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Originally Posted by . . . Yrs to Go
The insurance companies do push back. They try to lower the dollar amount they will cover for a specific procedure ("reasonable and customary"). They try not to cover other procedures. But at the end of the day, the insurance companies don't consume health care, people do. And the way our system is set up now many of those people don't pay much for it out of their own pocket so they just consume whatever their doctor says to without regard for cost. Insurance companies increase premiums to cover all the excess care. And employers reduce wages to pay for the higher insurance premiums. Ultimately the customer pays for his care, he just doesn't pay for it directly . . . and that is a huge part of the problem.
If you read the New Yorker article you might have noticed that Medicare spent more per person in McAllen, TX than the town's per capita income.
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This says it. Most Americans believe that "somebody else" is paying for their medical care -- either the insurance company, their employer, or the gov't. So, since it isn't their money, they want to do anything the doctor recommends. If the insurance company pushes too hard, it will find itself dealing with a complaint to the state insurance commissioner.
The "stimulus" bill included money for researching most effective practices. Some people where strongly against it because it might lead to the gov't deciding not to pay for some things. IMO, we won't make sustained progress on medical expenses until lots of people can see the cost in their own budget.
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