Is employer-based health insurance a barrier to entrepreneurship? • Hacker News Board

Re: Is employer-based health insurance a barrier to entrepreneurship?

#111

Post by mcculley » Mon, Feb 28, 2011, 3:14 PM UTC

anamax wrote: post #98

mcculley wrote: post #74

Earlier quoted context omitted.

Yes, individuals cannot buy health insurance for the same rates that employers pay. Some individuals cannot buy health insurance at all if they have preexisting conditions.

> Some individuals cannot buy health insurance at all if they have preexisting conditions. That's true only if they let their insurance lapse. As long as they don't do that, they can stay with their current, switch, etc, all without waiting periods or a significant premium relative to "well people". (It's been that way for years.) That's why I wouldn't let insurance lapse if I had a pre-existing condition, so why do…

> Or, are "we" ranting about the system without knowing rules that don't apply to us?

I don't know about you. I am ranting about the system that I pay into every month for my employees that doesn't cover their pre-existing conditions.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#112

Post by icey » Mon, Feb 28, 2011, 3:22 PM UTC

dnautics wrote: post #110

icey wrote: post #107

Earlier quoted context omitted.

> Why should I be forced to pony up for other people's healthcare, too? This entire argument is predicated on the idea that people who decide not to buy insurance will actually stay home when they get so sick that they feel their life is in danger, instead of going to the hospital. History has shown that's not the case; they end up in the emergency room with no insurance, and end up being a cost that hospitals have t…

"History has shown that's not the case; they end up in the emergency room with no insurance, and end up being a cost that hospitals have to recoup via higher rates for the people that have paid for their insurance." No. That is not "history". This is a recent phenomenon. This sort of thing was not generally occurring 30 years ago.

The 1990s are history: http://articles.baltimoresun.com/2001-01-31/business/0101310...

2002 is history: http://www.bizjournals.com/seattle/stories/2002/08/05/story3...

2003 is history: http://www.healthylivingnyc.com/article/58

2005 is history: http://www.msnbc.msn.com/id/7995137/ns/health-health_care/

2006 is history: http://www.hhs.gov/news/press/2009pres/07/20090715b.html

Affordability was quite different 30 years ago, perhaps that's why this is a relatively recent phenomenon. It doesn't really matter what the situation was 30 years ago though, because the trend over the past decade has been that uninsured people go to the emergency room when they're very ill.

I assume they didn't lay down and die at home 30 years ago either.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#113

Post by dnautics » Mon, Feb 28, 2011, 3:26 PM UTC

DrJokepu wrote: post #95

dnautics wrote: post #56

Earlier quoted context omitted.

Why don't you believe in a free market for health insurance? Forcing people to pay into a health insurance is kind of scammy - let's say that I have a genetic condition that is certain to kill me rapidly at age 30. I want to live my life to the fullest, and I'd rather not be forced to buy health insurance that protects me from things like adult onset diabetes, alzheimer's, cancer, parkinson's, etc, that I'm just not…

> Why don't you believe in a free market for health insurance? There are two main reasons. First of all, as someone mentioned it in another thread here a few days ago, healthcare does not follow the rules of supply and demand, since people would pay anything for survival. You're never going to say that "ah this treatment is a bit overpriced; I think I'll get more value for my money if I'll just die instead". It's rid…

"Most of the things people get treated for have nothing or almost nothing to do with genetic conditions."

Almost completely incorrect. Got the flu? Well that's because the flu virus latched onto a receptor that let it get into your respiratory cell. That receptor could be mutated in you.

Got into a car accident? The surgery is painful. They're going to give you an anaesthetic. Your response to the anaesthetic is going to be governed by genetics. The pharamacokinetics - how much anaesthetic you'll need - governed by genetics. Maybe the current standards of care will kill you.

"While having unlucky genes could decrease the chances of survival, ultimately everyone can get cancer."

Thanks for making my point for me. Cancer is extremely genetic. Got a mutation in BRCA? You're going to have an elevated (or possibly reduced) risk of breast and prostate cancers. And especially, individual cancers' response to drug treatments is going to be partially stochastic and highly dependent on the underlying genetics.

"As a European conservative, I truly believe that no life is unnecessary, no life is wasted."

Hypothetical: You see, I'm a biomedical engineer (true). Let's say I build a machine that can keep anyone alive. The machine is great, the quality of life for the user is awesome. And it's such a great machine, it works indefinitely. Here's the catch. To operate the machine takes 400 barrels of crude oil a day. There's no way around this. Now. If health care is a right, and no life should be unnecessary or wasted, then do people have a right to this machine?

