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Iowa insurance market collapse could ground young entrepreneurs' dreams

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

#71

Post by s73ver »

vsipuli wrote: post #44
madengr wrote: post #3

That's probably the main factor preventing me from quitting and working for myself. Crazy high medical insurance for a family of 4. That and educational savings for kids. "Free" medical and college would cause a hell of a disruption that corporations would not like.

Do employers really negotiate that much lower health insurance rates compared to what a self-employed can get?

Yes, at least the tech employers that most of us are likely to work for. And, with the repeal of the ACA imminent, this seems relevant: employer plans usually didn't discriminate on pre existing conditions. Individual plans did.

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

#72

Post by mikeash »

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…

Why do size and diversity matter? Size is solved by just doing more of the same. If Germany, say, needs X doctors and Y administrators, then the US needs approximately 4X doctors and 4Y administrators. There are problems which get dramatically more difficult with scale, but I see no reason to think that this is one of them, let alone that a factor of 4 is enough to take it from tractable to intractable.

I can't even figure out how diversity would factor into it. Medical treatment depends very little on people's race or culture. I don't get it at all.

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

#73

Post by mikeash »

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 that's what the word means.

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

#74

Post by DanBC »

brianwawok wrote: post #27
shard972 wrote: post #18

Earlier quoted context omitted.

What about drug R&D in those countries? For all the issues of the US healthcare system, one thing it has going for it is most of the new developments in medicine comes from the US.

Sure but why do i as a American consumer subsidize drug invention for England or India? If the goverment wants to pay for R and D awesome. Dont put it on my bill to see the doctor.

> Sure but why do i as a American consumer subsidize drug invention for England or India?

You don't. You subsidize the massive advertising budgets of the companies in the US.

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

#75

Post by sjg007 »

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…

Individual states would need need to pool together to make single payer work (except for maybe California). As Congress regulates interstate commerce already you may as well go single payer.

But this is likely what will happen and we will get there eventually. If you are poor in a lower income red state you will be screwed for 20 years unless you move.

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

#76

Post by DanBC »

Pulcinella wrote: post #28
toomuchtodo wrote: post #23

Earlier quoted context omitted.

Great for pharma stockholders, terrible for American citizens. Let's stop subsidizing drug R&D for the world on the backs of US citizens who are being squeezed to death by Washington and a for profit healthcare system.

Hell, how much of the money is spent on marketing, not actual R&D? It seems like there is a lot of Hollywood accounting in pharma.

Only $5 billion a year.

https://www.statnews.com/2016/03/09/drug-industry-advertisin...

> Ad spending soared more than 60 percent in the last four years, hitting $5.2 billion last year.

> And there’s no sign it’s slowing. On the contrary: Nine prescription drugs are on pace to break $100 million worth of TV ad time this year.

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

#77

Post by rasz »

harryh wrote: post #22

It's worth noting that Iowa is in particular trouble because of a single patient that costs ~1M a month[1]. In a relatively small market you end up with an unstable situation when there are more than 1 insurers because none of them know if they will have to take on this very expensive patient in any given year. 1. https://www.balloon-juice.com/2017/04/21/catching-the-fallin...

How exactly do you run a $1 million/month health bill? In EU that would mean one open heart surgery/heart/lung transplant done by world class specialists flown from all over the place every single month.

This sounds like a scam.

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

#78

Post by humanrebar »

mikeash wrote: post #70
humanrebar wrote: post #42

Earlier quoted context omitted.

> 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…

No faction should force through a marginally popular, sweeping change by the skin of it's teeth.

This is one of the reasons why the Constitution and amendment process exist. The Supreme Court ruled that the passage of the ACA was technically OK (I disagree, but that's moot I guess) but they didn't rule whether it was wise.

I'm saying given the political and practical mess on this issue, it was unwise. I think partisan finger pointing is likewise a bad idea.

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

#79

Post by harryh »

rasz wrote: post #77
harryh wrote: post #22

It's worth noting that Iowa is in particular trouble because of a single patient that costs ~1M a month[1]. In a relatively small market you end up with an unstable situation when there are more than 1 insurers because none of them know if they will have to take on this very expensive patient in any given year. 1. https://www.balloon-juice.com/2017/04/21/catching-the-fallin...

How exactly do you run a $1 million/month health bill? In EU that would mean one open heart surgery/heart/lung transplant done by world class specialists flown from all over the place every single month. This sounds like a scam.

Apparently the patient is a teenage boy with hemophilia. I'm fairly confident that it isn't a scam.

https://www.usatoday.com/story/news/nation-now/2017/06/01/io...

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

#80

Post by kaitai »

DanBC wrote: post #62
creaghpatr wrote: post #35

Earlier quoted context omitted.

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 U…

To amplify your last statement, I recently had a kid. It was a low-risk pregnancy and in the end a fast and boring birth -- could have had the kid in a clean barn with some qualified attendants, in the end. But to get this boring, normalish (breech) birth I had to spend some hours researching providers and my insurance options to work with someone who practices low-intervention, evidence-based medicine -- and I had to drive to another state to work with this guy. Everyone within 40 miles wanted to throw a lot of resources and a C-section at me -- for no mortality or morbidity benefit that persists after about 10 minutes. (Breech babies born the old-fashioned way generally have low 1-minute Apgar scores.) I saved my insurance company a ton of money, I have to say.

The whole experience of pregnancy was an experience of reading the medical literature and then trying to evade the "care" of obstetricians in the standard US care model. I'm glad we have the facilities to deal with all the complications that arise, but we don't have to use them just because they're there when they're not appropriate care.

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