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

Re: Employer health plans are getting pricier and skimpier

#411

Post by throwaway66920 » Thu, Sep 26, 2019, 2:28 AM UTC

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

This is a good analogy because it highlights the important problem. Insurance companies are incentivized to have healthcare prices increase so long as they get a discount. Why? Because it increase their value to the consumer to the point of necessity.

Re: Employer health plans are getting pricier and skimpier

#412

Post by grecy » Thu, Sep 26, 2019, 2:28 AM UTC

MuffinFlavored wrote: post #170

nickgrosvenor wrote: post #110

This is absolutely the biggest story in America, and most people aren't talking about it. An entire generation is draining their savings to keep up with premium costs. Not to mention the millions of people locked into careers they would otherwise get out of, if not for the health coverage. This situation is probably going to lead to unbelievable outcomes.

> An entire generation is draining their savings to keep up with premium costs. Knock on wood but, myself and pretty much everybody I know has insurance covered ~75% through our full time employers. I think my portion of my insurance is about... $100/mo? I've never had to use it way/shape/form in the past... 5-10 years. Isn't the truth that the most unhealthy people are what drives health care costs? It'd be interest…

> myself and pretty much everybody I know has insurance covered ~75% through our full time employers

So your continued physical health and financial health is utterly dependant on your current employer.

Do you not see any problem with that?

(I'm not American, I think it's vile, and closer to slavery than I have any interest in touching)

Re: Employer health plans are getting pricier and skimpier

#413

Post by ClumsyPilot » Thu, Sep 26, 2019, 2:34 AM UTC

kuzimoto wrote: post #399

plughs wrote: post #383

Earlier quoted context omitted.

Then imagine that there are some people who can't afford the food they need in the grocery store and are going to die. Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.

According to Wikipedia, there are only .5% of all physicians in the US who can perform neurosurgery. So it's probably safe to say the demand for brain surgery is much higher than the supply. This incentivises people to become doctors that perform such complecated procedures as it takes a lot of time and a lot of money to be able to do those things. If you were to force doctors to perform work on people that can't aff…

How did you come to your concluding without looking at demand?

I don't need brain surgery every tuesday.

Re: Employer health plans are getting pricier and skimpier

#414

Post by aianus » Thu, Sep 26, 2019, 2:41 AM UTC

rubidium wrote: post #403

kuzimoto wrote: post #399

Earlier quoted context omitted.

According to Wikipedia, there are only .5% of all physicians in the US who can perform neurosurgery. So it's probably safe to say the demand for brain surgery is much higher than the supply. This incentivises people to become doctors that perform such complecated procedures as it takes a lot of time and a lot of money to be able to do those things. If you were to force doctors to perform work on people that can't aff…

If money were the only incentive to life no one would become a schoool teacher. Your summary is missing something.

Someone will still become a school teacher, they'll just be incompetent at it: https://www.thestar.com/yourtoronto/education/2016/05/13/for...

Re: Employer health plans are getting pricier and skimpier

#415

Post by aianus » Thu, Sep 26, 2019, 2:44 AM UTC

arbuge wrote: post #408

I see alot of the proposed solutions to the US healthcare system boil down to some form of "Medicare for all". I think a single payer system would be great and I am all for it. That said, I doubt it would solve all the problems in the US healthcare system at this point. It seems to me the biggest one is that providers, i.e. doctors, hospitals and drug companies all bill way too much. I think it is just politically le…

This is the real problem right here.

I live in Canada and the government pays for healthcare but (or maybe 'therefore') the providers do all sorts of sleazy things to get more money like schedule separate billable in-person appointments for an STD test and the reading of the negative result of said test.

Re: Employer health plans are getting pricier and skimpier

#416

Post by patientplatypus » Thu, Sep 26, 2019, 2:48 AM UTC

So many healthcare deniers in this thread. This is, what, the second or third presidential election we've had where the central debate is about the skyrocketing cost of healthcare? Government healthcare has been shown to work in multiple other countries with lower costs, but I guess we can't let facts get in the way of HURF DURF SOCIALBISM HURF DURF.