Just to be clear, I don't think that no life is unnecessary or wasted, I just don't think that health care is a right, and I think that people need to accept the fact that they are going to die someday, and it's not such a horrible tragedy if medicine cannot save them, even if a possible cure existed and the only reason why they couldn't get access to it due to money. Obviously, I am not heartless and I think that situation should be minimized, via charitable actions - and I think that any system that tries to cover everyone will wind up costing everyone more and having rapidly diminishing returns in the face of reality, and will also really screw over corner cases. If such a system has the capacity to appropriate money from people against their will and the authority to make decisions for people, then the costs and the injustices will pile up even faster.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#114

Post by dnautics » Mon, Feb 28, 2011, 3:27 PM UTC

EiZei wrote: post #61

dnautics wrote: post #56

Earlier quoted context omitted.

Why don't you believe in a free market for health insurance? Forcing people to pay into a health insurance is kind of scammy - let's say that I have a genetic condition that is certain to kill me rapidly at age 30. I want to live my life to the fullest, and I'd rather not be forced to buy health insurance that protects me from things like adult onset diabetes, alzheimer's, cancer, parkinson's, etc, that I'm just not…

> why don't you believe in a free market for health insurance? Forcing people to pay into a health insurance is kind of scammy - let's say that I have a genetic condition that is certain to kill me rapidly at age 30. I want to live my life to the fullest, and I'd rather not be forced to buy health insurance that protects me from things like adult onset diabetes, alzheimer's, cancer, parkinson's, etc, that I'm just no…

I'm terribly sorry for you if you don't believe that protecting the rights of minorities and corner cases is important.

If you don't believe the section about minorities, then you are pulling a denial of science that is far worse than any climate science denier. There are two 'canonical' heterozygous recessive diseases that are covered in every high school biology textbook - cystic fibrosis and sickle cell anemia. Sickle cell anemia affects mostly people of west african descent. Cystic fibrosis mostly affects people of askenazi jewish descent. Sometimes I wonder why do we have high standards of care and treatment protocols, and are racing toward a cure for CF, while sickle cell anemia even has, an admittedly crude, known treatment (for a decade now) that still has languished in regulation. Why don't we have better research on SCA to figure out how to treat it?

Re: Is employer-based health insurance a barrier to entrepreneurship?

#115

Post by dnautics » Mon, Feb 28, 2011, 3:39 PM UTC

dnautics wrote: post #113

DrJokepu wrote: post #95

Earlier quoted context omitted.

> Why don't you believe in a free market for health insurance? There are two main reasons. First of all, as someone mentioned it in another thread here a few days ago, healthcare does not follow the rules of supply and demand, since people would pay anything for survival. You're never going to say that "ah this treatment is a bit overpriced; I think I'll get more value for my money if I'll just die instead". It's rid…

"Most of the things people get treated for have nothing or almost nothing to do with genetic conditions." Almost completely incorrect. Got the flu? Well that's because the flu virus latched onto a receptor that let it get into your respiratory cell. That receptor could be mutated in you. Got into a car accident? The surgery is painful. They're going to give you an anaesthetic. Your response to the anaesthetic is goin…

you know what. I know someone is going to criticize me for my hypothetical. So I'm going to just say, this is not far from reality (although it is not the reason why US healthcare costs so damn much). In 2004 Novartis reported that they were making the anticancer drug discodermolide. From scratch. (http://pubs.acs.org/doi/abs/10.1021/op034130e) This process started from petrochemical feedstocks and largely used chromatographic purification steps. According to FDA regulations, chromatographic media must be discarded after each use and basically cannot be efficiently recycled. The amount of resources that went into producing 60 grams of this drug is staggering - keep in mind that it is estimated that in the known universe only about 6 milligrams total of the material exists. Unless this was some sort of sick PR stunt, Novartis clearly thought that in the short term it could actually make enough for this drug to be profitable (it failed phase I trials on safety grounds, which gives you an idea of how bad an idea this was in the first place since to fail a safety trial on a cancer drug means your candidate really sucks). But the question of long-term sustainability of medical care is going to become very real in the not too distant future, whether or not this country and others gets the cost of our medical care down due to its structural problems.

Whether or not we like it, the issue of health care rationing is going to but up against the problem of limited global resources.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#116

Post by dnautics » Mon, Feb 28, 2011, 3:43 PM UTC

icey wrote: post #112

dnautics wrote: post #110

Earlier quoted context omitted.

"History has shown that's not the case; they end up in the emergency room with no insurance, and end up being a cost that hospitals have to recoup via higher rates for the people that have paid for their insurance." No. That is not "history". This is a recent phenomenon. This sort of thing was not generally occurring 30 years ago.

The 1990s are history: http://articles.baltimoresun.com/2001-01-31/business/0101310... 2002 is history: http://www.bizjournals.com/seattle/stories/2002/08/05/story3... 2003 is history: http://www.healthylivingnyc.com/article/58 2005 is history: http://www.msnbc.msn.com/id/7995137/ns/health-health_care/ 2006 is history: http://www.hhs.gov/news/press/2009pres/07/20090715b.html Affordability was quite different 30 years…

No, they went to emergency rooms, and got pro bono care. It wasn't even charged to someone else's account! Or they worked out simple payment plans directly with the hospital.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#117

Post by dnautics » Mon, Feb 28, 2011, 3:51 PM UTC

icey wrote: post #112

dnautics wrote: post #110

Earlier quoted context omitted.

