The profit-obsessed monster destroying American emergency rooms • Hacker News Board

Re: The profit-obsessed monster destroying American emergency rooms

#101

Post by skybrian » Sat, Oct 05, 2024, 5:15 PM UTC

swatcoder wrote: post #86

ryandrake wrote: post #74

Earlier quoted context omitted.

> traditional home/self care Not sure what you mean by this? If I have a broken bone, I'm not going to set it myself at home and take a few aspirin. Same if I'm puking my guts out. If you just mean getting exercise and eating healthy then I fully agree with you. But, when you're actually sick, and need to see a professional, that is the right time for "consumerized services".

You're welcome to take it as foolish pre-modern ignorance if it strikes you that way, but actually yes: many people do not think to go to a doctor for minor bone injuries or vomiting, and many more than that wouldn't think to do so for more common everyday illnesses like a familiar sore throat, rash, nosebleed, fever, etc For some, this is rooted in a confidence in their own personal-community care, for others its an…

I haven’t heard of some of this and it raises a whole lot of questions. Can you tell us more? What is a “minor bone injury?” What sort of alternative healthcare do they use instead to treat it?

Maybe give us an example of some people who do this?

Re: The profit-obsessed monster destroying American emergency rooms

#102

Post by eadmund » Sat, Oct 05, 2024, 5:17 PM UTC

ninalanyon wrote: post #96

JamesBarney wrote: post #84

Earlier quoted context omitted.

> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. I don't think this is true. Some countries with public healthcare are far more efficient than our system. But there are countries that have systems similar to ours that are far more efficient as well. We just have a really shitty system, and who pays f…

> But there are countries that have systems similar to ours Really? Which ones are they?

Switzerland has a private insurance model IIRC. Israel and the Netherlands, too, according to Wikipedia.

Re: The profit-obsessed monster destroying American emergency rooms

#103

Post by eadmund » Sat, Oct 05, 2024, 5:19 PM UTC

philwelch wrote: post #57

ghaff wrote: post #35

Earlier quoted context omitted.

When I was covered by an employer plan, a lot of people seemed to gravitate towards high deductible plans because they were cheaper so long as you didn't consume a lot of healthcare. (Personally, I never did but a lot of people were adamant that you saved money that way.)

I’ve long been a proponent of high deductible plans. The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account, which is money that you get to keep (and even invest) over the long term. You can spend that HSA money on medical expenses but if you save it, it turns into another tax-advantaged savings account like your IRA and 401(k).

HSAs can be wonderful, but you absolutely have to have a good one. Some of them still pay less than 1% interest and charge monthly fees. The ones which can be invested and have no fees are an amazing savings tool.

Re: The profit-obsessed monster destroying American emergency rooms

#104

Post by Retric » Sat, Oct 05, 2024, 5:20 PM UTC

JamesBarney wrote: post #97

ninalanyon wrote: post #96

Earlier quoted context omitted.

> But there are countries that have systems similar to ours Really? Which ones are they?

Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.

Netherlands has a mostly public system with heavily subsidized mandatory non-profit insurance under government oversight: Health insurers receive compensation for high risk individuals from the government,[5] and government subsidies pay about 75% of insurance costs. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Israel also has a public healthcare system in practice. Mandatory participation in 1 of 4 non profit insurance programs looks like private insurance but … https://en.wikipedia.org/wiki/Healthcare_in_Israel For the health tax, wage-earners and the self-employed must pay 3.1% of their monthly salary up to 60% of the average prevailing market wage (appx. NIS 6,300 in 2020), and 5% of anything earned above it.[25] Employers are legally obligated to deduct insurance contributions from their employees' salaries, while the self-employed must arrange payment on their own. Pensioners have contributions deducted from their pensions, as do those receiving unemployment benefits. Those who are not working but have income must pay 5% of their income in health tax, while those who are not working and have no income must pay NIS 104 a month.

Switzerland has a similar system with mandatory participation and non profit insurance programs. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

Re: The profit-obsessed monster destroying American emergency rooms

#105

Post by hintymad » Sat, Oct 05, 2024, 5:29 PM UTC

A key question is why the free market does not work in this case. Many business are "profit obsessed", yet it does not mean they won't provide quality products or services at increasingly lower prices. What's different in the health care?

Re: The profit-obsessed monster destroying American emergency rooms

#106

Post by bloopernova » Sat, Oct 05, 2024, 5:30 PM UTC

api wrote: post #9

29athrowaway wrote: post #2

MBAs will turn everyone into The Joker.

MBAs and similar types are the Western capitalist equivalent of the Soviet apparatchik: https://en.wikipedia.org/wiki/Apparatchik Entities like PE or conglomerates are a lot like Soviet bureaus: giant bastions of bureaucrats appointed to run things they have no direct expertise in running. The underlying issue here is what I call the "big dumb money problem." You get entities with more resources to deploy than intell…

I wonder what would happen if private equity firms all threw their money into planting trees?

