It's hard to get someone who salary is based on not understanding something to understand something. Premiums are set prospectively but we observe systematic premium increases which translates directly into profit at a fixed overhead. Your job, like that other guy, is not to reduce premiums. It is entirely to reduce claims -- costs -- to the bare minimum allowed by law. The value based care marketing (how can we reduce claims, but not have people up in arms? Let's make it vaguely based on "patient centered" outcomes--tell me, the paying patient, how I'm supposed to evaluate medical outcomes when it comes to care) is to sell it to chumps who won't complain when their plans become skinnier with high deductibles and premiums (revenue) increase.
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Jun 13, 2018 17:58
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Malcolm XML posted:You deny claims to the 80% mandated MLS then hope that the systematic costs (so you can ratchet up premiums) rise. Claims are costs, revenue is premiums. The industry-wide effort towards value based care is literally systematic cost reduction Which is why the effort that US private insurers are doing in value-based care has direct analogies in US Medicare, Canada, the UK, and other countries "The minimum MLR requirement is causing problems by making insurers avoid reducing costs" is just not something that is true
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Jun 13, 2018 18:00
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Malcolm XML posted:It's hard to get someone who salary is based on not understanding something to understand something. Value based care has absolutely nothing to do with higher deductibles. It's about moving away from the fee-for-service provider payment method.
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Jun 13, 2018 18:07
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Reik posted:When you say large revenue increase each year, are you referring to the exchange rates? Premiums in Aca esquilax posted:The industry-wide effort towards value based care is literally systematic cost reduction Yes the NHS famously uses NICE. That is not what I claim: in a for profit environment having a minimum MLR (a profit margin cap) and a way of getting around that cap -- raising premiums -- let's you increase total profit to the limit you can raise premiums. Which happened. Now that people are pushing back, you get profit margin protection programs i.e. Value based care, which nobody gave a poo poo about 5 years ago. Of course, value based care is a smokescreen to deny claims in general; that there is a lot of fat to be trimmed is a general consequence of years of poor economic incentives but now you can launder it into the modified MLR that ACA uses. The solution is a mandatory 100% MLR and single payer public UHC
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Jun 13, 2018 18:10
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Reik posted:Value based care has absolutely nothing to do with higher deductibles. not -entirely- true. it is perhaps better to say that value based care does not give a poo poo about higher deductibles, except insofar as they produce that most beloved of health insurance consumers, the NeverPay Vicar. https://www.youtube.com/watch?v=2n3M-0JDTCI the c-level didn't believe it when the analytics team told them the nude lady could be safely removed from the equation, but the results are pretty indisputable
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Jun 13, 2018 18:12
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Malcolm XML posted:Premiums in Aca ACA premiums are a very small percentage of Health Insurer revenue. 100% MLR implies the US equivalent to the NHS would be entirely volunteer staffed?
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Jun 13, 2018 18:13
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Reik posted:ACA premiums are a very small percentage of Health Insurer revenue. Do you think the prices hospitals charge don't pay for their staff
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Jun 13, 2018 18:40
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Malcolm XML posted:Premiums in Aca So then do you think that 2018 premiums would be lower if the regulatory oversight/rebate program around minimum loss ratios didn't exist at all? And that in the absence of this regulation, insurers would not have raised premiums as much as they did?
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Jun 13, 2018 18:55
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VitalSigns posted:Do you think the prices hospitals charge don't pay for their staff What?
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Jun 13, 2018 19:09
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Reik posted:What? see, in a world where your job wasn't to find people who need to be thrown out of the hospital for the crime of asking your employer to provide the service they paid your boss for, your salary comes out of the costs of providing care as opposed to the current situation, where you are paid to actively increase them, by finding where your boss can safely refuse to pay for providing care.
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Jun 13, 2018 19:23
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 https://twitter.com/tonyleys/status/1006947130500624384 quote:Gov. Terry Branstad, who decided in 2015 to hire for-profit Medicaid management companies, pledged that Iowa taxpayers would save substantial money from the shift. He predicted Iowa would save $232 million in the current budget year, which ends July 1. quote:Randol told the council Wednesday that estimating exact savings is difficult. "I think it's important that regardless of the methodology, there are savings," At least now they're finally running poo poo like a business!
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Jun 13, 2018 20:08
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Malcolm XML posted:That is not what I claim: in a for profit environment having a minimum MLR (a profit margin cap) and a way of getting around that cap -- raising premiums -- let's you increase total profit to the limit you can raise premiums. Which happened. You are also claiming that there is no limit to how much insurers can raise premiums which is untrue. Because employers will switch carriers or self-insure or contract with providers directly like Cisco does. Private insurer profit numbers have only now gone back to pre-ACA levels and that's because they're vertically integrating into areas that are much more profitable than private insurance. Profit margins on private insurance are under cost of capital -- that's not good for a company on the stock market. This is why they branched out. These are the actual facts. You are arguing a literal libertarian conspiracy theory from ten years ago when you should've just shut up and said you fundamentally disagree with the idea of for-profit private insurance.
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Jun 13, 2018 20:14
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Paracaidas posted:
Something like 80 percent of all Medicaid recipients are now covered under for-profit managed-care plans, including (especially) ultra-blue states like California. I think the last figure I read for California was that 90 percent of Medicaid recipients were in MC plans. (One in three people in the state are now covered by Medicaid.) Private profiteers in the Medicaid sector are doing really, really well--even when they don't meet standards of care. Here's California, e.g.:  quote:In anticipation of the Obamacare rollout, officials in California and elsewhere boosted their payments to managed-care companies because they expected Medicaid costs to increase as newly insured patients rushed to the doctor or emergency room after going years without coverage. But those sharply higher costs didn't materialize — and insurers pocketed more money as a result, especially in California. http://www.latimes.com/business/la-fi-medicaid-insurance-profits-20171101-story.html And the ACA was a boon to private managed-care plans, giving them revenue and profits they'd never seen before: quote:Before the ACA expansion, California's Medicaid plans collectively were barely in the black, with $226 million of net income for 2012 and 2013 combined. Traditionally, these insurance contracts have yielded slim profit margins of 2% to 3%. California said it aims for 2% when setting rates, based on prior claims experience and projected costs. [ibid.] So yeah: state and federal governments are gonna save money using MCOs rather than traditional FFS, but even the best part of the ACA, Medicaid expansion, ensured that the bloodsucking sector would get their non-inconsiderable vig. eta: Medicaid MCOs have to have an 85 percent medical-loss ratio, but it's hard to see how that's meaningful to reining in costs when it results in profits for those plans tripling within two years. Willa Rogers fucked around with this message at 22:30 on Jun 13, 2018 |
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Jun 13, 2018 22:26
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