Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger • Hacker News Board

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#101

Post by toddmorey » Wed, Aug 17, 2016, 6:36 PM UTC

seibelj wrote: post #2

Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

There's pretty enlightening chart on this article: http://www.commonwealthfund.org/publications/issue-briefs/20...

The general consensus is that the U.S. spends more on health care than other high-income countries but has worse outcomes.

"Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%)."

If there are benefits to a private system, we aren't seeing them. (That may be because we don't have a private system OR a public system. We have a frankenstein hybrid that's the worst of both and works for no one.)

The biggest problem is all the attention has been focused on who pays, rather than how much. The cost system for US Healthcare is so opaque, so disjointed that no one--not the providers, not the customers, not the insurers--have the required understanding or motivations to control costs.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#102

Post by mschuster91 » Wed, Aug 17, 2016, 6:37 PM UTC

ChuckMcM wrote: post #44

seibelj wrote: post #2

Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

In theory? As I understand it ... A market allows for innovators to find ways to deliver better service for less money and thus offer a more competitive product and gain market share. This competition forces all players to improve, or be forced from the market. A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.…

> If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database.

Well, there's a couple of problems here:

1) People who fail to pay their bills cause financial losses, which have to be covered by the hospital. Therefore, given identical personnel/equipment/etc costs, a hospital in a "poorer" (= more unpaid bills) area will always be higher in cost than a hospital in a "richer" area, since losses have to be distributed among the fully paying customers.

2) You cannot just compare different hospitals on pricing alone. Factors that make this impossible include rent, personnel costs, and equipment costs (e.g. a hospital which uses an old MRT will operate at a cheaper rate than one which buys a new MRT every year).

3) Medical procedure costs can not be estimated at all, given just the diagnosis. Right now my cat is at the vet hospital, turns out the (relatively simple) laying of a pipe to the stomach (she doesn't eat/drink anymore due to liver inflammation, and syringe feeding a cat is cruel for both owner and cat) isn't so simple at all for this unique cat. (For the fellow cat owners, the only thing not healthy about this cat is the liver. The rest of her is in a pretty good condition, and the vets believe she'll make it and purr on for years).

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#103

Post by notadoc » Wed, Aug 17, 2016, 6:37 PM UTC

organsnyder wrote: post #53

seibelj wrote: post #2

Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

A couple of arguments in favor of a marketplace: 1. In theory, a competitive marketplace should be able to cut costs and improve outcomes by incentivizing innovation and efficiency (of course, you also have to try to guard against incentivizing insurers to cut costs by reducing access to care). 2. Switching to a single-payer model would be incredibly disruptive to the economy. It would need to be done gradually to mi…

> In theory, a competitive marketplace should be able to cut costs and improve outcomes

Outside of theory, can you think of any example where this has actually happened in US health care?

The only cost cutting I can think of are notably lower payments to doctors, the insurers fighting every claim, and higher deductibles and co-insurance for the patients. So I guess that cut costs for the health insurer, but the providers and patients costs have gone up directly and dramatically.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#104

Post by csallen » Wed, Aug 17, 2016, 6:37 PM UTC

warfighting wrote: post #77

How long would a government run tech company survive in the valley? Now tell me again why you want them centrally planning your healthcare?

I never understood this mindset. It assumes that the govn't is incompetent (which it often is in many areas, fair point), but then ignores the most obvious response, which is to diagnose and fix the problems at hand. Simply abandoning the government solution is not the only option. In fact, one of the government's biggest problems is that so many people are obsessed with neglecting/sabotaging it just to prove some point that it's bad.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#105

Post by rch » Wed, Aug 17, 2016, 6:37 PM UTC

nfriedly wrote: post #4

Good riddance. Heath insurance in the US seems to benefit the insurance companies more than anyone else.

How about pharmaceutical companies?

It seems to me that 'insurance' has become more like a group pre-paid debit card for predictable medical expenses than a lower cost hedge against statistically rare events.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#106

Post by rayiner » Wed, Aug 17, 2016, 6:38 PM UTC

Apocryphon wrote: post #93

So how can consumers respond to this corporate chicanery? In a capitalist system, the natural recourse is for citizens to turn to the private market for alternatives. Could this provide an incentive for Aetna's competitors to make it easier for Aetna's customers to switch to them? One would assume that libertarians and free marketeers would cheer the concept of boycotts, as it is one of the mechanisms that citizens a…

What corporate chicanery? They took a loss on exchange plans last year. They have every right to pull out of the exchanges until the government makes them stay.

