Employer health plans are getting pricier and skimpier • Hacker News Board

Re: Employer health plans are getting pricier and skimpier

#311

Post by pravda » Wed, Sep 25, 2019, 10:10 PM UTC

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> Well they need to be paid a lot because medical school debt is 250k or more... why?

You are doing something called confusing cause and effect.

Medical school costs a lot because doctors earn a lot of money.

Re: Employer health plans are getting pricier and skimpier

#312

Post by [deleted] » Wed, Sep 25, 2019, 10:11 PM UTC

oarabbus_ wrote: post #299

throwaway5752 wrote: post #288

Earlier quoted context omitted.

You just proved my point, you know that right? It's the healthcare delivery and the markups along the way. If you paid doctors $0 tomorrow, healthcare costs would go down by 20%, at best, and probably less. Your analogy is perfect, actually. The problem in sandwich cost is rent, utilities, administrative expenses, marketing, an acceptable return on investment to the owners, etc, etc. The actual good being sold, a san…

On the contrary, you proved mine. I worked in medical devices and hospitals for a significant portion of my career, and I really don't care that you aren't impressed by the term "cartel", that's your prerogative to turn a blind eye to the facts. It's a combination of inflated salaries plus numerical shortage of doctors (the two are related) causing the root issues here. You claim to be familiar with other health syst…

[deleted]

Re: Employer health plans are getting pricier and skimpier

#313

Post by comnetxr » Wed, Sep 25, 2019, 10:12 PM UTC

simonsarris wrote: post #239

mullen wrote: post #218

Earlier quoted context omitted.

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will oc…

> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Why do you think this would be true? Why do you think the bargaining power would work the way you think it would? If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case? What about other goods? Laptops? Cruise missiles? etc. Actually is it true f…

What other goods is the US Gov the sole buyer of, for which the sellers can't easily shift to other customers? Cop cars clearly doesn't apply, as carmakers have other customers. Doctors, hospitals, and pharmaceuticals will face true monopsony, which means sell at gov rates or quit entirely. Some suppliers will quit entirely, but most won't.

Re: Employer health plans are getting pricier and skimpier

#314

Post by claudeganon » Wed, Sep 25, 2019, 10:13 PM UTC

nkurz wrote: post #159

It seems like a strange omission for this article not to mention that the reason health insurance is so expensive in the US is that health expenditures are so high. The US spends more than $10,000 per year per person on health care[1], more than any other country. Clearly, on average, premiums clearly must be higher than the amount paid out on behalf of the customer. If you want lower premiums, you somehow need to lo…

Only the latter option is a feasible solution. If you look at countries with mixed systems (like South Africa), a great deal of the cost savings disappear. Tim Faust has a great new book that breaks this down. Also, recommend his interview on the Death Panel podcast.

https://www.mhpbooks.com/books/health-justice-now/

https://deathpanelpodcast.com/2019/02/02/all-care-for-all-pe...

Re: Employer health plans are getting pricier and skimpier

#315

Post by throwaway66920 » Wed, Sep 25, 2019, 10:14 PM UTC

cwkoss wrote: post #268

throwaway66920 wrote: post #22

Earlier quoted context omitted.

Getting insurance as an individual is expensive because you’re not part of a group plan. With a group plan the insurance company has some reason to believe you’re not collectively a bunch of dying people committing moral hazard, you’re just one of a generally similar looking company workforce. If employers stopped providing it, I think it is presumed that the mentality towards individual plans would change

I think it is unfair to call a dying people seeking healthcare 'moral hazards'

It’s kind of created by the immoral environment of private insurance, but I would argue someone who doesn’t have health insurance to save a few backs, who can otherwise afford it, and waits until they suddenly have $100k expenses incoming to get insurance is a moral hazard even if they’re going to die.

Imagine there were no private companies but a perfect decentralized blockchain shamwow insurance system that magically worked and distributed all profits back to its participants.

I would think the dying man is committing moral hazard here. But it’s up for debate.

If you do this against a big private insurance company and they lose a penny, it doesn’t sound so bad, but I’m not convinced

Re: Employer health plans are getting pricier and skimpier

#316

Post by maxerickson » Wed, Sep 25, 2019, 10:14 PM UTC

kaibee wrote: post #177

eric_b wrote: post #148

The problem is that there is not a single reason that healthcare is so expensive. Even if you list the top 15 reasons, you still have to apply the "5 whys" to each of them to find root causes and possible solutions. - Doctor's are paid too much... why? - Well they need to be paid a lot because medical school debt is 250k or more... why? - Medical schools/the AMA are artificially limiting the number of students and re…

> (I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous) It is illegal for Medicare to negotiate drug prices. That needs to be fixed.

