Money Won’t Buy You Health Insurance • Hacker News Board

Re: Money Won’t Buy You Health Insurance

#351

Post by Tyrannosaurs » Tue, Feb 22, 2011, 2:09 PM UTC

danssig wrote: post #334

speleding wrote: post #325

Earlier quoted context omitted.

> free markets don't work for healthcare Healthcare can be broken up into a lot of smaller markets, and for a lot of those the free market works just fine. The market for coffee in the cafeteria of the hospital works fine as a free market. Do you know what percentage of healthcare cost pertain to the cost of the actual treatment itself? (hint: it's a very small part)

Could you please cite somewhere in the world where the free market is working for health care? Every other first world country either has socialized medicine or a tightly regulated health industry.

Singapore - arguably the most efficient healthcare system in the world. Tim Harford talks about it in his excellent book "The Undercover Economist" (worth commenting that he's not rampantly free market - he spends time putting the boot into the US system too as well as praising the UK's NHS).

Basically everyone has to maintain a fund (the government pay into it for the poorest) for healthcare. This is what they spend when they have healthcare needs.

Because the people are making the purchasing decisions themselves (as opposed to the insurance company doing it) they have a far stronger incentive to demand value and to be informed, and you get genuine competition between providers (as if you don't like them this time you'll go elsewhere next time with no insurance company mandating who you can see).

The government then picks up the few areas that aren't well catered for by this system.

I think it costs about 40% of what the US system costs (possibly even less) and Singapore has a typical life expectancy of 80.

Re: Money Won’t Buy You Health Insurance

#352

Post by cookiecaper » Tue, Feb 22, 2011, 2:15 PM UTC

klenwell wrote: post #249

dgabriel wrote: post #131

Earlier quoted context omitted.

What's the point of catastrophic insurance if they can drop you when you need it? It seems like you're paying for nothing.

Been in this situation. Asked myself this question. You're basically paying for the privilege, in the event of a large medical expense, to say, "Don't blame me, I paid for the insurance." It will make no practical difference, as some of the follow-up comments have already suggested. You're just spared the indignity of those ignorant of the realities of the American health care market (or, worse, fully conscious of th…

Also, ostensible insurance coverage gets you through the door and the treatment needed without taking all of your money. Cash patients often have to pay large chunks up-front.

As a person in a fluctuating employment situation with a pregnant wife, I know that cash OB/GYN pregnancy treatment programs cost $400-$500/mo, because they want you to prepay on the baby's delivery, as they don't trust cash patients to pay a $12,000 bill after the baby is born. If you have insurance, at the two ob/gyns we've been to, you don't even have to pay office copays and they bill it all after the delivery. The individual is usually billed $2000-$4000 after deductible and after the insurance pays its portion (generally 80%).

So, even if your insurer denies your claim, for some people the only practical way to get access to medicine is to have an insurer. Certain doctors (namely doctors with whom you will have a short-term ongoing relationship, like your infant's pediatrician or your OB/GYN) will totally shun you if you don't have insurance. I guess this is because most cash patients determine they've paid enough after they pay a pediatrician or gynecologist several thousand dollars.

Re: Money Won’t Buy You Health Insurance

#353

Post by mbesto » Tue, Feb 22, 2011, 2:16 PM UTC

acabal wrote: 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…

American expat in London here. Can't agree more. Healthy 26 year old with no conditions. I don't need NHS and don't mind pay taxes for it. I want to know it's there when I do need it though.

Re: Money Won’t Buy You Health Insurance

#354

Post by ThomPete » Tue, Feb 22, 2011, 2:17 PM UTC

maxharris wrote: post #309

damoncali wrote: post #201

Earlier quoted context omitted.

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.…

Few will admit that we don't have anything close to a free market in healthcare today (or for the past several decades). A truly free market is one unfettered by the FDA, medicare, medicaid, doctor regulations, hospital regulations, HMO regulations, insurance regulations, etc. All of these controls were ostensibly put in place to protect patients, but in actuality they serve to slow innovation and true access to medi…

How wrong you are.

No man is an island. Neither you, nor anything you create is created in isolation.

