US lawmakers eye health insurance reform as frustrations mount

[BumRushDaShow]

This discussion thread was locked as off-topic by Omaha Steve (a host of the Latest Breaking News forum).

Source: The Guardian

Tue 31 Dec 2024 12.02 EST
Last modified on Tue 31 Dec 2024 19.04 EST


In the wake of the killing of Brian Thompson, the CEO of UnitedHealthcare, and the outpouring of frustration about insurance coverage, prior authorizations have emerged as a particular roadblock in healthcare. Prior authorization requires medical providers to get an insurer’s approval before patients receive healthcare or medications.

“As a physician, prior authorization is the number one frustrating thing of practicing outpatient medicine right now, far and away,” said Dr Gabriel Bosslet, a pulmonologist and professor at Indiana University School of Medicine. “I spend more time trying to figure out how I need to get this medication approved than I do seeing the patient and making a diagnosis and writing the prescription.”

Originally intended to control the costs of certain medications and treatments, the frequency of prior authorization requirements has risen in recent years and they now plague common and inexpensive care. “This didn’t really happen five or seven years ago,” Bosslet said.

Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh, noted that “prior authorization is something that really proliferated with the growth of managed care in the United States”. One study found reforms such as setting maximum time periods for insurers to respond and standardizing requests would help give patients needed care. Several states and Washington DC have passed laws to reform prior authorization practices.

Read more: https://www.theguardian.com/us-news/2024/dec/31/health-insurance-prior-authorization

[Irish_Dem]

1. Probably mostly for show.

The billionaires are in charge now.

[sop]

2. Tinkering around with prior authorization by setting time limits for insurers to deny treatment is now "reform"?

What bullshit.

[NotHardly]

16. Real reform is needed, and with consequences for companies

Yeah, like that would ever happen ...

[airplaneman]

18. Right getting your denial promptly instead of waiting months

[quaint]

3. Recognition of the problems is step one.

Addressing the problems with the simplest solutions makes sense to me.

[Think. Again.]

5. Yes, hopefully they will begin to recognize the problems soon.

Because this isn't that.

[IronLionZion]

4. The GOP reform plan is for people who can't afford care to die quickly

[Think. Again.]

7. "Dr. Oz" has actually stated that uninsured people are not worthy of care.

https://www.democraticunderground.com/10143364952

[Delmette2.0]

14. Yep. Work hard, get sick (or injured) die fast. nt

[Old Crank]

6. Mandate that health insurance

can only have a 10% overhead rate. Medicare operates with about a 2% rate.
Private companies are very inefficient.

[Mr. Mustard 2023]

9. Yes, and notice how none of the...

...Republicon "efficiency hawks" ever mention unnecessary middle man private health insurance. Ohhhhh...."efficiency" is more important than results according to the "efficiency hawks" such as the DOGE Twins, Musk & Ramaswamy, or the over 3000 Republicon/MAGA hate radio jerks.

Yet when it comes to private health insurers who add zero value to the service of health care, and intentionally create more inefficiencies, then suddenly "efficiency" is never mentioned.

[paleotn]

12. Got to look at Republicans through an Orwellian lens. Otherwise, what they say makes no sense.

Efficiency, in the common meaning of the word? Of course not. It equals rigging the system to THEIR advantage. Actual government efficiency has got nothing to do with it.

[IbogaProject]

13. Medicare admin rates have increased with HIPAA

2% overhead was awhile ago, in 1991 it was over 3%, I think it's north of 5% now with HIPAA compliant technology costs. Private is over 30% that differential is nearly the entire cost to cover everyone. Lack of single payer was?l due to the Dixiecrats not wanting to cover minorities when many nations nationalized either Health Care or Insurance. I assume since they are mostly dead and went to the GOP, when the two partys switched North & South.

[70sEraVet]

8. US Lawmakers will not create laws without 'prior authorization'.....

from their mega-donors.
Turd45 is openly placing his mega-donors at the helm of the government.
I assume that the next Supreme Justice appointments will be Harlan Crow and Leonard Leo -- the billionaires can save money by cutting out the middle men.

[paleotn]

10. Ha! Which ones?

Other than Donny showing support for making it worse, there's no mention of which lawmakers are for what. That frustrates the hell out of me about stories like this because WHO is just as important as WHAT. In general, Republicans don't want to give anyone anything ever, and sometimes want to take what's ours. I find it extremely hard to believe ANY of them would advocate for any kind of reform. And THAT needs to be reported!!!!

[quaint]

11. Sounds like there is no hope, I tried the positive approach but no go here.

[bmichaelh]

15. Meaningful insurance reform would be...

Meaningful reform would mean removing decision on potential life saving treatments from the insurers.

But I doubt Congress would do that.

I experienced the denial of coverage, firsthand.

I was diagnosed with lymphoma in 1990; it returned in 2019.
I went through four unsuccessful treatments.
In my case, with each return, the lymphoma gets more aggressive and resistant to prior therapies.
The fifth treatment was initially approved; showed promise that the other 4 treatments did not.
My insurer tried to rescind approval for further treatments with some BS justification: '...eligible for stem cell transplant'
My provider successfully appealed; I was able to continue treatments and achieve remission.

The person who rescinded approval of my treatment was not an oncologist but a pediatrician.
And he or she was not making the decision based on medical evidence but some insurer regulation.
Why a pediatrician is making a decision about my cancer treatment is wrong.
Another problem with insurers is that they are bureaucratic.
My treatment had only been approved by the FDA in 2020; a year before I began treatment.
Were they denying treatment simply because it was new?

[jvill]

17. For-profit health insurance is a leech on society. It is unnecessary and provides zero value.

Private and for-profit health insurance makes zero contributions to society. It is a leech. All it does is slosh taxpayer money around, make the system run less efficiently and more painfully, and then take a chunk of the money for its trouble.

That's it. It adds nothing, it improves nothing. The insurance industry takes a system that works well in every other first-world country, injects profit-taking, and enshittifies it.

Private health insurance is a morally bankrupt industry—shame on the people who work in it.

[Omaha Steve]

19. AFTER a review by forum hosts LOCKING

Feature piece, analysis.

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