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

Re: Employer health plans are getting pricier and skimpier

#341

Post by shkkmo » Wed, Sep 25, 2019, 10:54 PM UTC

fennecfoxen wrote: post #163

greenonions wrote: post #138

What makes health insurance cheaper is a larger pool of people. There is no other mechanism by which costs can be reduced. This is why a single payer system is dramatically cheaper. It ensures complete coverage, reducing the cost of insurance to it's minimum. Furthermore, it leverages the collective bargaining power of all subscribers. There is no substitute for a national health insurance, and the United States slow…

What makes health insurance cheaper is not paying for as many expensive operations per capita . While there are a host of factors making US health insurance expensive, the critical factor since 2008 is laws: laws which require that the insurance cover patients who will have very expensive operations, and do so at the same rates as other patients. The primary advantage of a national health insurance scheme is that it…

There is little evidence to support the "US consumes too much healthcare" narrative and some good evidence that our total healthcare spending is inline with our level of wealth [0]. There is quite a bit of evidence to support the "Prices for equivalent healthcare are significantly higher in the US".

[0] https://randomcriticalanalysis.com/2018/11/19/why-everything...

Re: Employer health plans are getting pricier and skimpier

#342

Post by neetle » Wed, Sep 25, 2019, 10:57 PM UTC

ytNumbers wrote: post #338

romwell wrote: post #279

Earlier quoted context omitted.

If only we had examples where the government running something like healthcare resulted in a better outcome for citizens. Perhaps a country in Europe, as developed as the US is. I mean, a country that we literally border with would be too much to ask for. Perhaps some of us would be less amused by the concept of government-run healthcare. Too bad we don't have the example of literally all of Europe, Australia, and Ca…

In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer. By that yardstick, countries like Canada and England stack up quite poorly when compared to the USA. Canadians don't come to the US to save money on health care. They come to the US because they have an expensive potentially fatal medical condition, and they might not survive a six month waiting period fo…

The wait time for cancer treatment for the poor in Australia is the same as the rich, whereas the wait time in the US for the poor is "have you made funeral arrangements?"

Having had a family member just go through the Australian health system for breast cancer, her treatment was on a time-scale of a few weeks, but she had the time and was being checked often. In the US, we'd be making funeral plans and bucket lists because they'd not be able to afford treatment.

Re: Employer health plans are getting pricier and skimpier

#343

Post by romwell » Wed, Sep 25, 2019, 11:01 PM UTC

ytNumbers wrote: post #338

romwell wrote: post #279

Earlier quoted context omitted.

If only we had examples where the government running something like healthcare resulted in a better outcome for citizens. Perhaps a country in Europe, as developed as the US is. I mean, a country that we literally border with would be too much to ask for. Perhaps some of us would be less amused by the concept of government-run healthcare. Too bad we don't have the example of literally all of Europe, Australia, and Ca…

In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer. By that yardstick, countries like Canada and England stack up quite poorly when compared to the USA. Canadians don't come to the US to save money on health care. They come to the US because they have an expensive potentially fatal medical condition, and they might not survive a six month waiting period fo…

>In my opinion, the best yardstick for a health care system is how long you have to wait to be treated for cancer.

To quote a famous movie: well, you know, that's just like uh, your opinion.

Why would the wait time (and not treatment outcome, or rate of occurrence) for one group of diseases be a good metric for evaluating the overall performance of a healthcare system?

In my opinion, it's a horrible metric. To give a car analogy, the 0 to 60 time in snow while towing is surely a metric, but there are other things to consider as well when you are buying a vehicle.

>[Canadians] come to the US because they have an expensive potentially fatal medical condition, and they might not survive a six month waiting period for treatment.

A lot to unpack here! But, first, the TL;DR is no[1].

More specifically:

1)Cite sources on people and England and Canada having six-month waiting period on cancer treatments in cases where urgent intervention is deemed necessary ("might not survive").

2)Look at the number of those cases.

3)Compare and contrast with similar cases in the US when people don't get treated because they don't have the money.

4)Look at the numbers again.

5)Look at how many Canadians do come to the US (in absolute numbers, as a percent of the Canadian population, and as a percent of patients seeking the particular treatment).

6)Stop perpetuating misleading opinions.

I won't cite the numbers - that's your homework when making bold claims. I found the numbers hard to find, which means to me that your claims are likely not substantiated.

I'll be glad to be proven wrong here.

[1]https://www.washingtonpost.com/news/fact-checker/wp/2016/10/...

Re: Employer health plans are getting pricier and skimpier

#344

Post by otakucode » Wed, Sep 25, 2019, 11:09 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…

No reason? Hey, let's assume you're running a business. Only it's a special business. The customers really need your service. And they don't pay for your service. Someone else pays the bill for them. And they are extremely interested in acquiring the absolute top quality possible when using the service. So when you charge $50, but the guy across town charges $500, the customer will fight tooth and nail to get in and use your competitor instead. Call it 'reverse capitalism.'

That's insurance-supported medical care in the US. No one wants to go to the cut-rate bargain-basement doctor. And the majority of patients aren't paying their own medical bills. The insurance company is footing that bill. So when their kid gets sick, they're price-shopping in reverse. They only want the premium level, and offering a good deal actively stops people from using the service.

And that doesn't even get into the price-fixing that insurance companies engage in, entirely legally, because insurance is determined to be "not commerce" and therefore exempt from all antitrust laws. There is definitely a reason why Americas sub-standard care is so expensive - insurance.