Re: The profit-obsessed monster destroying American emergency rooms

#107

Post by pessimizer » Sat, Oct 05, 2024, 5:31 PM UTC

jerrycabbage wrote: post #87

alan-hn wrote: post #24

Earlier quoted context omitted.

Money and greed naturally get in the way. Is that not obvious? People are finding any way to game the system just to get more money You're thinking of using money as a measure but everyone else is using it as a target...

The answer is a wealth tax. The inequality grows leading into a need for investments like these. If all other assets weren't so inflated then we could at least wish PE wouldn't need to do things like this but this is what will happen. Excess capital keeps buying up assets lower classes need due to lack of options otherwise.

I'm still an advocate of the old-school top income tax bracket of 85-100% i.e. a maximum income. A general wealth tax always seems like double-dipping; today I take $1 out of your $10, and a year from now I take 90¢ from your remaining $9. It's more of a motivation for one to continue accumulating (a floor, even) just to tread water.

Property taxes are different, because more services get provided to people with more property. Income taxes are fine because we take it as a given that the state has the ability to regulate every aspect of domestic financial transactions and financial lives, at least in our currency (even if we don't or shouldn't, we of course can.)

A yearly individual income cap means at the least people would have to put money in more hands. Being corrupt on a large scale would hopefully require a larger conspiracy.

I'm fine with arbitrary wealth taxes and taxes on capital, with arbitrary justifications, so I'm probably not saying much here; but I'm not in support of a revolving wealth tax.

Re: The profit-obsessed monster destroying American emergency rooms

#108

Post by alistairSH » Sat, Oct 05, 2024, 5:31 PM UTC

tbrownaw wrote: post #63

titanomachy wrote: post #25

Earlier quoted context omitted.

$300 is your part of a regular doctor visit? Or the total bill? Do you have one of those high-deductible plans designed to discourage people from seeking any healthcare?

> high-deductible plans designed to discourage people from seeking any healthcare This is in fact not the purpose of those plans. They try to actually be insurance (ie, in case of unexpected high expenses) rather than a combination of insurance plus pre-payment of typical expenses.

But do they actually have that result? Or do they simply put people off of all early care

Re: The profit-obsessed monster destroying American emergency rooms

#109

Post by swatcoder » Sat, Oct 05, 2024, 5:42 PM UTC

skybrian wrote: post #101

swatcoder wrote: post #86

Earlier quoted context omitted.

You're welcome to take it as foolish pre-modern ignorance if it strikes you that way, but actually yes: many people do not think to go to a doctor for minor bone injuries or vomiting, and many more than that wouldn't think to do so for more common everyday illnesses like a familiar sore throat, rash, nosebleed, fever, etc For some, this is rooted in a confidence in their own personal-community care, for others its an…

I haven’t heard of some of this and it raises a whole lot of questions. Can you tell us more? What is a “minor bone injury?” What sort of alternative healthcare do they use instead to treat it? Maybe give us an example of some people who do this?

Well, to make an example that doesn't stretch into ethnic traditions and stays within the contemporary and modern experience that you and I probably share:

Consider two non-professional runners who develop a stress fracture. It's a fairly common injury for distance runners who push themselves too far. It presents as a certain kind of pain and that pain becomes aggravated under certain conditions. It's generally easy to self-diagnosis, and more serious fractures are generally evident because they're far more disabling and intensely painful.

One goes to a doctor, who quickly has a strong guess as to the problem. Nonetheless, they send the runner for an x-ray to confirm, then take another appointment to review the results and prescribe a treatment. That treatment will amount to rest and patience, and (with some doctors) some prescription for the pain. Total cost billed to someone is probably on the order of $1000.

The other is pretty confident in their self-diagnosis and can't fathom the time demands, financial cost, and social resource consumption of bringing in a industrial apparatus just to confirm that diagnosis and be told to take it easy on their affected leg for a few months.

Both examples play out everyday, and there's essentially no difference in health outcome for the vastly most common case. It's true that the latter is at higher risk of missing a more serious complication, but it's also true that the former invites costs, consequences, and risks of their own.

Re: The profit-obsessed monster destroying American emergency rooms

#110

Post by giardini » Sat, Oct 05, 2024, 5:56 PM UTC

29athrowaway wrote: post #2

MBAs will turn everyone into The Joker.

Indeed MBAs helped sell American USA) industrial production out to first Mexico and later to China. Sometimes a little knowledge can be a dangerous thing.

In Ricardo's simple economic model of "comparative advantage" an entire generation of CEOs and MBAs found justification to sell out corporate capital (everything except the labor, which was laid off) for billions.

A deeper understanding of the economy (not of economic theory necessarily, but of our economy) might have suggested that such a rapid and total sell-off might be very destructive to society.

But greed prevailed and now a generation passed before the full scope of the oversight was realized by most. Society took that long to realize a course correction was required.

Capitalism is be a formidable mechanism for good but pure unfettered capitalism usually has bad "side" effects. That's why we regulate businesses. Sometimes it works.