The private companies that administer much of Medicare drug coverage in fact do negotiate prices. CMS can't step into those negotiations.

Re: Employer health plans are getting pricier and skimpier

#317

Post by zanny » Wed, Sep 25, 2019, 10:14 PM UTC

simonsarris wrote: post #239

mullen wrote: post #218

Earlier quoted context omitted.

> One thing that will not make healthcare less expensive is "Medicare For All". It will just shift the bill to different people. Now, you can argue it's the morally correct course of action, or those people who will be forced to foot the bill (upper middle class taxpayers) are more capable of doing so, but you cannot credibly claim with a straight face that it will make anything cheaper. In fact, the opposite will oc…

> Having every person under the same plan that has the negotiating power of 327.2 million people will definitely drive costs down. Why do you think this would be true? Why do you think the bargaining power would work the way you think it would? If you were correct, then cop cars must be fairly cheap compared to normal cars. Is this the case? What about other goods? Laptops? Cruise missiles? etc. Actually is it true f…

Cop cars aren't collectively bought. For one its on a state by state basis, and then in some states individual PDs are responsible for their own vehicles, they just get a budget to buy and fix them.

That means they usually end up in an imbalanced power relationship of small 20-30 person local PD force approaching Ford / GM asking for their police cruisers.

Some states, of course, do collectively bargain their service vehicles like that, the USPS is probably the most prominent example of collective bargaining on a national scale - the post office bought 140,000 of them over 7 years for below consumer grade vehicle pricing. Even nowadays when they are reevaluating replacing their fleets it only averages out to about 41k per truck for a new model and that includes having to refit garages and post offices to accommodate them.

I'm also pretty sure there are licensing deals between US auto makers and various state bureaucracies to price control service vehicle costs, but its still never like a private automaker is getting an order for 80k cop cars from one entity.

Re: Employer health plans are getting pricier and skimpier

#318

Post by maxerickson » Wed, Sep 25, 2019, 10:15 PM UTC

Andrex wrote: post #267

kaibee wrote: post #177

Earlier quoted context omitted.

> (I don't want to hear one thing about negotiating power. That is a debunked line of reasoning. Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous) It is illegal for Medicare to negotiate drug prices. That needs to be fixed.

I was going to comment the same thing. Pointing to Medicare/Medicaid as examples for why drug negotiation doesn't work is an impressively incorrect line of thought.

Medicaid mandates drug prices at a fixed percentage of what private buyers pay.

Re: Employer health plans are getting pricier and skimpier

#319

Post by _bxg1 » Wed, Sep 25, 2019, 10:17 PM UTC

onemoresoop wrote: post #223

_bxg1 wrote: post #82

Our healthcare system is so wildly (and increasingly) inefficient, I don't doubt there will be a breaking point when politicians will finally be forced to nationalize it. Let it keep getting worse. Let them see the bed they're making.

They are covered %100, they won't feel the bad they're making.

Fortunately, pressure on politicians doesn't come solely from how their policy affects their own lives.

Re: Employer health plans are getting pricier and skimpier

#320

Post by ergothus » Wed, Sep 25, 2019, 10:17 PM UTC

bluecalm wrote: post #281

ergothus wrote: post #181

Earlier quoted context omitted.

> Medicare/Medicaid cover more people than many single payer systems in other countries, and their costs are still outrageous I appreciate your reasonable breakdown, but I don't understand this one. I've seen many reports talking about how the costs of basic supplies and procedures are dramatically higher in the US (and vary wildly within the US). Things like X-Rays, MRIs, etc, being off by an order of magnitude or m…

MRI is like 5x cheaper here (I paid less than 300$ for both knees) without any insurance just doing it privately. The reason I think is that it's easier to open a medical business here, people can't sue for damages (or they can but will never be awarded anything substantial), there is less regulation you need to comply with and the doctors and technicians make less money. All this makes it possible to provide medical…

> The quality of service is low but higher than in major metro areas in US

This is always my question when I hear about service being "great" or "terrible" - relative to what? I honestly have no idea if my healthcare is "good" or "bad", because I've only experienced one system. I have plenty of complaints, but there are also lots of things that don't go wrong that could.

People complain about lines in other countries, but me/my family has had waits of 2-6 months getting appts for new ob/gyn, dermatologists, rheumatologists, sleep specialists, etc. Mental health experiences have been worse until we stopped trying to do it through insurance at all and just ate the costs. Involved treatments (e.g. at a hospital, even outpatient) involve multiple, pricey bills.

So when you say "quality is low", what does that MEAN?