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Money Won’t Buy You Health Insurance

nytimes.com

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Re: Money Won’t Buy You Health Insurance

#251

Post by caf »

Dylanlacey wrote: post #146
caf wrote: post #74

Earlier quoted context omitted.

It's not really moral hazard, since that implies a rational choice is being made to make themselves sick because they know that they won't be bearing the financial costs. However, there are a plethora of non-financial costs to the diseases you've mentioned - up to and including death - so the moral hazard is mostly avoided. It's simply that some people make irrational, bad choices, and the incentives on the whole mak…

Moral hazard doesn't have to be rational, just a deliberate choice. Such as the choice to smoke, or over-eat. Yes, they can be addictive, but there are supports and cures for both, and involve willpower and sacrifice, but they're there. I say this as a fatarse who has lost 20Kg by eating less (The Horror!) and doesn't blame anyone except himself.

Moral hazard is a concept entirely based on rational economic actors.

If the potential future cost of dying of lung cancer doesn't deter people from smoking, then the potential future cost of bankruptcy from paying for lung cancer treatment isn't going to, either.

It's about the mispricing of future risk rather than moral hazard. If you brought the cost up-front, by giving them health insurance but charging additional risk premiums to smokers, then you would likely find more rational decision-making around smoking.

Re: Money Won’t Buy You Health Insurance

#252

Post by Zak »

joe_the_user wrote: post #237
tptacek wrote: post #207

Earlier quoted context omitted.

This is a weird summary of how "free markets" and "supply and demand" work. Yes, you will pay everything you have for a cure. But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business. Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your…

Presently, no American hospital publishes its price list.

Almost every American hospital publishes its price list to its primary customers: the insurance companies. The problem as I see it is that the insurance companies are the only entities that can get fair prices for health care, and they want to keep it that way. A potential solution would be to ban insurance discounts; a health-care provider could charge any price it wants, but it would be required to charge all customers the same price. Insurance companies would still negotiate for lower prices, so it would benefit all of us.

Re: Money Won’t Buy You Health Insurance

#253

Post by mrcsparker »

joe_the_user wrote: post #237
tptacek wrote: post #207

Earlier quoted context omitted.

This is a weird summary of how "free markets" and "supply and demand" work. Yes, you will pay everything you have for a cure. But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business. Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your…

I will try to speak for the parent. I think that he meant that everything being equal most people would rather save that dollar.

Re: Money Won’t Buy You Health Insurance

#254

Post by retroafroman »

stellar678 wrote: post #134
georgieporgie wrote: post #84

I'm 35, single, and paying something like $120 per month for Blue Cross coverage that I found on ehealthinsurance. I've used them each time I've not been actively employed, and I've always found an acceptable deal. Mind you, I took the high deductible route since I'm only concerned with catastrophic illness at right now. Also, the moment anything serious comes up, they can cleverly drop me, since they have ludicrous…

Even most newborns were presumably born in a hospital. Guess that's a pre-existing condition too.

Believe it or not, my cousin's newborn baby was born some sort of small issue (maybe like not breathing properly) which was fixed quickly and routinely, when he was very first born, and now her and her husband's insurance will not cover him because of a pre-existing condition. It's that ridiculous.

Re: Money Won’t Buy You Health Insurance

#255

Post by klenwell »

ajays wrote: post #138

The irony is: the same Congresscritters who vote against universal health insurance get top-notch health insurance paid for by taxpayers: http://www.suite101.com/content/health-care-for-the-us-congr... After 5 years of service, they get lifetime health insurance, the same as all federal employees and retirees: http://www.opm.gov/insure/retirees/index.asp?MainQuestionId=...

A few tea partiers turned down the insurance this year on principle. One was interviewed on NPR, where he acknowledged that the insurance rates he found on the open marker were a bit of a shock:

http://www.npr.org/2011/02/09/133629806/16-Freshmen-GOP-Decl...

Still, he rationalizes away the benefits of the new Health Care law:

"But I think that if we had true health care reform that I wouldn't be paying $1,300 a month for this health care. If we had true tort reform, if we had true health care reform where physicians weren't ordering unnecessary, you know, procedures just to protect their backside, I'd think that a lot of us would see a reduction in what we pay in any health care, whether it's, you know, employee - helped, subsidized, or, you know, employer-subsidized."

In case you miss his weasel words: tort reform makes virtually no difference and hasn't had a noticeable impact in states where it has passed. Otherwise, the new law is about the most realistic first step you're going to get passed in this country toward controlling costs. Meanwhile, the one area where the law is halfway decent is in extending more affordable health insurance coverage to more people.

