People Lose Their Employer-Sponsored Insurance Constantly • Hacker News Board

Re: People Lose Their Employer-Sponsored Insurance Constantly

#131

Post by davidw » Wed, Apr 17, 2019, 7:03 PM UTC

clairity wrote: post #111

davidw wrote: post #21

Earlier quoted context omitted.

Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'. As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives. I mention Italy because 1) I lived there and 2) it's not some perfectly…

i'm keen on the idea that such a model of a government entity (or two) in competition with an open market would provide the most favorable outcome, because a truly free and fair market (one where competition leads to efficiency and low prices) seems mythically distant at this point. government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-c…

> politics and bureaucracy

Health care was way less bureaucratic in Italy. Every time you go to the doctor in the US, you fill out forms. And then hand them to the person in the office who spends their days doing insurance stuff.

In Italy - you just go to the doctor.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#132

Post by [deleted] » Wed, Apr 17, 2019, 7:06 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

[deleted]

Re: People Lose Their Employer-Sponsored Insurance Constantly

#133

Post by ThrustVectoring » Wed, Apr 17, 2019, 7:06 PM UTC

u801e wrote: post #63

imgabe wrote: post #52

Earlier quoted context omitted.

If private insurance is going to work, then every healthcare provider has to accept payment from every insurance. This clusterfuck we have where you have in-network providers with one price and out-of-network providers with a different price just has to stop. Oh you went to an in-network hospital, but this one doctor walked into the room for five minutes and she was out-of-network, so now your bill is 10x higher than…

I've always wanted to add a clause to those consent forms stating that my consent is conditional to the provider being in-network for the insurance information I provided the hospital. It is their responsibility to make that determination before they start treatment. If they provide treatment and find that they're not in network, then they forgo the right to bill for that service.

A great alternative strategy is to structure your finances so that it's impossible for creditors to seize your assets - that way, your practical liability is limited to the up-front costs. Which, by being up-front, you can actually reason about and make informed decisions on.

This is less difficult than it sounds. Move to Texas, and keep all your assets in retirement accounts, home equity in your primary residence, and possibly annuities if you've made too much money for that all to hold everything. Note that this should be done before possibly incurring debts.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#134

Post by InclinedPlane » Wed, Apr 17, 2019, 7:08 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

Capitalism as it exists today in the US (and other parts of the world) is a paperclip optimizer. The pressure is for those with power to leverage that power toward their maximum short term financial benefit. One consequence of this is that health care has essentially been parasitized by profit seekers who extract money from the system as if it were a strip mine. You can easily see the impact of this in the gross statistics in the form of the extremely high spending on health care in the US vs. comparatively poor return on that spending in terms of overall health outcomes. This is a corrupt system which today produces health care only as a side effect of its main purpose of wealth extraction. That is a natural consequence of our culture, economic incentives, etc. combined with the vast power imbalances between health care "providers" (hospitals, drug makers, device makers, etc.), insurance companies, employers, and individuals. There's no such thing as a patients or insurance holder union, the imbalance is enormous and there's very very little to tip it back from being dominated by the interests of the powerful.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#135

Post by EamonnMR » Wed, Apr 17, 2019, 7:09 PM UTC

sairahul82 wrote: post #71

The fundamental problem is no body knows the cost of anything beforehand. Neither insurance company not doctors tell the cost of the care. Its really frustrating ! The first step to fix the problem is getting the cost of the care transparently. Without this i am not sure how any of the scheme works whether it is done by govt or private insurance companies !

I think the problem is that hospitals can use the price of procedures as a bargaining chip. They can jack up the price for the uninsured (on paper) then lower it if they're actually going to bill a person. Then they take the jacked up number and use it to negotiate with insurance companies, and insurance companies can likewise point to the number and say "look what will become if you if you don't stick with us!"

The first step should be disallowing this negotiation. That should massively lower the on-paper prices, or let insurance companies at least make the tough decisions about what procedures are actually worth it, which is supposed to be one of their functions anyway. If that isn't their function, I'm not sure what their function is.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#136

Post by analog31 » Wed, Apr 17, 2019, 7:13 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

>>> This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit.

