I'm a Brit and America, your health care system is torturing me • Hacker News Board

Re: I'm a Brit and America, your health care system is torturing me

#71

Post by kasey_junk » Sat, Jan 05, 2019, 8:18 PM UTC

tptacek wrote: post #70

kasey_junk wrote: post #69

Earlier quoted context omitted.

I'd probably report I liked my car insurance if it included a twice a year detailing and paid for my lyft rides from the bar. Especially if the real cost of it was hidden from me. That is to say, the consumer of health care being unable to accurately judge the quality and efficiency of the funding of that care is at the heart of the problems with the market based approach to health care funding. The fact that one of…

Our health insurance system is inefficient, and some of that inefficiency does come from the way employer-provided private health insurance works. My point though is that the numbers suggest that there are larger structural factors that operate independently of that inefficiency. It's possible that the pathologies of our system created those other structural flaws; like, if we had an NHS instead of private insurers,…

You’ll note most of my commentary centers around employee provided health insurance. That’s because it’s the outlier. Other countries have similar systems to ours on the provider, Medicare & Medicaid side. Employee provided insurance is, as far as I know, unique. And it’s a dramatically stupid way to fund health care.

Further, it’s a less dramatic thing to change. We’ve already been through a much more impactful change in living memory in the form of moving away from pensions.

My position is that changing that are of funding brings price transparency to the biggest segment of the population & it derisks the migration.

Re: I'm a Brit and America, your health care system is torturing me

#72

Post by tptacek » Sat, Jan 05, 2019, 8:22 PM UTC

kasey_junk wrote: post #71

tptacek wrote: post #70

Earlier quoted context omitted.

Our health insurance system is inefficient, and some of that inefficiency does come from the way employer-provided private health insurance works. My point though is that the numbers suggest that there are larger structural factors that operate independently of that inefficiency. It's possible that the pathologies of our system created those other structural flaws; like, if we had an NHS instead of private insurers,…

You’ll note most of my commentary centers around employee provided health insurance. That’s because it’s the outlier. Other countries have similar systems to ours on the provider, Medicare & Medicaid side. Employee provided insurance is, as far as I know, unique. And it’s a dramatically stupid way to fund health care. Further, it’s a less dramatic thing to change. We’ve already been through a much more impactful chan…

It's not clear to me how it does that.

Re: I'm a Brit and America, your health care system is torturing me

#73

Post by jjeaff » Sat, Jan 05, 2019, 9:01 PM UTC

zaarn wrote: post #20

jjeaff wrote: post #13

This is more of a sidenote, but after having way, way more experience in healthcare system over the past few years, I thought I would share my experience. The Affordable Care act made some big changes in health insurance. Unfortunately, making it "affordable" was not one of the things. But, if you do have money, you have the option now to have absolutely great health care. For about $1300 a month, you can cover a fam…

In 2017, the median income of households in the US was 61'000 $. Meaning half the population has to pay half their income (maximum) into this healthcare plan. And 61'000$ income isn't being dirt poor either. In some economic models this is the lower middle class in terms of income. For people who only graduate high school and no college, this is 80% of their income. If they go to some college about 70% (14'000$ left…

With a multi-person household and $60k income, you would qualify for subsidies to reduce the premiums and out of pocket costs.

Re: I'm a Brit and America, your health care system is torturing me

#74

Post by bb88 » Sun, Jan 06, 2019, 12:12 AM UTC

tptacek wrote: post #67

pcwalton wrote: post #66

Earlier quoted context omitted.

It's very easy to explain Republican opposition to the ACA. The 2016 election has made it clear that the GOP is motivated not by outcomes, not even by ideology (the current GOP, driven as it is by one person, has no coherent ideology), but by tribalism. Obama was and still is considered an enemy who cannot be allowed to score a victory at any cost, and so Republicans had to oppose the ACA. I know that this take is li…

That's an argument I'm familiar with and sympathetic to, but not something I'd necessarily argue in mixed company, which is what I think of HN as. I don't understand the current coherent argument the GOP has regarding health care but I'm open to there being an ostensible argument and would only ask that Republicans recognize that whatever the new argument is, it's distinct from the original argument, which is that we…

This is what I don't understand either. I understand the desire to cut medicaid to reduce taxes and the size of government argument. But weren't there free market incentives they could have done as well?

Here's one: tax cuts to insurance companies based upon the number of people they insure over time, to help offset the cost of insuring sick people.

This seems like a no-brainer republican solution, which probably would have gotten a fair number of democrats on board.

Re: I'm a Brit and America, your health care system is torturing me

#75

Post by hackeraccount » Sun, Jan 06, 2019, 2:40 PM UTC

tptacek wrote: post #24

jjeaff wrote: post #13

This is more of a sidenote, but after having way, way more experience in healthcare system over the past few years, I thought I would share my experience. The Affordable Care act made some big changes in health insurance. Unfortunately, making it "affordable" was not one of the things. But, if you do have money, you have the option now to have absolutely great health care. For about $1300 a month, you can cover a fam…

The ACA reduced the rate of growth in health insurance premiums, but health insurance premiums continue to grow and have been for decades --- spiraling health care costs were a part of the Republican Party platform... in 1980. Guaranteed issue, community-rated health insurance is a necessity for a private health care system, and the ACA brought those badly-needed features here. But the big problem with US health care…

Saying the ACA reduced the rate of growth in healthcare spending is arguable. The last time I looked at this there was indeed a reduction in the rate of growth by my understanding is that it predated the ACA by several years.

The most interesting thing I've seen about health care inflation is what it looks like in the U.S.A. vs. the other developed countries. The answer is not that different. There was a huge increase in the 80's but after that the growth rate of the U.S. is somewhere in the middle.