I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-subsidization, propping up money-losing individual plans with profits from group plans. And then they berate companies for pulling out of money-losing enterprises, as if providing healthcare for people who can't afford it is the job of private companies rather than the government.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#107

Post by njkanjsd » Wed, Aug 17, 2016, 6:38 PM UTC

bcohen5055 wrote: post #15

njkanjsd wrote: post #5

Earlier quoted context omitted.

The healthcare system in countries like France, Canada, Germany is much more efficient and provides better healthcare to most of it's citizens than the US healthcare system pre and post obamacare. https://www.oecd.org/eco/growth/46508904.pdf http://www.commonwealthfund.org/publications/press-releases/...

*citations needed

http://www.commonwealthfund.org/publications/press-releases/...

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#108

Post by gnaritas » Wed, Aug 17, 2016, 6:38 PM UTC

tracker1 wrote: post #90

gnaritas wrote: post #63

Earlier quoted context omitted.

That's not how government works; it's not about pragmatic solutions or logical solutions; it's about what you can get enough people to agree on, which is what Obamacare is, the most enough people could agree on to get it passed. Whatever isn't in there, isn't there because it wouldn't have passed so all Monday morning quarterbacking about what it should have been entirely misses the point about how government works.…

And the problem is that everyone in congress is trying to push for their own optimal interests, so the compromises are less ideal than a more pragmatic approach that would have the same effect as compromise from all parties. It's not either's ideal, but still better. If I had the financial independence to run for Congress, I absolutely would.. unfortunately I need to work for a living, and being able to sustain a liv…

> so the compromises are less ideal

Such is the nature of democracy and all design by committee, accept it, it's better than the alternative: dictatorship.

> than a more pragmatic approach

Forcing more pragmatic approaches would require dictatorship and thus is simply not the correct measure to be looking at.

> If I had the financial independence to run for Congress, I absolutely would..

That wouldn't make any difference, there'd still be a committee and the resulting solutions will never be the more pragmatic ones.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#109

Post by jasonlotito » Wed, Aug 17, 2016, 6:39 PM UTC

mhurron wrote: post #84

jasonlotito wrote: post #39

Earlier quoted context omitted.

> For the citizen, none. Actually, that's false. I can assure you that having lived in Canada and having moved to the US because of health care, having options beyond "deal with it" when not getting any sort of care or service is wonderful. Single-payer is great if you are actually getting the care you need. But when it fails, you are left with little to no alternative. What's worse is that because of the perception…

You must be pretty healthy or never actually had to pay for care in the US. You also probably shouldn't assume you're the only one in the room who moved to the US from another country. I moved to the US from Canada, thankfully I am pretty healthy and don't need the healthcare system beyond my yearly checkups. The first place I lived had someone who lived down the street who will be paying off a $100k bill until they…

> You must be pretty healthy or never actually had to pay for care in the US.

Wrong. You probably shouldn't assume you know anything about me, or the situation I'm in.

> You also probably shouldn't assume you're the only one in the room who moved to the US from another country.

You probably shouldn't assume that it matters.

> The first place I lived had someone who lived

I was referring to problems with the system as a whole for entire groups of people, not just individual stories. My children being one of those where the Canadian system fails them horribly.

But no, continue believing that Canadian Health Care is perfect for everyone and that there are no benefits the US system for normal citizens.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#110

Post by Randgalt » Wed, Aug 17, 2016, 6:40 PM UTC

gnaritas wrote: post #95

Randgalt wrote: post #29

Earlier quoted context omitted.

The purpose of government is not to require the most efficient option. Government isn't capable of it anyway. Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will. For example, in Canada (until recently) people were prohibited from using private health…

The purpose of government is about whatever the governed of the current day decide that purpose is. Your view of government is just that, your opinion, not a fact. Liberals in particular tend to see the purpose of government as providing options for those who don't have any other options because the market fails many people. As such social programs have existed for decades, it's factually self evident that the purpos…

"The purpose of government is about whatever the governed of the current day decide that purpose is" - I believe you can see that the logical conclusion of that point of view is not a world you'd want to live in. In the US, at least, we have a Constitution that prevents the worst uses of government (though not as much as it used to).