If only your local MD could cure criminal stupidity.

Re: Employer health plans are getting pricier and skimpier

#417

Post by nine_k » Thu, Sep 26, 2019, 2:51 AM UTC

doctorpangloss wrote: post #404

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

This isn’t a very good analogy. In a just world, nobody would go hungry, nor would anyone die prematurely or suffer needlessly due to lack of care. We can obviously afford both, in this country, just like they can everywhere else in Europe or Canada. So this entire argument about insurance is a straw man. It’s not the doctors who set up this world. It’s people who want to pay less taxes, but blame doctors.

Regarding Europe, which I happen to have friends all over: it's not exactly as rosy.

European countries do have more doctors per capita, which is good.

They don't have nearly as much resources in the system, though. Come to a doctor with a bad cough, get a prescription for Paracetamol. You got to have a pretty bad infection to get a prescription for an antibiotic. Endure a long discussion with a doctor to renew an antidepressant prescription made in another country.

Lines are pretty long, too. Wait for two weeks to get an appointment about your coughing and sneezing. Have a deteriorating chronic condition and be prescribed painkillers and be told to wait for a year. You're not yet feeling so bad as the people who are currently being treated and who take up the capacity; these people also waited a long time.

All are examples from my friends dealing with the health systems of Netherlands, Sweden, Germany.

The US system has a ton of issues, but I still take it over these European systems. Have I been floored by medical bills? Yes, from my dentist, from my wife's heart surgery. But I somehow managed — and we both received instant, high-quality help.

Even the Russian system is better, or used to be back in the day. You could buy local insurance, and the choice was reasonably wide. You could pay upfront in cash, and the sums were manageable — Moscow definitely not being a cheap city, more expensive than many EU capitals.

Of course, I'm talking from a perspective of a well-earning software engineer who lives in metropolises, not in countryside. Still I think that either system has downsides, and the European systems are not superior, but just suck differently.

Re: Employer health plans are getting pricier and skimpier

#418

Post by nine_k » Thu, Sep 26, 2019, 2:56 AM UTC

kuzimoto wrote: post #399

plughs wrote: post #383

Earlier quoted context omitted.

Then imagine that there are some people who can't afford the food they need in the grocery store and are going to die. Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.

According to Wikipedia, there are only .5% of all physicians in the US who can perform neurosurgery. So it's probably safe to say the demand for brain surgery is much higher than the supply. This incentivises people to become doctors that perform such complecated procedures as it takes a lot of time and a lot of money to be able to do those things. If you were to force doctors to perform work on people that can't aff…

I suppose that the amount of doctors graduating each year is below the supply-demand equilibrium, and this us because the artificial supply-side limitation. Most doctors are overworked, despite their very high throughput and medical offices' efficiency.

This gives doctors a way to pay out their colossal student debt, though!

Re: Employer health plans are getting pricier and skimpier

#419

Post by maerF0x0 » Thu, Sep 26, 2019, 3:00 AM UTC

plughs wrote: post #383

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

Then imagine that there are some people who can't afford the food they need in the grocery store and are going to die. Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.

No, but alternatives and transparent pricing allow us to weigh alternatives and to have an adult conversation about all of us will die someday (save singularity). Then we get to negotiate about what it's worth to extend that date of death forward 1, 2 .. N days for $N .

Next we look to that "scorecard" (bank account) which is the value provided but not called upon and get to see if we can call in enough "favors" to afford the healthcare

Re: Employer health plans are getting pricier and skimpier

#420

Post by closeparen » Thu, Sep 26, 2019, 3:04 AM UTC

comnetxr wrote: post #360

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No prices are labeled in store, they just detect whatever you take and send you a bill at the end of the month. (Differing brands of the same food product are not available in store of course.) Individuals are charged 3-100x more per product than negotiated rate…

From the consumer perspective, calorie needs are stable and predictable, fundamentally different from what insurance is for.

From the supply chain’s perspective, there is a very sophisticated insurance system to smooth out issues with crop yields, weather, etc. called the commodity futures market.