Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income • Hacker News Board

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#711

Post by bhupy » Fri, May 22, 2020, 7:51 PM UTC

chii wrote: post #675

AnthonyMouse wrote: post #615

Earlier quoted context omitted.

> you've cleverly argued in a way to make hidden the major point i wanted to make - which is that insurance companies making a profit is a loss to the payer. I'm purely talking about the insurance system, and not the medical provider system (hospitals/doctors etc). But then you're not addressing the majority of the problem, because insurance company profits are only a single digit percentage of premiums. And even the…

> not using insurance for low cost routine care, which makes the patient price sensitive i would argue the patient cannot be price sensitive. The utility of staying alive is infinite - therefore, a patient will pay _any_ price for a procedure that saves them. I don't want to see a world where going to the GP for a cold is not free. But that's the world we live in today. The insurance efficiency, if any, is just a dro…

> i would argue the patient cannot be price sensitive. The utility of staying alive is infinite - therefore, a patient will pay _any_ price for a procedure that saves them.

The vast majority of healthcare is non-emergency care. It's either preventive health checkups, or planned treatments. The price elasticity of demand in healthcare is virtually identical to the price elasticity of demand in food. The utility of not starving to death is infinite — therefore a patient will pay _any_ price for food that nourishes them, right?

The huge flaw with that argument is that the value to the patient might be infinite, but the cost to provide it is not. In an open market, competition brings down the cost to the minimum possible value — unless you have barriers to entry or a cartel.

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#712

Post by bhupy » Fri, May 22, 2020, 7:56 PM UTC

chii wrote: post #595

AnthonyMouse wrote: post #572

Earlier quoted context omitted.

> Under the gov't version, if you were healthy, you're "free". You only cost when you actually need the medical treatment. Government insurance is still insurance. It isn't that each individual costs the government $10,000, it's that most cost them nothing and one in ten gets cancer and costs $100,000. Insurance is the same. The large majority of the money isn't going to the insurance company, it's going to healthcar…

you've cleverly argued in a way to make hidden the major point i wanted to make - which is that insurance companies making a profit is a loss to the payer. I'm purely talking about the insurance system, and not the medical provider system (hospitals/doctors etc). > The large majority of the money isn't going to the insurance company, it's going to healthcare providers. Any money going into insurance as profit is a lo…

> Any money going into insurance as profit is a loss to the payer - insurance doesn't _provide_ value. If the gov't is the one "doing the insurance" as you say, then any profit from that operation will count as a lowered cost of providing medical treatment.

The other users have already mentioned that insurance profit margins, on average, are about 5%. But you should also know that a lot of insurance carriers in the US are non-profit — including Blue Cross Blue Shield and Kaiser Permanente.

> The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end. Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.

That's true, in theory, but in practice Medicare fee schedules aren't that much better than private insurers. Additionally, providers themselves are starting to charge out-of-network rates that are LOWER than Medicare fee schedules. For example, Wal-Mart has launched healthcare in Georgia, charging $25 for a cleaning[1], which is significantly lower than the amount for a cleaning (procedure code D1110) set by Medicare/Medicaid. You can look it up yourself by visiting the FAIR Health code lookup tool (https://www.fairhealthconsumer.org/dental/results), and setting the ZIP code to that of Carlton, GA (location of the Wal-Mart clinic), 30627. The average allowed amount is $64.

Finally, the US government has historically been pretty bad at setting prices, as a monopsony buyer. The US military spends more per capita on the military largely because it pays more per-soldier, per-fighter jet, etc than any other nation on the planet. You would think that, as the sole buyer of US defense sector fighter jets, it could negotiate better rates. The F-35 is expected to cost $1.5 trillion (!!) over its lifetime, and the US enjoys monopoly/legislative powers over that cost.

Another example: NASA's planned SLS moon mission is a bit of a disaster — way over budget and way behind schedule. Because the boosters aren't reusable, each launch is expected to cost $1B (with a B) dollars — EACH launch! Meanwhile SpaceX's target cost-per-launch is $50M.