Re: Money Won’t Buy You Health Insurance

#256

Post by tptacek »

muhfuhkuh wrote: post #238
tptacek wrote: post #223

Earlier quoted context omitted.

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 cou…

"Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance" Guaranteed-issue meaning "you have to get it, but we [the insurer] can charge whatever the hell we want. So, you, small biz of 10 employees with one person who had cancer, you premium is now more money than the GDP of Haiti, per month. Thanks and come again!" That kind of practice can be fixed by either 1) price-fixing or 2)…

When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up. It's hard for me to take you seriously. You sound like a DailyKos diarist.

I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat. So, first, you attempt to paint me as against all reform and in favor of people dying instead of companies going into debt. Now, you've tried to reframe the discussion so that you're either in favor of market-based approaches or a "socialist".

And, after you've done your level best to suck all the oxygen out of the conversation, it turns out... you agree with me.

Please stop writing like this on HN.

Re: Money Won’t Buy You Health Insurance

#257

Post by dualogy »

damoncali wrote: post #201
muhfuhkuh wrote: post #110

Earlier quoted context omitted.

Japan forces their doctors to charge only what's published in a book that the government issues and negotiates prices periodically. Simple price fixing in an otherwise private healthcare market. In return, Japanese doctors and hospitals (FYI, there are more private hospitals in Japan than the US) are allowed to set whatever prices for ancillary services (like private or semi-private rooms) that they want. BTW, the av…

What people don't like to admit is that free markets don't work for healthcare. What is the price you're willing to pay for curing that tumor in your gut? Everything you have. There is no supply vs. demand. Only supply vs infinity. What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty. Because of that, some sort of non-market intervention is simply unavoidable.…

"What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty."

You turned cause and effect upside down. You think the free market for food "works" because food supply is "abundant"? Think again. The supply is high because it's market is "free" (not really but fairly) globally and (sorta) works.

Re: Money Won’t Buy You Health Insurance

#258

Post by s3graham »

Groxx wrote: post #217
s3graham wrote: post #214

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…

But by the "whole system" argument you're making, health care could easily have a negative cost.

Let's hypothesize that all the engineers working in SV get an AIDS-like illness caused by spending too much time on news.yc.

If there was a health care solution that would make sure that all the employees of Google, Intel, HP, etc. continued to function as usual by caring for those engineers, then even an extremely high up-front cost for that care would result in a net-win for the budget/economy/country.

Of course, that's silly as it won't happen to that extreme. But, I don't think the downward-spiral of more-cuts-here-and-there that you describe is the only possible outcome. A positive virtuous-cycle of increased wealth production is also possible.

Re: Money Won’t Buy You Health Insurance

#259

Post by joe_the_user »

Groxx wrote: post #203
Vivtek wrote: post #189

Earlier quoted context omitted.

The takeaway - you're actually paying for what should be your healthcare in your taxes as an American, but you're not actually getting the healthcare, because that would be socialism.

> that would be socialism. That is a massively incorrect statement, which pops up every time government-mandated healthcare debates appear, which I wish to squash ASAP: http://en.wikipedia.org/wiki/Socialism Universal healthcare != socialism. Not even remotely . It's a political mud-slinging attempt to equate healthcare changes with the historical fear of the USSR that seems to have infected far more people than it s…

I think the parent meant "pundits would say 'that would be socialism'".

I think most here know nationalize health isn't socialism.

Re: Money Won’t Buy You Health Insurance

#260

Post by SapphireSun »

joe_the_user wrote: post #237
tptacek wrote: post #207

Earlier quoted context omitted.

This is a weird summary of how "free markets" and "supply and demand" work. Yes, you will pay everything you have for a cure. But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business. Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your…

I work in healthcare and while I might be incorrect, this is my understanding of the situation.

Medicare is the largest payer of insurance claims by far. Medicare also has a lot of rules. One of these rules is that, in order to prevent providers from shortchanging Medicare, they have to charge everyone the same price (otherwise medicare would be overpaying....). Medicare will then pay 80% of the indicated amount and the rest is covered by medigap insurance, Medicaid, or by the patient.

As you might imagine, the lack of ability to price discriminate, even to patients, hugely distorts the market. However, private insurers have gotten around this (how I don't totally understand), by using what is called the contractually "allowed amount". This is an agreement that the provider will write off the variance between the allowed amount and the billed amount. This results in de facto price discrimination for large insurers while getting around the medicare law. Patient's don't have this kind of gig.

Of course, there are tons of other corruptions and inefficiencies in the system. I could tell you a story about a friend who once worked for NY Medicaid who was actively prevented from working to prevent the state from going bankrupt by paying claims.

I don't have the answers, but there is serious distortion of the market ATM.

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