The Hidden Cost of Privatization • Hacker News Board

Re: The Hidden Cost of Privatization

#111

Post by antisthenes » Wed, Jun 14, 2017, 8:06 PM UTC

maxerickson wrote: post #105

r_smart wrote: post #88

Earlier quoted context omitted.

You're confusing insurance with healthcare. Insurance is supposed to be for risk mitigation, rare but extremely damaging events. If everyone uses insurance for everything health related, like we all want to do now, it's impossible for insurance to be anything other than a premium you pay on top of your healthcare costs. Insurance shouldn't be used for routine stuff, and people shouldn't be required to have it unless…

it's impossible for insurance to be anything other than a premium you pay on top of your healthcare costs. And yet each year there are millions of people that receive medical services in excess of their insurance payments (including premiums, copays, etc).

Which doesn't invalidate what the parent comment in any way, because we're talking about the aggregate costs.

So what was your point?

Re: The Hidden Cost of Privatization

#112

Post by harryh » Wed, Jun 14, 2017, 8:10 PM UTC

subverter wrote: post #96

rayiner wrote: post #80

Earlier quoted context omitted.

> Why do so many oppose such a solution where everyone can much more easily find a place where they agree with the "social services" offered (or not)? Because it creates collective action problems. Countries can exercise their sovereign powers to control commerce and the flow of people so as to reinforce their chosen social welfare systems. If they offer universal healthcare, for example, they can control immigration…

In your example of Maryland and Virginia and universal healthcare, Maryland will continually need to ensure they're collecting enough money (i.e., through taxes of some sort) to pay for universal healthcare. If an influx of unhealthy people enter the state, they'll have to increase taxes to pay for the higher healthcare bills, which will in turn make them less competitive with other states, and cause people to leave.…

Universal healthcare works in various countries because everyone is forced to participate. Everyone pays into the system, everyone gets care when they get sick or are injured.

A US state can't do this on it's own because they can't force everyone to participate and they can't reject entrants from outside. In the Virginia/Maryland example Maryland would face an exodus of healthy and productive people who want lower taxes and an influx of sick people who want the free health care. It's not about "remaining equal in all other categories." It's that it wouldn't really work at all.

That's why you can't really have a system with massively different social services at the state level: the unbridled state to state migration.

Re: The Hidden Cost of Privatization

#113

Post by maxerickson » Wed, Jun 14, 2017, 8:10 PM UTC

antisthenes wrote: post #111

maxerickson wrote: post #105

Earlier quoted context omitted.

it's impossible for insurance to be anything other than a premium you pay on top of your healthcare costs. And yet each year there are millions of people that receive medical services in excess of their insurance payments (including premiums, copays, etc).

Which doesn't invalidate what the parent comment in any way, because we're talking about the aggregate costs. So what was your point?

The premium on top of aggregate cost complaint would also apply to "pure insurance". Or else no one would bother selling it.

Anyway, I'm pretty sure they were saying that insurance didn't work, which is manifestly untrue. If they are complaining that it makes healthcare more expensive, well fine, but that is probably more about the principal agent problem than the administrative costs and profits of insurers.

Re: The Hidden Cost of Privatization

#114

Post by ZeroGravitas » Wed, Jun 14, 2017, 8:10 PM UTC

r_smart wrote: post #88

matchbok wrote: post #49

Earlier quoted context omitted.

Because if you don't mandate insurance, then the entire system falls apart. Sick people need it, healthy people don't want to pay for it. You need everyone to pay to make it affordable.

You're confusing insurance with healthcare. Insurance is supposed to be for risk mitigation, rare but extremely damaging events. If everyone uses insurance for everything health related, like we all want to do now, it's impossible for insurance to be anything other than a premium you pay on top of your healthcare costs. Insurance shouldn't be used for routine stuff, and people shouldn't be required to have it unless…

"insurance" in this case is also a savings account. People need to be forced to put money into the system when young and/or healthy so that's there's enough money available when they are not.

If they're not forced to do this, then they won't and people are forced to stand by and watch as they fall ill and due which is bad for the economy and may already disease, even if you don't care about the moral aspects.

There's little benefit to seperating these things out and obvious downsides to them not being mandated.

Re: The Hidden Cost of Privatization

#115

Post by frgtpsswrdlame » Wed, Jun 14, 2017, 8:11 PM UTC

subverter wrote: post #98

frgtpsswrdlame wrote: post #94

Earlier quoted context omitted.

>You're assuming that if the government didn't mandate health insurance, nobody would step in to help those people No, the assumption is that if government mandated dollars stopped coming in, voluntary contributions wouldn't make up the difference. And that seems pretty obvious to anyone who pays attention to the political dialogue. Look at the Republicans who believe Obamacare is too costly. Their sole goal is to ha…

That's also assuming the costs would stay the same, which they wouldn't if government stopped intervening. With lower costs, more people could afford to pay for healthcare out-of-pocket, which would reduce the amount of voluntary money necessary to cover those who truly need it.

Have you ever considered that your beliefs are utopian in nature? That if we give over everything to the market things won't just solve themselves?

Besides healthcare costs are lower in countries where the government intervenes more than ours does disproving the point.

