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Money Won’t Buy You Health Insurance

nytimes.com

221–230 of 442 posts

Re: Money Won’t Buy You Health Insurance

#221
post #217

Earlier quoted context omitted.

There is also corporate tax, and personal tax is assessed at graduated rates depending on income. If their income is low, say ~60k split between husband and wife, they would pay roughly ~0 for health care.

Corporate taxes come out of paychecks. Unless all that is refunded if that's their income, then they're still paying something for it in addition to their direct monthly bill. It can be carried further: money they get refunded comes out of other areas' funding, as the difference gets made up somehow. Their property taxes go up, the cost of food goes up because others are carrying a heavier burden, jobs across the boa…

And breaking a window stimulates the economy because it means the window-fitter gets more business.

Re: Money Won’t Buy You Health Insurance

#222

Earlier quoted context omitted.

This is basically a recap of the Japan segment of the Frontline special "Sick Around The World", which you can watch online at: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ . The Japanese system is not without its problems. More importantly, the "price fixing" approach to health insurance simply isn't going to happen in the US. What parts of it do you think we really can adopt? Because nobody is going…

"More importantly, the 'price fixing' approach to health insurance simply isn't going to happen in the US." Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund? Th…

I think the goal was more to state that our government is heavily influenced by rich special interest groups, who won't let it happen here, even if it costs them billions of dollars every year to fight it off.

Funny mental picture though :D In my head they're wearing those stereotypical nurse hats and brought their own stretchers to carry off the wounded / exhausted / weaponry.

Re: Money Won’t Buy You Health Insurance

#223

Earlier quoted context omitted.

This is basically a recap of the Japan segment of the Frontline special "Sick Around The World", which you can watch online at: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ . The Japanese system is not without its problems. More importantly, the "price fixing" approach to health insurance simply isn't going to happen in the US. What parts of it do you think we really can adopt? Because nobody is going…

"More importantly, the 'price fixing' approach to health insurance simply isn't going to happen in the US." Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund? Th…

No, there won't be riots in the streets, because it would take amendments to the Constitution to institute price-fixed health care. Clinton's wildest single-payer fantasy (which, coincidentally, is one of my wild fantasies) would be easier to accomplish, and it, too, is D.O.A.

My objection to your point is twofold:

(1) It is total wishful thinking.

(2) It's wishful thinking in the face of pragmatic solutions that could resolve the problems we have now without utterly restructuring the market for health care.†

I'd also appreciate it if you wouldn't attempt to frame any critique of your comments in terms of "you're either with me or against health care reform". As you can see from a casual glance at this vast, Reddit-like thread, few opponents of health care reform would dare poke their head up on HN these days. I'm not an opponent of reform.

Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance, an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today), and broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics.

Re: Money Won’t Buy You Health Insurance

#224
post #213

Earlier quoted context omitted.

That's not exactly encouraging.

[deleted]

Sorry - I was joking. Perhaps I should have added a smiley. I get what you're saying. I also think that:

1. the medical industries/professions work very hard at discouraging price competition.

2. price competition is not sufficient to create a healthcare marketplace that works well for society. I'd like to see people without means have at least some access to medical technology/services, even at the cost of inefficiency. But that's just me.

Like I said - it's a beast.

Re: Money Won’t Buy You Health Insurance

#225
post #64

Can someone please explain to me why five thousand self employed people can't form a corporation together and get group insurance? Do shell corporations like that already exist?

Freelancersunion.com I believe does something similar with their health plan.

Re: Money Won’t Buy You Health Insurance

#226
post #2

This really highlights how utterly insane our system is. I'm living off of my own business, which means that I don't have an employer to cover me under group insurance. But I really only make enough to live frugally and save a tiny amount each month--to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the…

"instead of doing anything serious about it, we've done almost the worst possible option: require every one of us to be a customer of these monstrous companies, with little regulation on cost or other government oversight"

This is a common misunderstanding of the economics of this situation. The principle involved here is "Adverse Selection".

To illustrate, let's look at automobile liability insurance. The reason this insurance is so affordable for most americans is that 1) everyone with a car must pay it and 2) there is price competition among insurers.

Imagine for a moment that automobile liability insurance was optional. Who would benefit the most from having this insurance? Accident-prone drivers or non-accident-prone drivers?

That's right - the accident-prone drivers.

And since accident-prone drivers have the most incentive to have liability insurance, you would see the customer pool of the insurance start skewing heavily towards these high-risk drivers.

Then, since it's mostly the high-risk drivers in the customer pool, the number of claim payouts would go dramatically up along with the average payout per claim.

In order for the insurance company to remain in business they would be forced to raise their rates OR to be super strict about not insuring customers that seem risky.

Naturally, the insurance business only works if you have more money coming in than going out. And in order for the insurance to be "affordable" to most people, then the risk needs to be spread amongst most people (not just the more risky ones).

So, while I understand and share your frustration at the current state of health care in the U.S. - it's important to point out "why" everyone needs to be insured in order for the rates to be "affordable".

