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

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

#241

Post by 20yrs_no_equity » Wed, Aug 17, 2016, 8:59 PM UTC

Spooky23 wrote: post #160

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…

> you end up controlling costs by compelling the providers

This is the basic premise of socialism. But it never works out. What you end up getting is either very low quality at high prices or very low availability.

Obamacare attempts to do exactly that, and as a result the providers are simply leaving the "market". Meanwhile, price has skyrocketed, and quality of coverage has dropped dramatically.

My marketplace plan would likely bankrupt me if I got a serious condition, however the coverage I had before Obamacare was very good and very cheap. I'm not that much older!

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

#242

Post by harryh » Wed, Aug 17, 2016, 9:00 PM UTC

Apocryphon wrote: post #233

onewaystreet wrote: post #180

Earlier quoted context omitted.

The headline is misleading. Aetna didn't threaten to pullout if their merger wasn't approved, they said that they would be forced to do so because they would be losing too much money. That isn't "attempting to thwart antitrust law," it's simply stating the facts.

Then so be it. If Aetna is unable to withstand the rigors of the post-Obamacare climate, then they should fail accordingly. Their competitors seem to be able to hold on without resorting to monopolistic tactics. Better they fail now, before they become too big to fail through mergers and acquisitions.

The issue is not that the ACA is causing Aetna to fail. Aetna makes an enormous amount of money on employer sponsored health care plans. Where Aetna was losing money was on the public exchanges, a new line of business that didn't exist before the ACA.

And it's not just them. Nearly all of the large insurance companies are pulling out of the exchanges because they're losing money. A lot of people believe this is because, as they are currently constructed, the public exchanges are untenable. And that's a very big deal if it's true. Not for the profitability of insurance companies, but for public health care policy in this country.

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

#243

Post by st3v3r » Wed, Aug 17, 2016, 9:01 PM UTC

X86BSD wrote: post #79

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/...

Yeah I'm not buying this and never have. You're going to need to cite some kind of scientific statistics or stats or studies. When people get sick they come to the US for treatment if they can. You don't see world leaders and those with money going to Canada or Europe for treatment. Not when it's dire. The US is hella expensive for many reasons one is that we have the most bleeding edge medical technology.

David Beckham tore his ACL, and despite playing for Los Angeles at the time, went to Finland for his surgery.

http://news.bbc.co.uk/sport2/hi/football/europe/8567353.stm

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

#244

Post by thinkcontext » Wed, Aug 17, 2016, 9:01 PM UTC

ruste wrote: post #169

vidarh wrote: post #161

Earlier quoted context omitted.

Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with. The difference is that with most socialised systems there are two system in parallel: A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years". A…

Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government. Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't g…

> Except you can sue your insurance provider if they deny > you coverage for something that they're obligated to > cover.

There's an enormous information and power imbalance in the health insurance contractual relationship. The large number of medical bankruptcies by people that had health insurance is surely a testament to this fact.

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

#245

Post by twblalock » Wed, Aug 17, 2016, 9:03 PM UTC

danielweber wrote: post #20

saosebastiao wrote: post #6

Good. Block their deal, let them drop out of obamacare, and then give us the Single Payer that we've always deserved and watch those fuckers go bankrupt like they've always deserved.

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.

The most likely outcome is a public option in the exchanges. I don't expect that many private insurers will continue to participate in the exchanges if they have to compete with a public option, so the public option will end up being a de-facto single-payer system for poor people who have to use the exchanges.

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

#246

Post by lotsofpulp » Wed, Aug 17, 2016, 9:04 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…

It's because in healthcare, the vendor never knows if or when they will be paid, and how much it will cost to get paid, so the strategy is to charge as much as possible and just hope for the best. That means people who are dead broke get their care for free since they have nothing to pay with, insurance companies and the government strong arm the vendor into discounts since they buy in volume, and the person that gets screwed is the little guy who makes enough money to not be poor, but not enough money to have gold plated insurance but he also can't fight the hospital.

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

#247

Post by twblalock » Wed, Aug 17, 2016, 9:04 PM UTC

I don't understand why so many private insurers participated in the exchanges in the first place. It seems pretty obvious that the people who need to purchase from the exchanges are less likely to be healthy than the general population, because they probably haven't had much preventative care in the past, due to their prior lack of insurance, and also because poverty and poor health are highly correlated.

Imagine that you ran a car insurance company, and the government set up an exchange where the least-skilled drivers could purchase insurance. Would you participate?

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

#248

Post by Broken_Hippo » Wed, Aug 17, 2016, 9:08 PM UTC

harryh wrote: post #166

Frondo wrote: post #162

Earlier quoted context omitted.

Oh, I'd agree completely that, as an implementation of universal health care, Obamacare falls far short. I always say, it's better than what preceded it, but that is a pretty low bar to achieve. (My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.) But while the implementation is pretty poor, the idea beh…

(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.) Probably you were denied personal health insurance not for BS reasons, but because the insurance companies knew they would (probabilistically) lose money insuring you. But now under Obamacare, if they participate on the exchanges, they are obligated to…

Well, not really. I had my gall bladder out about '08. I couldn't eat properly before it got out. It wasn't emergency, but the pain put me in the emergency room more than once. I didn't have gallstones, it quit working. It has been years since I got it out. I still have a few problems eating greasy foods (especially meat), but now generally avoid those and am mostly vegetarian. No other complications, and I have not required any sort of care for that surgery outside of that. Neither has my brother, who got his out about 5 years ago. Neither has my mother, who got hers out in 1978.

This type of thing isn't so much a pre-existing condition as much as they are "I had a health issue that was more severe than a simple infection". It isn't the same as "I have diabetes" or "I have chronic issues with x", which can cause expenses.

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

#249

Post by ashark » Wed, Aug 17, 2016, 9:10 PM UTC

Randgalt wrote: post #219

Randgalt wrote: post #191

Earlier quoted context omitted.

"What is the alternative?" - a system of rights based on the nature of human beings. Human beings survive by producing the things we need to survive. We need governments to protect others from initiating force against us in opposition to our primary needs of living. Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.

"I'm having trouble figuring out how this doesn't still boil down to people making judgement calls on what is and isn't a right" - at the end of the day we're ruled by people. But, there should be a standard by which decisions are made other than "whatever the majority decides".

> But, there should be a standard by which decisions are made other than "whatever the majority decides".

It seems like a standard is just a reason for choosing a given set of things to call rights and a given role for government, and we're all set to circle right back to where we were—the people with the power to affect government choosing those things, based on reasons (which was implicitly the case before, anyway). At some point there must be compelling evidence for selecting a given standard over any other, and one would hope that standard may change in the face of new evidence.

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

#250

Post by ruste » Wed, Aug 17, 2016, 9:10 PM UTC

st3v3r wrote: post #227

ruste wrote: post #169

Earlier quoted context omitted.

Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government. Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't g…

"Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. " With what money? And furthermore, what good will that do if you die before the trial is over?

You can have the procedure done then sue them when they won't pay for what they're contractually obligated to. You don't generally get a hospital bill until the procedure is done.