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[quote=Anonymous][quote=Anonymous]Did anyone read the CNN article about health insurance denials?  On a personal level, they are all terrible stories … but on an economic/policy level, I’m not so sure.

The 70 year old woman from Worcester complains that she pays hundreds of dollars a month but her insurer would not cover more than 6 weeks in a post-acute rehab center after her surgery, although it appears that center cost about 5K a week…..the economics just don’t add up.  Most elderly people will have multiple health issues and surgeries are not uncommon.  If the insurer is charging hundreds in premiums, yet paying out tens of thousands in provider charges, how can this make sense?  It used to be that these large costs were rare so the premiums paid by healthy people covered the costs of the unlucky, but now it seems like almost everyone has some health condition or needs a surgery to improve quality of life.  Post-acute in patient care is great but that wasn’t even really a thing 20-30 years ago—you just had to have family that would stay with you to help you post-surgery.

And the young girl with cancer probably picked a cheaper plan with a higher co-pay, figuring she was young and healthy.  Should insurance companies not be permitted to offer those types of plans?  I really don’t know.  The problem is that most health care consumers don’t really adequately assess their potential risks and everyone is operating with insufficient information about what their health needs might be, and what things actually cost.

As far as the paramedic and his MRI….that seems ridiculous and he probably has a good appeal.

https://www.cnn.com/2024/12/12/business/us-health-care-insurance-frustrations/index.html

[/quote]

This really isn't it.  Americans go to the doctor less and spend less time in the hospital than people in other countries.  There's a perception that Americans are lazy and stupid and go to the doctor for everything, but we actually consume less health care than in peer countries.

The issue is that we pay more to doctors and hospitals for the same services.  In our current system, each individual insurance company negotiates with providers to set reimbursement rates.  Each insurance company has limited market power, so it can only negotiate the price down so much before the providers drop that insurer altogether. 
 In a single-payer system, the government is the primary purchaser of services, so it has tremendous market power, allowing it to negotiate the price far lower than any one insurance company could.  The government, unlike insurance companies, also isn't trying to turn a profit, which provides further savings.

I'm not saying single-payer is the answer, but high costs aren't being driven by overconsumption of care.

https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/#Distribution%20of%20difference%20in%20per%20capita%20health%20spending%20between%20the%20U.S.%20and%20comparable%20countries,%20by%20spending%20category,%202021[/quote]

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