Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The profit-obsessed monster destroying American emergency rooms

vox.com

Post reply on HN
Print view View original

131–140 of 163 posts

Re: The profit-obsessed monster destroying American emergency rooms

#131

Post by Cthulhu_ »

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.

NL may be better than what's in the US but it's quickly deteriorating after the 2006 reforms. We've got dozens of competing health insurance companies big and small, but their base coverage package is the same because that's legally required. So the main thing they differentiate is with nonsense; minor differences between competitors, but mainly marketing, bullshit apps, etc. That is, a nontrivial portion of health insurance payments is spent on marketing.

Then there's the other big problem. Base insurance, which btw goes up to €150 / month next year (per adult), only covers cheap generics whose purchase prices are negotiated by the government (or something like that). The consequence now is that the manufacturers are not willing to pay the import fees for their generics, because the profit margins are too slim. Thousands of types of medications are now no longer available, difficult to get, or will only be available again in X months. This is stuff like basic painkillers, adhd, diabetes, etc.

The system is failing, is all I'm saying.

Re: The profit-obsessed monster destroying American emergency rooms

#132

Post by sowbug »

ALittleLight wrote: post #49
morkalork wrote: post #5

Earlier quoted context omitted.

Vote for politicians who support a single payer health care system

Does a single payer healthcare system change this? Presumably that would change who pays the healthcare provider - not who owns the healthcare provider, right?

It's a collective-action problem. Nobody likes the current healthcare system, but what can we do? Ask the ambulance to shop around while we're bleeding out in the back?

But as the single payer, the government would have the incentive and power to address the problem systematically and deliberately.

Re: The profit-obsessed monster destroying American emergency rooms

#133

Post by PaulDavisThe1st »

alistairSH wrote: post #108
tbrownaw wrote: post #63

Earlier quoted context omitted.

> 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

as they say on the internet .. por que no los dos?

1. they do (post-ACA) function as effective bankruptcy insurance

2. they likely deter the people enrolled to avoid early/minor/preventive medical visits.

Re: The profit-obsessed monster destroying American emergency rooms

#134

Post by PaulDavisThe1st »

phil21 wrote: post #85
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 are great. They are designed to allow you to take pretax money out and use it to either invest like an IRA or spend it on healthcare. In other words they are actually insurance. Not a prepaid healthcare plan. No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu. They are a small fight against the massive principal agent problem which is th…

> No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu.

The inhabitants of just about developed industrial/post-industrial society other than the USA seek to differ.

Re: The profit-obsessed monster destroying American emergency rooms

#135

Post by PaulDavisThe1st »

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).

> The part you’re missing is that you also get the opportunity to contribute pre-tax money to a Health Savings Account

Post-ACA, high-deductible and HSA-compatible are not the same thing anymore. In my state, for example, there are no longer any HSA-compatible insurance plans but there are several high deductible ones.

Re: The profit-obsessed monster destroying American emergency rooms

#136

Post by Gibbon1 »

jaco6 wrote: post #68

The problem with American healthcare is the attempt to compromise between healthcare as a universally available public utility and healthcare as a commodity on the private market. (Arguably this is a legacy of pre-modern healthcare, where hospitals were operated by charities run by nuns and funded by aristocrats and royal families, hence all the “Saint” names in hospitals nowadays). There’s a variety of weird example…

There is the idea of elite over production. We have private health insurance in order to create a couple thousand upper class jobs. With a half dozen billionaires running things.

Re: The profit-obsessed monster destroying American emergency rooms

#137

Post by Cthulhu_ »

404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

These pain points are present in the UK as well; a ton of people have to go to A&E and wait for hours there because their primary caregiver / GP is booked full. 1-2 days wait up to a week for non-urgent care sounds fine to me, but at $300 it's a bit ridiculous.

People end up getting worse and cost the system more, so the cycle continues.

Re: The profit-obsessed monster destroying American emergency rooms

#138

Post by JamesBarney »

Retric wrote: post #104
JamesBarney wrote: post #97

Earlier quoted context omitted.

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 no…

Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

Re: The profit-obsessed monster destroying American emergency rooms

#139

Post by Retric »

JamesBarney wrote: post #138
Retric wrote: post #104

Earlier quoted context omitted.

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 no…

Yes health care is very different in every country in the world. There are a 1000 ways to do it well but the US is unique in having insane healthcare costs. Having non profit insurance companies isn't the difference, having mandatory health insurance isn't the difference. It's not that easy to fix.

Each of things individually is lowering healthcare costs. Medical billing is a significant multiplier for US healthcare costs, and going to a highly regulated nonprofit only system would help.

There’s other factors like our obesity rate, but we’re basically intentionally shooting ourselves in the foot when it comes to healthcare costs because cost savings is lost profits for someone else.

Re: The profit-obsessed monster destroying American emergency rooms

#140

Post by ghaff »

PaulDavisThe1st wrote: post #134
phil21 wrote: post #85

Earlier quoted context omitted.

High deductible plans are great. They are designed to allow you to take pretax money out and use it to either invest like an IRA or spend it on healthcare. In other words they are actually insurance. Not a prepaid healthcare plan. No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu. They are a small fight against the massive principal agent problem which is th…

> No one should be using “insurance” to cover every day expected expenses like random doctor visits for the flu. The inhabitants of just about developed industrial/post-industrial society other than the USA seek to differ.

That's largely how, e.g. dental works. You (outside of certain company insurance) pay for dental on your own which is also sanely priced.
Post reply on HN