Iowa insurance market collapse could ground young entrepreneurs' dreams • Hacker News Board

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#61

Post by jballanc » Fri, Jun 23, 2017, 4:34 PM UTC

harryh wrote: post #58

jballanc wrote: post #29

I always wonder why, in all the coverage about health care and insurance groups "pulling out" of the marketplace, no one seems to want to state the obvious: * Insurers are not pulling out of the insurance market . * Insurers are pulling out of selling to individuals . * This is happening because selling to large groups (like entire companies) is easier/more profitable. * It is easier to sell to larger groups because…

I know what you are getting at here but almost any individual market at the state level is going to be bigger than almost any entire company from a risk pool amortization perspective. Given that, your fourth bullet point would point in the direction of insurance companies preferring the state pools to selling to companies one at a time. The problem with the state pools is not (for the most part) one of size, but of a…

I'd actually be interested to see the numbers. Obviously, as you say, it's not just size but also the risk profile of the group...but add to that the fact that this pool is being split between as many companies as are selling on the marketplace, I wouldn't be surprised if size is part of it.

Regardless, if universal health coverage is a goal, the only way to truly amortize risk is to have everyone in one pool. Anything less pits some very perverse incentives against an inherently inefficient market. It's no wonder no one wants to participate!

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#62

Post by DanBC » Fri, Jun 23, 2017, 4:39 PM UTC

creaghpatr wrote: post #35

avs733 wrote: post #17

Earlier quoted context omitted.

Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our socie…

Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients. Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... If we implemented single-payer in the form of Medicare as it is now,…

The US government spends more on health care than some other G7 nations, not including private insurance.

http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...

If you include both government spending and private insurance the US leads the G7 in spending on healthcare (but doesn't seem to get results that match the massive spending); if you only include government spending the US pays more than Canada, the UK, Italy, and the OECD average. It pays about the same as (a bit less than) France.

> If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse.

This is because of the pisspoor state of US healthcare that insists on huge amounts of over testing, over diagnosis, and over treatment - causing excess harm at every step.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#63

Post by harryh » Fri, Jun 23, 2017, 4:42 PM UTC

jballanc wrote: post #61

harryh wrote: post #58

Earlier quoted context omitted.

I know what you are getting at here but almost any individual market at the state level is going to be bigger than almost any entire company from a risk pool amortization perspective. Given that, your fourth bullet point would point in the direction of insurance companies preferring the state pools to selling to companies one at a time. The problem with the state pools is not (for the most part) one of size, but of a…

I'd actually be interested to see the numbers. Obviously, as you say, it's not just size but also the risk profile of the group...but add to that the fact that this pool is being split between as many companies as are selling on the marketplace, I wouldn't be surprised if size is part of it. Regardless, if universal health coverage is a goal, the only way to truly amortize risk is to have everyone in one pool. Anythi…

Even small states like Iowa (total population ~3 million) are going to have 10s of thousands of people on the individual exchanges. That's bigger than all but very large corporations (who tend to self insure anyways).

I hear you about universal health coverage. I've come around to the idea that we should have it at the national level above some sort of cap. I think free markets can still work when it comes to your annual checkup or small expenses like a broken arm or a monthly prescription for non esoteric drugs.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#64

Post by glhaynes » Fri, Jun 23, 2017, 4:44 PM UTC

pc86 wrote: post #47

mikeash wrote: post #16

Earlier quoted context omitted.

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a publi…

> study the systems of other first-world countries and incorporate the things that work best into ours The problem with this line of thought is that the US is orders of magnitude larger, more diverse, and more complex than most European nations. For any single European nation I'd wager at least two of those are the case. But we have a way to do this already without massive Federal overhauls - allow individual states…

If it's as successful as proposed, it would not take very long to most states to offer something similar.

IMO this isn't clearly true. Lots of states (especially those that currently have the worst health care outcomes) seem far more driven by the ideology that has caused their problems than by this kind of pragmatism. Example 1: the ACA's Medicare expansion.

Hell, it might even work the opposite way: proof that something worked in California could end up as an argument against it. "Candidate x wants to implement the same sort of government health care system that's taken over California. This November, send him a message that we don't do things that way here."

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#65

Post by pc86 » Fri, Jun 23, 2017, 4:45 PM UTC

toomuchtodo wrote: post #60

pc86 wrote: post #55

Earlier quoted context omitted.

Well the board felt it was reasonable, and I'd expect the board of a publicly traded company to know more about its finances than me. The question was about how much R&D happens in single-payer counties, not how much one particular CEO made. I am a proponent of single-payer health care in the US but responding to unrelated, valid questions with, "yeah, but this one person made a lot of money and that makes me mad!" i…

That CEO only made that amount because of FDA regulations related to the manufacture of generics, as well as her family connections. http://amp.timeinc.net/time/money/4502891/epipen-pricing-sca... My point is that the entire for profit healthcare system in the US is broken, and it's time to burn it to the ground.

> responding to unrelated, valid questions with, "yeah, but this one person made a lot of money and that makes me mad!" is ridiculous.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#66

Post by pc86 » Fri, Jun 23, 2017, 4:47 PM UTC

glhaynes wrote: post #64

pc86 wrote: post #47

Earlier quoted context omitted.