Dependencies are ever-present and failing to understand this leads to failed ideas such as "true free market" not unlike the idea of "true communism".

In reality the very fact that you are alive to write your words is a testament of other peoples effort including your parents to guard you against the many many dangers in this world.

Ultimately you don't own the right to anything, not even yourself.

It's an agreed upon right not a natural law.

I agree that there are some times too many regulations. But claiming what you do here is simply wrong in a very unfortunate Ayn Rand way.

Re: Money Won’t Buy You Health Insurance

#355

Post by cookiecaper » Tue, Feb 22, 2011, 2:23 PM UTC

potatolicious wrote: post #181

georgieporgie wrote: post #156

Earlier quoted context omitted.

It's a gamble. I imagine that the risk of being dropped is directly proportional to the amount of attention I garner. Break a leg? Probably not a big deal. Get cancer? Better look out.

> "Break a leg? Probably not a big deal. Get cancer? Better look out." This is a horrifying, inhumane, uncivilized concept. Why the American public simply accepts this is mind-boggling.

We obviously don't accept it, people have been trying to change it and it's been a major election issue for several years now. There's just a lot wrong about health care, so there are lots of facets for people to latch onto and say, "We have to fix this part!", and then the people who want to fix another part spend a few years bickering about which part is the key to fixing the whole thing (no part individually, but don't tell people that).

Also, people do not evaluate things independently and rely on pundits like Glenn Beck or Rachel Maddow to evaluate the situation and give them an opinion. Glenn Beck and the rest of the Fox News/right-side cadre tell everyone that health care reform is socialism, our system is the greatest in the world already, the government can't do anything right, and we'll all be turned into savages because socialism will steal our morals and make our children sniveling, awful thieves and layabouts. This is Glenn Beck's position mainly because the President is currently a Democrat. Maddow says the opposite of course.

Media in the US works by validating the opinion of your target audience, and doing this in an emotionally gratifying way that sounds like you are being logical and reasonable, and gives people little soundbites they can use to justify their position. People listen to Beck, Hannity, et al because they enjoy the emotional experience that it induces -- they like the righteous anger and validation of their beliefs, they are gratified by blaming all of the problems on the people that have an opposing viewpoint. They enjoy hearing little snippets that can be used to justify their (adopted) political positions in a sentence to a friend or colleague. It's just easier this way, and doesn't require any intellectual effort.

In short, it's all about flattery. People give you money, influence, and power when you spend all day flattering them, irrespective of its basis in reality.

There's a lot of misinformation out there.

The majority of Americans also have passable health coverage, so since it doesn't affect them, the people that are not politically inclined are not particularly interested in the debate and they don't understand the difficulty for people that aren't happy to be bound to BigCo forever.

Re: Money Won’t Buy You Health Insurance

#356

Post by jasonlotito » Tue, Feb 22, 2011, 2:24 PM UTC

shiny wrote: post #109

tonfa wrote: post #25

Earlier quoted context omitted.

If you are inclined to move somewhere else, there are lots of countries with affordable healthcare (most of Europe, and I guess Canada for example).

How easy are these countries to get into (and become a working member of their society)? I know Switzerland and New Zealand are particularly tough.

Did you miss the Montreal open-source thread here yesterday? =)

Canada is great for tech people looking for work. We need people up here. Sure, it gets cold in the winter, but it's really not that bad.

Re: Money Won’t Buy You Health Insurance

#357

Post by netcan » Tue, Feb 22, 2011, 2:31 PM UTC

nerfhammer wrote: post #291

netcan wrote: post #186

Earlier quoted context omitted.

Australian private health insurance isn't necessarily a good comparison for two reasons. First, it's a complimentary insurance meaning that it's for extras that people otherwise pay out of pocket or go without like dental, private hospital rooms, etc. It doesn't cover the really expensive unpredictable things like major surgery, cancer treatment. The basics (eg GP visits) and the big expenses are covered by medicare.…

I also looked at insurance intended for non-Australians living in Australia (not covered at all by national insurance) and found prices to be pretty much the same

From Wikipedia the total annual cost of medicare (the australian national insurer) is about $18.3b, $900 - $1000 per person living in Australia.

