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

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

#151

Post by larrik » Wed, Aug 17, 2016, 7:04 PM UTC

Randgalt wrote: post #29

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?

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…

I don't know, I think USPS is better than FedEx.

Also, here in Connecticut (the place where the rich historically sent their kids to school), there are plenty of public schools that are at least as good or better than at least some nearby private schools. When you get into preschool, for instance, the public schools are a HUGE improvement over all but the top-tier private ones. Likewise, the "magnet" program schools are a public option that is as good or better than most private schools nearby (they are special, well-funded by the state, and use a lottery to get in, though).

This is coming from someone who agrees with you in principle, too. Reality is nuanced, though.

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

#152

Post by Randgalt » Wed, Aug 17, 2016, 7:05 PM UTC

gnaritas wrote: post #127

Randgalt wrote: post #110

Earlier quoted context omitted.

"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).

Wrong, it's exactly the world I want to live in and the Constitution happens to agree, which is why we've amended it many a time, because the governed decided it was outdated. The notion that we should still be living by the dictates of men long dead is simply absurd, every generation has a right to decide for itself how its government works as it should, and as we have done.

So, if the majority votes to take away the rights of, oh I don't know, Japanese citizens -- that's a world you want to live in? You're not thinking clearly about the issue.

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

#153

Post by Spooky23 » Wed, Aug 17, 2016, 7:05 PM UTC

derekp7 wrote: post #118

Mister_Snuggles wrote: post #24

Earlier quoted context omitted.

It's hard to tell if there are inefficiencies and waste or if health care is just simply really expensive. Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending. Is that due to waste or inefficiencies? I honestly have no idea.…

I would really like to see a breakdown of the actual costs to provide a given service. Take something simple like removing an appendix or gall bladder. You have one surgeon, one or two surgical assistants (typically med students / interns), plus a couple nursing staff, and the anesthesiologist, for about an hour. 6 people, assume 200K per year, that's $100 per hour, so $600 in people salaries. (Throw in another coupl…

The anesthesiologist alone will be $5k.

They are the person most able to kill you when they screw up, so a significant portion of that bill is insurance. They also make $300-500k.

Also recovery room or ICU time is very expensive -- something like $1000/hr in some cases.

That type of procedure (gall bladder) will cost something like $15-20k.

When I had a spinal fusion, it was a 4-5 hour procedure involving a neurosurgeon, his PA, an anesthesiologist and his nurse, and 4-5 others. That procedure cost ~ $125k.

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

#154

Post by QuarterReptile » Wed, Aug 17, 2016, 7:05 PM UTC

danielweber wrote: post #98

eridius wrote: post #34

Earlier quoted context omitted.

There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.

The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player. http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.

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

#155

Post by bluGill » Wed, Aug 17, 2016, 7:06 PM UTC

notadoc wrote: post #103

organsnyder wrote: post #53

Earlier quoted context omitted.

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 provi…

The US health care market is not competitive in that way because of the incentives do not work that way. The US health care market is not consumer driving it is employer driven, and employers want all the things you bring up because it lowers their costs. What employers fear is that someone will offer a health insurance plan that is competitive to theirs, which makes it easier for my to change jobs.

Employers like the fact that I pay $200/month for my health insurance, they pay $1000/month. If I want a health insurance plan that improves outcomes and which costs $1500/month I have to come up with the $1500/month, not just the $300 difference. (the above numbers are all made up, but they are realistic)

I have long believed that we cannot solve the US health care problems without removing the incentives that force me to use my employers' policy like it or not.

In short, you don't see those examples in the US because the system is not competitive on outcomes, only costs. Since cost is the only thing they compete one insurers offer lower payments to doctors, fight every claim, add higher deductibles (which is a hidden cost on me) and co-insurance for the patients. These are innovative, not all are innovations that I would want my insurance company to come up with, but since I'm not a customer they don't care what innovations I want.

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

#156

Post by harryh » Wed, Aug 17, 2016, 7:07 PM UTC

nfriedly wrote: post #4

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

That's silly. Insurance is a great method of hedging risk. If my apartment burns down it would cost me A LOT of money to replace my stuff. But the chances of it burning down are really small. So I can purchase renters insurance for just a couple hundred bucks a year, an expense I can easily afford.

That benefits me a great deal!

Maybe when you said insurance you meant to say "health insurance" but the same principle applies. If I have a heart attack then treating it will be hideously expensive, but that's also unlikely to happen.

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

#157

Post by Frondo » Wed, Aug 17, 2016, 7:12 PM UTC

skylan_q wrote: post #68

Frondo wrote: post #57

Earlier quoted context omitted.

Private insurers also ration the amount and quality of care given.

Everyone rations. The difference between the US and the single-payers is that more care is given and better care is given vs. the rest of the world where gov't budgets are constrained so care is constrained. I'm in Ontario and I can't even get a general practitioner. This is worse than communism.

More care may be given, but I can't find any way that the statement "better care is given" could be taken as a true statement. The US falls far below every other western nation in terms of money spent vs patient outcomes.

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

#158

Post by tptacek » Wed, Aug 17, 2016, 7:14 PM UTC

rayiner wrote: post #106

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-su…

You're a supporter of single payer? Health care is something like a fifth of the whole US economy. You're comfortable with the USG setting prices for it?

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

#159

Post by harryh » Wed, Aug 17, 2016, 7:16 PM UTC

snsr wrote: post #10

Kind of ironic given that Aetna is largely responsible for the elimination of the public option from the Affordable Care Act. Thanks again Joe Lieberman https://en.wikipedia.org/wiki/Aetna#Lobbying_and_campaign_co...

If you think a ~$100,000 a year to a politician (plus another couple million to some other politicians) is largely responsible for the rules that govern how 20% of our economy functions you are quite mistaken.

There are huge economic and political forces at work that render Aetna's tiny expenditure irrelevant in the grand scheme of things.

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

#160

Post by Spooky23 » Wed, Aug 17, 2016, 7:17 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?

Remember that the existence of private players doesn't mean that you have a free market, which tends to drive efficiencies.

In the US, it's more of a planned/command economy.

A retail consumer gets the worst price. (Think the "rack rate that you never pay that's in the back of a hotel door) The government through Medicare/Medicaid/Tricare gets the best price. Everyone else is in the middle, on a spectrum of discount based mostly on size or some other market power.

In a single payer system, you end up controlling costs by compelling the providers to work for the system (similar to an HMO like Kaiser), prioritizing certain services and using regulation to discourage bad vendor behavior, like drug profiteering.