> study the systems of other first-world countries and incorporate the things that work best into ours The problem with this line of thought is that the US is orders of magnitude larger, more diverse, and more complex than most European nations. For any single European nation I'd wager at least two of those are the case. But we have a way to do this already without massive Federal overhauls - allow individual states…

If it's as successful as proposed, it would not take very long to most states to offer something similar. IMO this isn't clearly true. Lots of states (especially those that currently have the worst health care outcomes) seem far more driven by the ideology that has caused their problems than by this kind of pragmatism. Example 1: the ACA's Medicare expansion. Hell, it might even work the opposite way: proof that some…

That sounds like democracy working. Democracy means as many people as possible get the government they want. This get progressively easier as the government gets more local. Overall people are much happier with local, then state government than the federal government.[0] If the people Mississippi don't want single-payer health care, and the people in California do, I'm in favor of a system that gives both of them what they want.

[0] http://www.people-press.org/2012/04/26/growing-gap-in-favora...

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#67

Post by gizmo686 » Fri, Jun 23, 2017, 4:58 PM UTC

justicezyx wrote: post #57

mikeash wrote: post #16

Earlier quoted context omitted.

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a publi…

> socialized medicine When you put this word here, they succeeded. Socilized has a special meaning here, and it's installed through near 5 decades of propaganda (number could be wrong, you get the idea). WHY pooling the society's resource for health care is "socialized"?! WHY WHY WHY WHY... When anyone examine this idea, everything falls apart. WHY? I don't know, and I will surprised anyone knows.

> WHY pooling the society's resource for health care is "socialized"?!

Because it is pooling some of societies wealth into the government to distribute as a good.

The only difference between this and full socialism is that this does not extend to the entire economy.

Also, keep in mind that a self proclaimed socialist is currently the most popular politician in the US.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#68

Post by glhaynes » Fri, Jun 23, 2017, 5:00 PM UTC

pc86 wrote: post #66

glhaynes wrote: post #64

Earlier quoted context omitted.

If it's as successful as proposed, it would not take very long to most states to offer something similar. IMO this isn't clearly true. Lots of states (especially those that currently have the worst health care outcomes) seem far more driven by the ideology that has caused their problems than by this kind of pragmatism. Example 1: the ACA's Medicare expansion. Hell, it might even work the opposite way: proof that some…

That sounds like democracy working. Democracy means as many people as possible get the government they want. This get progressively easier as the government gets more local. Overall people are much happier with local, then state government than the federal government.[0] If the people Mississippi don't want single-payer health care, and the people in California do, I'm in favor of a system that gives both of them wha…

Well, that's some type of democracy having some effect, yeah. But I was taking issue with the specific idea you put forward that good healthcare ideas would likely spread (in today's political environment) through the "laboratories of democracy" that are the states. It sounds good in theory; it's not so good if it doesn't happen in practice and you're poor and sick in Mississippi. You and I can move (and likely would have health care regardless). They mostly can't.

EDIT: also, I think this framing can badly mislead us: "If the people Mississippi don't want single-payer health care, and the people in California do, …". We get a picture in our head of Mississippi residents monolithically not wanting it while Californians monolithically do. In actuality it may be that 49% of Mississippi residents want it and 51% of Californians do. This is of course a broader topic (the benefits and failings of democracy and of various electoral systems) but I do think it's worth being aware when certain ways of phrasing might distort.

EDIT2: I don't at all mean to imply that your framing was intended to mislead; I don't think that at all.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#69

Post by toomuchtodo » Fri, Jun 23, 2017, 5:05 PM UTC

pc86 wrote: post #65

toomuchtodo wrote: post #60

Earlier quoted context omitted.

That CEO only made that amount because of FDA regulations related to the manufacture of generics, as well as her family connections. http://amp.timeinc.net/time/money/4502891/epipen-pricing-sca... My point is that the entire for profit healthcare system in the US is broken, and it's time to burn it to the ground.

> responding to unrelated, valid questions with, "yeah, but this one person made a lot of money and that makes me mad!" is ridiculous.

Waste is waste, and must be eliminated from the system with extreme prejudice.

Excessive profits are waste.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#70

Post by mikeash » Fri, Jun 23, 2017, 5:07 PM UTC

humanrebar wrote: post #42

mikeash wrote: post #16

Earlier quoted context omitted.

The reasons Washington can't come up with real solutions are simple: ideology and money. A big chunk of Washington firmly believes that socialized medicine is evil, and they will fight it. It doesn't matter what the facts are, it's part of their identity at this point. For the rest, the desires of insurance companies and similar get in the way. For example, the main, perhaps only reason the ACA didn't include a publi…

> For example, the main, perhaps only reason the ACA didn't include a public option is because Joe Lieberman, Senator from a state where the health insurance industry is huge, refused to vote for a bill that included it and his vote was required for passage. ...there were 40 other senators who were not voting for the ACA. The bill didn't, and still doesn't, have enough popular support. You can't blame one play on a l…

I can and will blame one voter for a lost ballot. Republicans controlled 40 seats. Democrats controlled 58 and had two independents who mostly leaned their way. They needed all 60 of those votes to pass something. Lieberman was one of those independents, and he explicitly threatened to filibuster any bill that included a public option, while the other 59 accepted it.

Republicans were going to vote against the ACA no matter what it contained. That means they had no power over the content of what got passed. Lieberman had huge power over the content.