Of course there are other important variables affecting health insurance premium rates (rising health care costs is a major one), but the "Adverse Selection" issue is probably the most important.

-----

Another point to consider is that the current big health insurance companies have focused their skill on just a couple things:

1. Avoiding risky customers (by denying them or offering only super-high premiums)

2. Paying out as little as possible (by reducing health care costs and denying claims)

The dynamics of the health insurance market are about to be dramatically changed. #1 will no longer be nearly as important and there will be a huge jump in the size of the market. This will be a huge opportunity for disruption in the industry.

The old health care companies are extremely slow, bloated, and resistant to change. It's easy to see that new entrants will be able to grab significant market share from them and initiate some real price competition.

It's frustrating to have to wait the few years until this happens, but I'm very optimistic about the future (assuming the recent health care reforms won't be diluted before they can be enacted).

Re: Money Won’t Buy You Health Insurance

#228

Earlier quoted context omitted.

So, the solution to that in the US is for the patients to either die or go bankrupt rather than hospitals or insurers going into debt. Everything has a price, but that seems a little lopsided.

This is an utterly nonresponsive comment. If the economics of providing healthcare don't work out, they don't work out. It's not as if "go into debt" means "fat cats make less money". No, it means that the skilled labor and capital that drives the insolvent health care system will simply migrate somewhere they can deliver it profitably. Say goodbye to hospitals for rural and poor areas.

"Say goodbye to hospitals for rural and poor areas."

That was happening anyway, if it weren't for Medicaid, that is. There was a definite brain drain of doctors (especially specialists) who choose to go to affluent suburbs and urban areas simply because they get more (and better quality, AKA rich) patients. You think if we _further_ privatized the market, those in rural areas would be _better_ served? Isn't that the opposite of what the free market would actually do? In fact, take a look at this study[1] about physicians in rural America. It's eye opening how they advocate federal and state intervention (read Medicaid and Medicare) as one of the solutions (along with opening training up to more potential candidates, which even I as a liberal elitist supports).

[1]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071163/

Re: Money Won’t Buy You Health Insurance

#229
post #32

I would have died at the age of 19 if it weren't for the help of the UK's National Health Service. My parents and I didn't have to worry about hospital bills, future insurance issues, being tied to a job, any of that crap. Just get some rest, get better, go out there and be productive again. The American system looks like a horrible joke from over here. I just can't understand any of it.

I challenge anyone with a painful but non-life-threatening injury - say, a torn labrum, or a torn ACL - to go live in Canada or the UK and see what their treatment is like compared to here. Anyone?

I have not torn an ACL in the US, but when I did in Canada, I found the treatment professional and quite reasonable in timeliness (Vancouver, BC).

I saw 3 different doctors, including seeking multiple opinions from 2 different knee specialists. I decided not to have surgery right away, and got a brace.

A few years later, my preferred leisure activities changed, so I decided to have surgery done. It took 11 weeks to get an appointment (as it was elective surgery at that point). The surgery was done by an experienced surgeon (a few hundred ACLs under his belt), and he met with me 4 times himself during the following year to follow up on my recovery progress.

Total out of pocket cost was ~$300 for a couple optional recovery devices (icing machine, etc.).

Physiotherapy appointments were, however, covered by my employer's extended medical at the time. That was about $1-2k that I would have had to pay had I been completely uninsured. I probably would have elected for less and cheaper physio care in that case though.

Short version: after reading this article/thread, I'd honestly be scared to join YC in SV, especially now that I have a daughter.

(Side note, I tore my ACL in Ontario and had an initial appt there, but ended up getting treatment in BC. It seems a lot of posts here talk about which state you have coverage in? Is the paid-for insurance not country-wide either??)

Re: Money Won’t Buy You Health Insurance

#230
post #155

Earlier quoted context omitted.

What explains the rapid and sustained rise in costs? Health care might have cost thirty years ago but not the same degree. Further, Health care is approaching twenty percent of GDP where once is was less than five. Wouldn't that be large factor in costs? And doesn't that seem a tad less than necessary?

Part of the rapid and sustained rise in costs comes from that a) more things are being treated that existed before but got no treatment, and b) more availability of new drugs, because we're now able to create ones which were impossible / inconceivable back when costs were 5%. Would you rather go back to colloidal silver someone sold you as a wonder-drug out of the back of their wagon? Or use the significantly more te…

Not that it accounts for all of the change. Or even a large portion.

Then what is your argument??

Just that the rise isn't entirely due to waste.

No one argued that.

Even the most egregious health insurance policy abuses are generally something more than waste. Often, there's been an effort to enhance "choice" and "responsibility" but generally without understand that the average person simply has limited horizon for navigating such things.

It's not mere waste, it's mere corruption but a combination of multiple "perverse incentives" - effort to fuse government and private industry which aim for the best of all possible worlds but end in the worst.

"It begins with a blessing, it ends with a curse. Making life easy by making it worse 'My mask is my master', the trumpeter weeps But his voice is so weak, as he speaks from his sleep" Soft Machine

We face a challenging world today...

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