Re: The Hidden Cost of Privatization

#116

Post by subverter » Wed, Jun 14, 2017, 8:11 PM UTC

gnaritas wrote: post #99

subverter wrote: post #64

Earlier quoted context omitted.

Affordable for whom? It has become much less affordable for those who are healthy. How do you justify the healthy paying for the unhealthy? And is it really affordable, even for the unhealthy?

> How do you justify the healthy paying for the unhealthy? Over the course of time, everyone falls into both categories; this idea that there are healthy people is silly, everyone's health fails eventually and often randomly. Healthy is a temporary state. Everyone should contribute so everyone is covered when they become the unhealthy, as they all will. Better to pay a little bit all of the time than to pay nothing a…

But not everyone is (or becomes) healthy or unhealthy to the same degree. If I have no family history of health issues, or I simply want to take a chance that I'll remain healthy, why should anyone else tell me how much I should value my health?

Re: The Hidden Cost of Privatization

#117

Post by maxerickson » Wed, Jun 14, 2017, 8:11 PM UTC

subverter wrote: post #110

maxerickson wrote: post #104

Earlier quoted context omitted.

In your example of child labor, it's arguably better for everyone if Virginia can produce cheaper goods. (Please don't think I'm in any way arguing for child labor.) So is it arguably better for everyone or should there be protections for the children (who are presumably part of "everyone")? I think if you immediately include a disclaimer about the children you probably don't believe there is much of an argument to b…

Child labor is complex subject that we should avoid getting into here. The reason I added my disclaimer is because my argument is about cheaper goods, not any particular way they happen to be produced.

The banality of saying that cheaper goods are good is impressive and doesn't have much to do with the argument rayiner was making.

Re: The Hidden Cost of Privatization

#118

Post by subverter » Wed, Jun 14, 2017, 8:25 PM UTC

harryh wrote: post #112

subverter wrote: post #96

Earlier quoted context omitted.

In your example of Maryland and Virginia and universal healthcare, Maryland will continually need to ensure they're collecting enough money (i.e., through taxes of some sort) to pay for universal healthcare. If an influx of unhealthy people enter the state, they'll have to increase taxes to pay for the higher healthcare bills, which will in turn make them less competitive with other states, and cause people to leave.…

Universal healthcare works in various countries because everyone is forced to participate. Everyone pays into the system, everyone gets care when they get sick or are injured. A US state can't do this on it's own because they can't force everyone to participate and they can't reject entrants from outside. In the Virginia/Maryland example Maryland would face an exodus of healthy and productive people who want lower ta…

They can't? How do they force everyone to pay state/local taxes? I doubt states would find it difficult to enforce participation.

On "unbridled state to state migration", I already covered that. Maryland would have to face the real cost of providing universal healthcare, and residents would have to decide whether it's still worth it to live there. Many sick people would decide that it's not, and choose to stay put in Virginia.

And if it truly wouldn't work, then it begs the question: Does it really work on the federal level? Why are costs skyrocketing and providers leaving exchanges?

Re: The Hidden Cost of Privatization

#119

Post by bjl » Wed, Jun 14, 2017, 8:30 PM UTC

subverter wrote: post #108

gnaritas wrote: post #102

Earlier quoted context omitted.

> There's a significant part of the U.S. population that wants to roll back gay marriage. Oppressing others isn't something that should be allowed to happen, period; those people are simply wrong, the position is immoral and indefensible. These things belong at the federal level, states should not be allowed to say oppression is OK because a majority of our citizens want to oppress gays.

To quote you above[1]: > That's a matter of opinion. To be clear, I am not one who is in favor of rolling back gay marriage. But you cannot logically say > Oppressing others isn't something that should be allowed to happen, period while in the same breath calling for the oppression of those you disagree with. It's an inconsistent position using the same argument you're railing against. [1] https://news.ycombinator.co…

Good thing the paradox of tolerance has been solved for over a century! Now if only we could get the message out to people like you that seem to delight in ignoring centuries of philosophical discussion on this topic.

Re: The Hidden Cost of Privatization

#120

Post by frgtpsswrdlame » Wed, Jun 14, 2017, 8:30 PM UTC

subverter wrote: post #116

gnaritas wrote: post #99

Earlier quoted context omitted.

> How do you justify the healthy paying for the unhealthy? Over the course of time, everyone falls into both categories; this idea that there are healthy people is silly, everyone's health fails eventually and often randomly. Healthy is a temporary state. Everyone should contribute so everyone is covered when they become the unhealthy, as they all will. Better to pay a little bit all of the time than to pay nothing a…

But not everyone is (or becomes) healthy or unhealthy to the same degree. If I have no family history of health issues, or I simply want to take a chance that I'll remain healthy, why should anyone else tell me how much I should value my health?

It's really about double jeopardy. For a second put yourself behind the veil of ignorance. You are prebirth, you have no control over any factor of your birth other than one. That factor is that you get to pick whether you are born into a country with universal healthcare or one with non-mandated insurance where companies are able to discriminate on pre-existing conditions. Anyone who is risk averse is going to pick the universal healthcare one, otherwise you are risking a life where you are both sick but also bankrupted by medical costs.

That some people in society look at the circumstances of their birth and post-hoc reason that they don't want universal healthcare because it wouldn't have benefitted them is not the point really.