In reality, it's less efficient.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#137

Post by henrikschroder » Wed, Apr 17, 2019, 7:15 PM UTC

majormajor wrote: post #82

ummonk wrote: post #57

Earlier quoted context omitted.

That actually sounds like the high deductible plan is functioning as it should though. Causing consumers to price-shop and avoid price-gouging providers.

What if the cheaper place is cheaper cause it's not as capable ? How am I supposed to know? In what other scenario are we similarly encouraged to act on price alone? Price transparency is meaningless with quality transparency.

Measuring quality is also incredibly difficult, patient input is practically worthless.

Every time patients are asked to rate the quality of the care, they consistently rate simple feel-good care like massages, chiropractice, or just therapy as very good, but saved-your-lfe-operations get rated very badly, because the experience and recovery is often miserable. You live, but you don't feel good, so you rate the quality of the care after how you feel, even though you ought to rate it Five-star, A++++, would transplant a failed heart again!

So the rational person abandons subjective ratings and look at objective ratings, what's the medical outcome for a provider? Sure, that's better, but the quality of the outcome is incredibly dependent on the quality of the patients! It's a well-known fact that a positive attitude helps immensely with recovery, how do you measure that? How do you integrate that with an outcome measurement?

Re: People Lose Their Employer-Sponsored Insurance Constantly

#138

Post by ummonk » Wed, Apr 17, 2019, 7:18 PM UTC

pnutjam wrote: post #127

ummonk wrote: post #109

Earlier quoted context omitted.

If you're in that dire an emergency you're going to max out your in-network limits anyway, so it doesn't really matter which emergency room you get taken to, you pay the same.

My in network max is around $13k, my out of network is $99,999,999.

EPO / HMO?

Re: People Lose Their Employer-Sponsored Insurance Constantly

#139

Post by dv_dt » Wed, Apr 17, 2019, 7:20 PM UTC

aantix wrote: post #123

dv_dt wrote: post #114

Earlier quoted context omitted.

If you look at the paper, private drug discovery is creating drugs at a declining rate. I would suggest this is because those private efforts are much less research than development, and it's actually the public system that drives much fundamental research. And the drugs to market rate is in serious decline because of a the widespread application of increasingly austure public funding budgets for medical research cau…

When you dump a link to a 60 page pdf and you’re going to reference it, please list the page number and/graph you’re referring to. I don’t want to guess.

Sorry, Fig 1, page 15 is the data on drugs discovered per billion. Table 1, pg 18 shows some sample breakdowns of drug investments broken down between basic research and commercial development.

I don't necessarily subscribe to everything in that report, but I do think that modeling drug development in terms of a simple risk-reward model for the private drug industry needs further thought.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#140

Post by munk-a » Wed, Apr 17, 2019, 7:21 PM UTC

aantix wrote: post #110

munk-a wrote: post #102

Earlier quoted context omitted.

Ha! This is a silly talking point that lots of companies bounce around - you know how insulin costs money because it was so expensive to develop... Except no, it was invented in Canada and the researchers released the formula for free[1] as a "benefit to humanity" thing... then a few US companies acquired rights to produce it and proceeded to establish market control in the US - the fact that insulin isn't being sold…

Of course it does. Because people don’t buy and use the drug if they don’t know about it..? Money matters. Marketing to recoup costs matters. Piles of cash to get every dollar of return on an investment matters. That allows the company to turn around and invest in future promising drugs, trials, other companies, marketing to bring awareness to the solution and hopefully get people to buy and use it.

Making sure doctors are well informed about treatment options are one thing... egging patients on to request a possibly mismatched medication and taking doctors out to lunch to encourage the prescription of a possibly mismatched medication is entirely different.

The ideal case for drugs is that no one actually needs them so no one takes them - this is a large contributor as to why this market should be heavily nationalized.