So while you're right that, in theory, a monopsony can extract the lowest possible price, there's absolutely no guarantee of this, indeed American empirical evidence has at times proven otherwise.

[1] https://www.bloomberg.com/news/articles/2020-02-25/walmart-t...

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#713

Post by AnthonyMouse » Fri, May 22, 2020, 7:56 PM UTC

rbg246 wrote: post #666

AnthonyMouse wrote: post #615

Earlier quoted context omitted.

> you've cleverly argued in a way to make hidden the major point i wanted to make - which is that insurance companies making a profit is a loss to the payer. I'm purely talking about the insurance system, and not the medical provider system (hospitals/doctors etc). But then you're not addressing the majority of the problem, because insurance company profits are only a single digit percentage of premiums. And even the…

But none of these things are happening in US, you have double the cost of healthcare for a lower life expectancy than countries of comparable living standards who have universal healthcare. What's going wrong with the system of perfect competition with insurance companies?

> What's going wrong with the system of perfect competition with insurance companies?

The biggest problem is the regulatory incentives for employer-provided insurance. This creates indirection (a corporation is choosing the insurance plan rather than the patient) and whatever is spent is tax exempt, which creates the incentive for employers to provide the most expensive low-deductible plans that are also the least efficient and involve the insurance bureaucracy in the smallest dollar value medical procedures.

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#714

Post by JoeSmithson » Fri, May 22, 2020, 8:02 PM UTC

klmadfejno wrote: post #708

JoeSmithson wrote: post #699

Earlier quoted context omitted.

> Ok, and if they raise wages, they'll need to raise prices. No, not necessarily. In fact if they were able raise prices, surely they would have done so already? What they would actually do is either go without a janitor, or go without something else - a coffee machine, or computer upgrades or something. The point is, unskilled labour is currently priced against desperation on the part of the worker. With a UBI it's…

> No, not necessarily. In fact if they were able raise prices, surely they would have done so already? What they would actually do is either go without a janitor, or go without something else - a coffee machine, or computer upgrades or something. I think you're underestimating the necessity of janitors, but for the sake of arguments, let's switch to another low paid shitty job that's definitely necessary. Say... slau…

Why wouldn't raising the minimum wage have the same effect?

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#715

Post by BasedCode » Fri, May 22, 2020, 8:22 PM UTC

bhupy wrote: post #710

BasedCode wrote: post #669

Earlier quoted context omitted.

I get the impression you're idealising the free market. The numbers[1][2] speak for themselves in proving that universal healthcare is the most affordable way to provide good healthcare. [1] https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h... [2] https://en.m.wikipedia.org/wiki/List_of_countries_by_life_ex... In the UK the NHS (2016) per capita cost was $4,192 (PPP) and in the US the per capita cost was $…

Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western Eu…

>"Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised."

A socialised healthcare system forces government and the healthcare service to write and maintain policies that consider the health of the nation. Where as a private insurance based service doesn't.

The US opoid crisis is a perfect example of this. Many of those addicts in the US moved on from prescription opoids that they had been prescribed unnecessarily to streets heroin because there was little concern of the wider public health implications. In the UK getting a prescription for addictive strength opoid pain killers has long been near impossible because the healthcare system has to be careful not to create another problem in trying to fix the first one because it's their responsibility to fix it which also means Doctors are not motivated to meet the patients wants (e.g pain free) and only fulfil their healthcare needs. This is why the UK didn't go through the same crisis

So I say that life expectancy is a good measure of healthcare systems because it forces policy makers at all levels to consider the wider impact of public policy on public health.

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#716

Post by WalterBright » Fri, May 22, 2020, 8:28 PM UTC

charlesu wrote: post #674

WalterBright wrote: post #645

Earlier quoted context omitted.

> compensation for labor has an inverse relationship with actual value. Value is what people are willing to freely pay for it. Any other definition of it is subjective and fairly useless.

You’re talking about price. Price is not value.

