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

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

#181

Post by maxerickson » Wed, Aug 17, 2016, 7:50 PM UTC

toddmorey wrote: post #101

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 (F…

I absolutely think that a national policy should focus on maximizing outcomes across society, but it is easy to imagine that some people don't care about the outcomes that other people receive.

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

#182

Post by Steko » Wed, Aug 17, 2016, 7:51 PM UTC

harryh wrote: post #175

jlmorton wrote: post #170

Earlier quoted context omitted.

This is not proof at all that "Obamacare is a Rube Goldberg machine." This is a major insurer pulling out the markets, but over trivial amounts of losses. I don't know what you mean about Kentucky. There are plenty of health insurance companies with offering on the Kentucky exchanges (Anthem BCBS, CareSource Kentucky, Humana, Aetna, and Bluegrass Family Health). And in any event, even if there truly were no insurance…

I don't think it's fair to categorize Aetna's annual loss of ~300M as trivial. That represents about 12.5% of their profits. If someone cut your salary by 12.5% I don't think you would think that was trivial.

Salary is analogous to revenue not profits.

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

#183

Post by wavefunction » Wed, Aug 17, 2016, 7:51 PM UTC

Randgalt wrote: post #121

VonGuard wrote: post #114

Earlier quoted context omitted.

I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age.

Galt doesn't need anyone to take care of him.

It's true, Galt was a fictional caricature.

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

#184

Post by harryh » Wed, Aug 17, 2016, 7:52 PM UTC

Steko wrote: post #182

harryh wrote: post #175

Earlier quoted context omitted.

I don't think it's fair to categorize Aetna's annual loss of ~300M as trivial. That represents about 12.5% of their profits. If someone cut your salary by 12.5% I don't think you would think that was trivial.

Salary is analogous to revenue not profits.

Salary is the money I get from my employer to buy stuff with.

If I'm a shareholder of a company, then my cut of their profits (not revenue) is money I get to buy stuff with.

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

#185

Post by ashark » Wed, Aug 17, 2016, 7:55 PM UTC

Randgalt wrote: post #150

ashark wrote: post #128

Earlier quoted context omitted.

> 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. "Rights" are basically just freedoms we've decided we like a whole lot and want the government to guarantee, so that's not exactly a static category. So on the one hand we can just decide whicheve…

"'Rights' are basically just freedoms we've decided we like a whole lot and want the government to guarantee" - as I said below, the logical conclusion of that argument is not a world you'd want to live in. -- "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.

> "'Rights' are basically just freedoms we've decided we like a whole lot and want the government to guarantee" - as I said below, the logical conclusion of that argument is not a world you'd want to live in.

How is that not the world we live in? What is the alternative? At some point someone's deciding what's a right and what isn't. Other people may disagree. Rights aren't a law of nature, they're a fuzzy category, subject to conditions and caveats and shifting over time.

> "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.

But a lot of the things government does that don't fall within that narrow limit really, really appear to make my life and the lives of the people I care about much better, at relatively little cost (for a broad definition of cost). Few or none of the OECD states seem too bad, to put it mildly. None are unqualified disasters, or even close. Meanwhile a "drown it in a bathtub" government coexisting with an advanced economy (correct me if I'm wrong) remains hypothetical—indeed, I think it's fair to call mainstream the view among experts that governments' special ability to overcome coordination problems and take action to nurture markets is vital to an advanced economy—as do the effects of such a system. So it's definitely going to be an uphill battle convincing me that our government "should be limited to protecting other people's rights", without some other state practicing that and full of citizens telling me "no, really, it's pretty great".

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

#186

Post by Steko » Wed, Aug 17, 2016, 7:57 PM UTC

harryh wrote: post #184

Steko wrote: post #182

Earlier quoted context omitted.

Salary is analogous to revenue not profits.

Salary is the money I get from my employer to buy stuff with. If I'm a shareholder of a company, then my cut of their profits (not revenue) is money I get to buy stuff with.

Profits is the money left over after expenses. This is not what salary represents to the average worker.

Edit: not a 3 year number

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

#187

Post by nfriedly » Wed, Aug 17, 2016, 7:58 PM UTC

harryh wrote: post #156

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…

I was referring to health insurance specifically. I edited that in just now to clarify.

Health insurance should work exactly as you describe, but far to often I've seen it cover the little things like colds, and then fail to adequately cover big things like a heart attack.

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

#188

Post by jlmorton » Wed, Aug 17, 2016, 8:03 PM UTC

harryh wrote: post #175

jlmorton wrote: post #170

Earlier quoted context omitted.

This is not proof at all that "Obamacare is a Rube Goldberg machine." This is a major insurer pulling out the markets, but over trivial amounts of losses. I don't know what you mean about Kentucky. There are plenty of health insurance companies with offering on the Kentucky exchanges (Anthem BCBS, CareSource Kentucky, Humana, Aetna, and Bluegrass Family Health). And in any event, even if there truly were no insurance…

I don't think it's fair to categorize Aetna's annual loss of ~300M as trivial. That represents about 12.5% of their profits. If someone cut your salary by 12.5% I don't think you would think that was trivial.

I should clarify, I didn't mean it was trivial to Aetna. I meant it was trivial compared to the cost of the existing subsidies and risk corridors in the ACA, and that this is not an existential problem for ACA.

Over the past few months, several major insurers have either reduced or ended their participation in the ACA exchanges. That is troubling news. However, setting aside the political feasibility, it's hardly an unsolvable problem. If the risk pool does not improve, and insurers keep losing money, then we can raise funding for the risk corridors.

To put this in perspective, Aetna, one of the largest insurers in the marketplace, is losing about $300 million. We're spending about $200 billion/year on ACA currently.

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

#189

Post by maxerickson » Wed, Aug 17, 2016, 8:03 PM UTC

Apocryphon wrote: post #43

danielweber wrote: post #20

Earlier quoted context omitted.

Anyone who thinks this is leading to single-payer is dreaming. Whether you think it's a good idea or not, the political will wasn't there for in 6 years ago, and there is much less political will for it now.

Then at least Aetna will twist in the wind for their avarice.

By walking away from the exchanges they are just walking away from a money losing business. That isn't twisting in the wind.

The ACA established programs to make payments to insurance companies that got unusually expensive customers but the funding for those payments has been blocked.

http://www.modernhealthcare.com/article/20160517/NEWS/160519...

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

#190

Post by parasubvert » Wed, Aug 17, 2016, 8:05 PM UTC

Mister_Snuggles wrote: post #140

graeme wrote: post #85

Earlier quoted context omitted.

Why do you say inefficiencies? 40% is entirely out of context, because you haven't listed what other budgeting responsibilities Canadian provinces have. Canada spends far less per capita on health than the us, and gets better outcomes. It's certainly expensive, but it's hard to make the case that Canadian care is expensive relative to the US.

I was replying to this part of the parent comment when I used the words "inefficiencies" and "waste": > Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste? I also acknowledged that I have no idea if $20B is good or bad. And I did not make the case that it's more or less expensive relative to the US. Another commenter took the…

It's all relative. Alberta is "high" compared to other provinces though in the ball park of the other prairie provinces (Sask & Manitoba) per capita, though BC only spends $18B-ish for a higher population.

Ontario spends $50.8B, pop 13.1m, which seems more efficient per capita than Alberta; France is inline with that per capita ; the UK spends $195.8B (CAD), pop 64.1m, which is even lower.

In general, health care is really damn expensive.