"History has shown that's not the case; they end up in the emergency room with no insurance, and end up being a cost that hospitals have to recoup via higher rates for the people that have paid for their insurance." No. That is not "history". This is a recent phenomenon. This sort of thing was not generally occurring 30 years ago.

The 1990s are history: http://articles.baltimoresun.com/2001-01-31/business/0101310... 2002 is history: http://www.bizjournals.com/seattle/stories/2002/08/05/story3... 2003 is history: http://www.healthylivingnyc.com/article/58 2005 is history: http://www.msnbc.msn.com/id/7995137/ns/health-health_care/ 2006 is history: http://www.hhs.gov/news/press/2009pres/07/20090715b.html Affordability was quite different 30 years…

"the trend over the past decade has been that uninsured people go to the emergency room when they're very ill."

I really don't understand that. I was unemployed for a few months last fall when I went to go take care of a friend who was dying of cancer, and during this time I got a really terrible case of giardia from drinking poorly purified tap water (the US is rapidly becoming a third world country). I went to a local medical clinic and got to see a doctor the same day, for about a half hour and it cost me $35. Heck, I even offered to pay the actual cost of $55 but they insisted i pay the lower rate because I was unemployed (I think they get some extra kickback from the local government if they report unemployed people coming in). The wait was relatively short and I got a scrip for a drug that worked. The clinic really did a good job of taking care of low income individuals at very reasonable cost.

I'm really not certain why there is such a need to go to emergency rooms when there are great places like this. Are people just misinformed about their options, or are places like this few and far between? I don't know.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#118

Post by icey » Mon, Feb 28, 2011, 3:52 PM UTC

dnautics wrote: post #116

icey wrote: post #112

Earlier quoted context omitted.

The 1990s are history: http://articles.baltimoresun.com/2001-01-31/business/0101310... 2002 is history: http://www.bizjournals.com/seattle/stories/2002/08/05/story3... 2003 is history: http://www.healthylivingnyc.com/article/58 2005 is history: http://www.msnbc.msn.com/id/7995137/ns/health-health_care/ 2006 is history: http://www.hhs.gov/news/press/2009pres/07/20090715b.html Affordability was quite different 30 years…

No, they went to emergency rooms, and got pro bono care. It wasn't even charged to someone else's account! Or they worked out simple payment plans directly with the hospital.

Do you genuinely believe that pro bono care comes at no cost? That the doctors and nurses opt not to get paid for the time that they deal with people who don't have insurance? That the electricity company doesn't charge to keep the lights on when there are uninsured people being cared for? That the landlord says "eh, 20% of your patients didn't have insurance, how about a reduction in your rent this month"?

Simple payment plans don't really work out when an emergency visit to the hospital can easily cost more than $100,000.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#119

Post by [deleted] » Mon, Feb 28, 2011, 4:05 PM UTC

dnautics wrote: post #116

icey wrote: post #112

Earlier quoted context omitted.

The 1990s are history: http://articles.baltimoresun.com/2001-01-31/business/0101310... 2002 is history: http://www.bizjournals.com/seattle/stories/2002/08/05/story3... 2003 is history: http://www.healthylivingnyc.com/article/58 2005 is history: http://www.msnbc.msn.com/id/7995137/ns/health-health_care/ 2006 is history: http://www.hhs.gov/news/press/2009pres/07/20090715b.html Affordability was quite different 30 years…

No, they went to emergency rooms, and got pro bono care. It wasn't even charged to someone else's account! Or they worked out simple payment plans directly with the hospital.

[deleted]

Re: Is employer-based health insurance a barrier to entrepreneurship?

#120

Post by dnautics » Mon, Feb 28, 2011, 4:22 PM UTC

icey wrote: post #118

dnautics wrote: post #116

Earlier quoted context omitted.

No, they went to emergency rooms, and got pro bono care. It wasn't even charged to someone else's account! Or they worked out simple payment plans directly with the hospital.

Do you genuinely believe that pro bono care comes at no cost? That the doctors and nurses opt not to get paid for the time that they deal with people who don't have insurance? That the electricity company doesn't charge to keep the lights on when there are uninsured people being cared for? That the landlord says "eh, 20% of your patients didn't have insurance, how about a reduction in your rent this month"? Simple pa…

of course I don't believe that. The question is how best to handle that cost? Through voluntary action or through an inefficient behemoth of a bureaucracy. I'm going to get overtly political here, but I have to say: I cannot honestly believe that a country that fails to successfully take care of osama bin laden without slaughtering millions of innocents along the way, has any hope of managing something as delicate as individual healthcare needs for 300 million.