The value of something is price where the supply & demand curves cost.

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#717

Post by WalterBright » Fri, May 22, 2020, 8:29 PM UTC

Frondo wrote: post #687

WalterBright wrote: post #660

Earlier quoted context omitted.

I'm not aware of any social problem that has been adequately resolved by any organization, government or private. There's always someone who thinks it's not good enough. Certainly UBI isn't going to do it, either.

There are 12 US cities that have achieved "functional zero" homelessness -- no chronic homelessness and no homeless vets. The country of Finland has done the same, with a plan to reach absolute zero (nobody staying temporarily with friends or relatives) by 2022. Right now, over there, with 5.5 million people, 500 people don't have permanent housing of their own. Does that count?

> 500 people don't have permanent housing of their own.

I.e. it's inadequate.

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#718

Post by bhupy » Fri, May 22, 2020, 8:43 PM UTC

BasedCode wrote: post #715

bhupy wrote: post #710

Earlier quoted context omitted.

Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western Eu…

>"Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western…

Again, it's debatable, but as I continued in my comment, even when charitably accepting your premise, your argument loses its strength.

A fully socialized healthcare system is one of many implementations of universal healthcare in the developed world today, and you'll have to find an answer for why the most efficient system in the world is the one that just happens to rely the most on consumer-driven market mechanisms.

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#719

Post by BasedCode » Fri, May 22, 2020, 8:51 PM UTC

AnthonyMouse wrote: post #709

BasedCode wrote: post #669

Earlier quoted context omitted.

I get the impression you're idealising the free market. The numbers[1][2] speak for themselves in proving that universal healthcare is the most affordable way to provide good healthcare. [1] https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h... [2] https://en.m.wikipedia.org/wiki/List_of_countries_by_life_ex... In the UK the NHS (2016) per capita cost was $4,192 (PPP) and in the US the per capita cost was $…

This is the same old tired argument again and again. "European countries have lower costs, therefore socialism is better than capitalism." There are two problems with it. First, the US system is completely broken. It isn't a free market system, it's a worst of both worlds compromised hellscape. It's like comparing the USSR to Colombian druglords as evidence that communism is a great system. The USSR isn't great, Colo…

Ultimately the problem with a private healthcare system is there is no incentive to provide appropriate affordable healthcare and every incentive to divide, marginalize, and monopolize markets in the aim of driving down competition and driving up profits.

Now that the US healthcare industry has grown so rich and powerful it can lobby and win against any serious political efforts to either increase market competition or socialise healthcare. I.don't. Know how you could politically fix a system that is essentially "every man for himself" the incentive for corruption is far too high when payouts equal political power.

I doubt the US is subsidizing medical research as much as you'd think. The Pharmaceutical industry for example is very profitable compared to other industries. A socialised healthcare service would enable more competitive prices eating into industry profits for these products due to market scale like we see in the UK due to the buying power of the NHS.

"Among the largest 25 companies, annual average profit margin fluctuated between 15 and 20 percent. For comparison, the annual average profit margin across non-drug companies among the largest 500 globally fluctuated between 4 and 9 percent."

https://www.gao.gov/mobile/products/gao-18-40

Re: Jack Dorsey is giving Andrew Yang $5M to build the case for a basic income

#720

Post by Apofis » Fri, May 22, 2020, 9:01 PM UTC

nogabebop23 wrote: post #256

>> Yang says Humanity Forward plans to immediately distribute Dorsey’s contribution in the form of small cash grants of $250 to nearly 20,000 people who’ve lost their jobs or taken an economic hit as a result of the COVID-19 pandemic So money based on certain non-universal conditions? Isn't this one of the root problems? People cannot accept a truly universal system - you've already got too much; that guy lives in th…

That's going to do absolutely nothing. Small UBI is damn near worthless. You need to go toward at least minimum wage's worth per year to see any decent effects.

Whoever figures out how to do full UBI on that level will be heralded as a messiah if they can actually put their plan in place and execute it.