Re: Employer health plans are getting pricier and skimpier

#345

Post by nostrademons » Wed, Sep 25, 2019, 11:12 PM UTC

mullen wrote: post #218

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…

> 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. Don't want to pay what the government says it is going to pay? Good luck finding customers then, because the government is bargaining on behalf of all of the customers in the US.

So my mom and her boyfriend are both under Medicare now, as was her late 2nd husband. My mom and I had both generally been Medicare For All supporters (with some reservations in my case), but I got an earful recently about how people who support Medicare For All don't know what they're in for...

The problem is with Medicare's system of billing codes. Sure, if a hospital doesn't like the reimbursement rate, they can't go find other customers. But they can - and will - find other procedures. Not making enough money from that doctor's visit? Well, we better do some tests, then, just to be sure there's no lurking problem. Oh, there was a spot on that X-ray - more tests. We didn't find anything serious, but there was a benign growth that you probably should get taken care of. Don't worry, it's a quick procedure, it could potentially be done as an outpatient but you might want to make it an overnight hospital stay just to be sure. Shit, you contracted an infection in the hospital? Gotta extend that stay until you're better.

Basically, if they can't raise prices, they will find ways to do more procedures. My mom's description of what modern American health care is like as a senior citizen is truly terrifying - basically they manufacture illnesses so that they can cure them and bill for it.

I came to the conclusion (reinforced by every corporate scandal you read about on HN, and my time in the financial and tech industries) that the problem isn't health care per se, but something is deeply broken in American culture. People don't give a shit about their fellow Americans as people, only as dollars, and as a result no matter what system you institute it will end up being gamed in harmful ways. The U.S. is falling from a high-trust to a low-trust society, and there are few if any ways to bring it back.

Re: Employer health plans are getting pricier and skimpier

#346

Post by charwalker » Wed, Sep 25, 2019, 11:13 PM UTC

JMTQp8lwXL wrote: post #200

throwaway22424 wrote: post #186

Earlier quoted context omitted.

> Not to mention the millions of people locked into careers they would otherwise get out of, if not for the health coverage. Replying with a throwaway for obvious reasons. I work at one of the big tech companies -- I'm paid well, but the benefits are very good. I just got an offer from a startup that I really like. It's a job I would like to take. I'm going to have to turn down the offer. Part of the reason I'm going…

Sounds like this could be solved, if the startup could offer a higher base salary, bonus, or a combination.

Yes, but that isn't the root cause is it?

Even if the current employer is big enough to negotiate lower prices or deals for its coverage and that's a barrier to entry for the startup, both companies could be set one a level field in a universal healthcare system removing this cost center from both companies. Even if the cost is (partially) rolled into something like payroll or income taxes, it would still impact the big company and the startup much more equitably.

Barriers to entry are one item this site and many of its users and are fighting to better disrupt industries and create value. If you can't get talent because you can't provide healthcare and a solution for that exists in most developed nations (universal care), why are we not engaging that?

Re: Employer health plans are getting pricier and skimpier

#347

Post by romwell » Wed, Sep 25, 2019, 11:28 PM UTC

dmitrygr wrote: post #337

jandrese wrote: post #294

Earlier quoted context omitted.

Zero people from other nations come to the US to save money on health care. The ones that do come are looking for specialists for some exotic condition, not because they love the level of care or the price tags.

And do you think those specialists would exist here if we had medicare for all? no, evidence: all those other countries that have that and no such specialists.

Yes they would. The Americans also go to other countries to seek treatment in special cases.

Also, if our healthcare works well to treat rich foreigners in special cases, but sucks otherwise — I say, we should scrap it.

But sure, we can cherrypick metrics all day long.

Re: Employer health plans are getting pricier and skimpier

#348

Post by huac » Wed, Sep 25, 2019, 11:30 PM UTC

dmitrygr wrote: post #337

jandrese wrote: post #294

Earlier quoted context omitted.

Zero people from other nations come to the US to save money on health care. The ones that do come are looking for specialists for some exotic condition, not because they love the level of care or the price tags.

And do you think those specialists would exist here if we had medicare for all? no, evidence: all those other countries that have that and no such specialists.

if everyone had that specific knowledge, there would be no specialists. no, different countries develop different specialties. famously, Kobe Bryant went to Germany (a country with national healthcare) to get a knee procedure from a specialist.

Re: Employer health plans are getting pricier and skimpier

#349

Post by UnFleshedOne » Wed, Sep 25, 2019, 11:33 PM UTC

payne92 wrote: post #238

I just got my renewal quote: $2,372/month for a family of 4 is going to $2,883/month. That's a ~20% increase, to $34,595 PER YEAR. (And this is while benefits continue to be cut back: $150/month for many prescriptions, etc.) As others have written, there's no single reason. But, I think there's a major unintended structural problem: under US law, insurance companies are required to pay a high percentage (like ~90%) o…

That's slightly lower than my family is paying in total taxes in Canada...

Re: Employer health plans are getting pricier and skimpier

#350

Post by fuzz4lyfe » Wed, Sep 25, 2019, 11:35 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…

>Medical schools/the AMA are artificially limiting the number of students and residents for their own ends (keeping wages and scarcity high) so they need to charge a lot... why? - I honestly don't know.

The AARP advocates for social security... why? - I honestly don't know.

Imagine if you put the teamsters in charge of infrastructure spending, every road in the country would be under construction perpetually. It would be illegal to shovel your own driveway without paying someone in the union to sit in front of your house and supervise.