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

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

#91

Post by dragonwriter » Fri, Jun 23, 2017, 6:31 PM UTC

antisthenes wrote: post #90

creaghpatr wrote: post #6

Iowa has only one ACA insurer left and they are raising their rates 43.5%. Basically providing Obamacare was hemorrhaging so much money that Wellmark and BCBS left, leaving a single payer, that ACA users are forced to use. http://www.thegazette.com/subject/news/health/medica-to-stay...

Did people actually think ACA was sustainable or anything but a payout to insurance companies as it was passed? Knowing that insurance companies can willingly just abandon the market makes the ACA even more of a joke than one would have originally thought. And no, before anyone tries to suggest it, temporarily insuring a few million poor people and people in poor health (at the cost of fucking over young and healthy…

> Did people actually think ACA was sustainable or anything but a payout to insurance companies as it was passed?

Well, they thought it was the former (in part because of the ways in which it was the latter; a sustainable public service not provided directly by government typically involves payment from the government to the service providers.)

Much of the collapse and withdrawal is due to payments they were mandated under the ACA not being funded by Congress (resulting in a giant stack of lawsuits and at least one $200 million+ judgement against the government in favor of an unpaid insurer), with the deliberate intent of causing a collapse of just the kind that is occurring. (And the recent acceleration is that exacerbated by additional uncertainty deliberately injected by the Trump Administration with the intent of producing exactly that result.)

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

#92

Post by kcorbitt » Fri, Jun 23, 2017, 8:16 PM UTC

mikeash wrote: post #72

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…

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…

Diversity definitely makes implementing generous social programs more difficult politically. The average working-class voter in any country will be much more supportive of eg. universal healthcare if he feels like the benefits are going to people with backgrounds similar to his own, just perhaps a bit worse off, as opposed to (implied-minority) "welfare queens" living off the fat of the land. The larger and more diverse a population, the less said everyman will feel like his taxes are actually serving people he knows and trusts.

That said, I do think we're moving in an encouraging direction. The percentage of the developed world that's willing to recognize others from different cultures and backgrounds as part of their own society seems to be growing, ever so slowly and fitfully. There will be years and perhaps even decades feel like regressions, but on average it feels like things are getting better.

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

#93

Post by rasz » Fri, Jun 23, 2017, 9:28 PM UTC

harryh wrote: post #86

rasz wrote: post #85

Earlier quoted context omitted.

Hemophilia Federation of America: "A million dollars per month is something we've never heard of," sure makes it sound like a scam, maybe by hospital?

Given that the insurance companies know exactly who the patient is, exactly what treatments he is receiving, and exactly when and where they are happening it seems like it would be pretty easy to uncover a scam if there was one. And they have a lot of incentive to do so!

Would you consider $1 mil/month a good incentive to scam?

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

#94

Post by gruez » Fri, Jun 23, 2017, 10:20 PM UTC

notadoc wrote: post #81

I got a letter from my insurance provider saying they're pulling out of the local market in 2018. I pay full price directly, no subsidy, not through any exchange, it's very expensive and I've poured tens of thousands into premiums over the years. I can't help but relate the entire industry to a ponzi scheme.

>I can't help but relate the entire industry to a ponzi scheme.

In what way is the insurance industry a fraudulent investment operation where the operator generates returns for older investors through revenue paid by new investors, rather than from legitimate business activities?

Seriously, I feel that phrase to be misused so often it has lost all of its original meaning. /rant

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

#95

Post by s73ver » Sat, Jun 24, 2017, 4:30 AM UTC

anovikov wrote: post #7

s73ver wrote: post #2

Basically, do we want to send the signal that entrepreneurship is for everyone, or just the rich and healthy?

Entrepreneurship is not for everyone. It is for people who take risks. And yes it takes being healthy, because it is a stress which even most absolutely healthy and young people can't endure. And preferably rich because it sucks being left at the mercy of investors.

That's a terrible way to look at things. There are many people, myself included, who developed a pre existing conditions while a teenager. I require health insurance. So now, you're telling me I shouldn't be able to be an entrepreneur because of that?

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

#96

Post by mikeash » Sat, Jun 24, 2017, 6:15 PM UTC

kcorbitt wrote: post #92

mikeash wrote: post #72

Earlier quoted context omitted.

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…

Diversity definitely makes implementing generous social programs more difficult politically. The average working-class voter in any country will be much more supportive of eg. universal healthcare if he feels like the benefits are going to people with backgrounds similar to his own, just perhaps a bit worse off, as opposed to (implied-minority) "welfare queens" living off the fat of the land. The larger and more dive…

I can see how that might make it more politically difficult to pass something, but it wouldn't make it harder to come up with a plan that works. A plan that works and can pass is a harder, but unfortunately I was already in the realm of fantasy the moment I started talking about looking at foreign countries to see what worked for them.

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

#97

Post by brianwawok » Sun, Jun 25, 2017, 3:24 PM UTC

DanBC wrote: post #74

brianwawok wrote: post #27

Earlier quoted context omitted.

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.

Drug advertising -> Drug Sales -> Drug Profits -> Profit for Drug Company -> More R&D For Next Drug

If all drug advertising went to 0, it would not significantly impact drug prices in the US. It might in fact increase prices as there would be less users per drug. (Which of course may be a better result for society, but I digress)

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

#98

Post by vsipuli » Mon, Jun 26, 2017, 3:56 PM UTC

avs733 wrote: post #51

vsipuli wrote: post #44

Earlier quoted context omitted.

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

1) yes 2) you are assuming that it was even possible to buy health insurance as a single person prior to the ACA. I actually tried and found it incredibly difficult.

So what realistic options did self-employed have before the ACA: either pay for an expensive insurance or be uninsured? What did most typically choose?

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

#99

Post by vsipuli » Mon, Jun 26, 2017, 3:57 PM UTC

s73ver wrote: post #71

vsipuli wrote: post #44

Earlier quoted context omitted.

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.

Would you be able to quantify the difference somehow? Individual plans where more expensive by a factor of two, or more?

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

#100

Post by avs733 » Thu, Jun 29, 2017, 1:16 PM UTC

vsipuli wrote: post #98

avs733 wrote: post #51

Earlier quoted context omitted.

1) yes 2) you are assuming that it was even possible to buy health insurance as a single person prior to the ACA. I actually tried and found it incredibly difficult.

So what realistic options did self-employed have before the ACA: either pay for an expensive insurance or be uninsured? What did most typically choose?

(Obivously the IAMAE note applies here)I choose uninsured because I was young...and dumb. There were some options out there, especially for add on things like dental and vision. Insurance was available, but it was hard to find as an individual and very expensive in my experience. COBRA was an option but was still tied to a previous job and had limits.

As an entrepreneurship scholar, I see health insurance as one really strong limiter of entrepreneurial activity in the US. The lack of single payer significantly privileges those with the means, the young, and those without children to conduct entrepreneurial activity.