The graphs comparing total healthcare spending of various countries put Australia's at close to $3500 per capita, so medicare must only be part of the total.

There are some funds going into health in one off ways like states funding hospitals, donations, people paying above medicare rebate amounts (usually about 30% more for GPs in my experience). There's drugs, some of which are subsidized. Then of course there's private insurance which a substantial portion of people have.

I had private insurance for foreign students for a few years. From what I understood it's basically a tax administered by an insurance agency.

Basically it's complicated and subsidized in all sorts of ways. It's like that in The States too. You can't just look at a doctor's bill or insurance premium in one place and assume that it's representing cost in some meaningful way.

Re: Money Won’t Buy You Health Insurance

#358

Post by cookiecaper » Tue, Feb 22, 2011, 2:39 PM UTC

rikthevik wrote: post #285

krschultz wrote: post #180

Earlier quoted context omitted.

Have you actually tried getting a big claim paid by them. My GF is currently embroiled in a dispute with United Healthcare over a temporary insurance plan she bought to cover the gap between graduating college and when her full time position started covering her (wouldn't it have been great if the new healthcare law was in effect at the time and she could have stayed on her parents insurance). Anyway, she had a hospi…

This is the very frightening thing. You fill out your forms, you pay your premiums and you still get screwed. I know that in Canada, if I am sick, I will be looked after. I won't go bankrupt trying to pay for my treatment or trying to pay for the legal bills in a court battle, trying to get my insurance company to pay out. The American system is so truly and completely fucked, I can't understand why anyone would defe…

Is it cheaper to hire a good lawyer or just to pay the bill? Unless it's catastrophic it's probably cheaper to just pay the bill than to fight it.

Re: Money Won’t Buy You Health Insurance

#359

Post by cookiecaper » Tue, Feb 22, 2011, 2:41 PM UTC

jseifer wrote: post #311

krschultz wrote: post #180

Earlier quoted context omitted.

Have you actually tried getting a big claim paid by them. My GF is currently embroiled in a dispute with United Healthcare over a temporary insurance plan she bought to cover the gap between graduating college and when her full time position started covering her (wouldn't it have been great if the new healthcare law was in effect at the time and she could have stayed on her parents insurance). Anyway, she had a hospi…

United denies everything they possibly can and they make "mistakes" that take so long to find you get past their dispute time. Do not go through United trying to get them to pay this. Prepare for a day spent on the phone with the hospital until you find the person in the billing or services department who can really get to the bottom of it. They will figure out for you which technicality the insurance company is tryi…

Again, health insurance does this because insurance is all about paying for something and not using it. Since everyone uses health insurance, insurers resort to schemes like this to keep their profits where they like them. Insurance is a completely horrible paradigm for medical billing.

Re: Money Won’t Buy You Health Insurance

#360

Post by cookiecaper » Tue, Feb 22, 2011, 2:48 PM UTC

SoftwareMaven wrote: post #233

Health insurance is broken because the people who pay the bills (the insurance companies) are not the people receiving the services (patients). If patients were actually paying the bills, they would be much more price-conscious and you would see price competition on that stupid-expensive MRI (for evidence, look at how much cheaper LASIK surgery has become and how much better it has become, yet insurance does not cove…

Heh, I paid almost $1000/mo for COBRA coverage for six months last year. I think that the only plausible thing to do in that situation is to flee to Canada, or figure out how to consistently receive medical care without paying for it.

Unless you're bringing in the cash hand over fist, it's just not a feasible proposition for an entrepreneurially-minded patriarch with multiple uninsurable family members to stay in the US. Your options are basically to totally ruin your credit constantly and eventually be banned from all nearby medical facilities or pay $15k+ each year for medicine. It's plausible (though not very likely with four kids) that there may be a couple of relatively quiet years medically, and then you can only hope that you don't end up paying more than $10k in bills that year. With every X-ray, mammogram, MRI, or other routine imaging procedure costing $500+, and a fifteen minute appointment costing $100-$200, it really adds up.

For a multi-millionaire it's doable, but pretty difficult for anyone else.