141–150 of 304 posts
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You’ve got the answer right there. It should be nationalized. And a major reason it will never be nationalized is because of lobbying by health insurance corporations.
Well that and people finding the idea repellant and voting against it.
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Realistically, the big cost differential in absolute terms in healthcare are borne in the elder group (65+). See this: https://pmc.ncbi.nlm.nih.gov/articles/PMC7411536/ . This is exactly where the "government social safety net" takes effect (medicare and medicaid) and, in my opinion, the real spending bazooka of US subsidies take effect. I say this as someone who wound up owning one business in this area (health insu…
Yes, we pay more per-capita for our public healthcare system than some countries do for universal coverage, but we don’t cover everyone. Just for the public parts. Once you actually tally up how many people are having their healthcare paid for by public dollars—local, state, and federal workers plus retired; the military, active and retired; Medicare (old people); Medicaid (poor and disabled); CHIP (poor kids); the f…
Yes, because the US is currently experiencing an adverse selection bias where healthy avoid enrolling until an issue occurs. See this: https://www.aeaweb.org/articles?id=10.1257/app.20170117
> Once you actually tally up how many people are having their healthcare paid for by public dollars—local, state, and federal workers plus retired; the military, active and retired; Medicare (old people); Medicaid (poor and disabled); CHIP (poor kids); the families of some of those categories; et c—it’s really not the case that moving to entirely public-funded would even be as big a leap as one might suppose. A whole lot of people already have government-funded healthcare.
Government funded but it's not a social safety net or mandate in a conventionally sense: it's an insurance subsidy. It effectively incentivizes depressing your own personal income to achieve high-subsidy plans (namely, the silver plan in most if not all states) resulting in abnormally high subsidies. It's just a form of tax planning today. See people taking "early retirement" with substantial assets (>1mm, which isn't much for HN but substantial in much of the country) at 40, reducing disbursements, and effectively costing the taxpayer ~36k/year in subsidies.
In an idea world, your assets would be subject to seizure under means testing on assets, not just income, before subsidies are provided. Seriously, go check out reddit /r/fire. They talk about it (and how a reduction in ACA subsidies in 2025 will force them out of retirement at the advanced age of 45).
> What we really lack, that every single other OECD state I’ve looked at has as a feature of their healthcare systems, is more-aggressive price controls, either set directly or via partial or complete monopsony. We’ve sniffed around at it, but never taken a full bite.
I'm going to be real: this is just wrong. Price controls only works in two circumstances:
* You are willing to tolerate reduced availability of goods and services * You are actively willing to prohibit others from purchasing goods and services with their own money
1 is complete anathema to the US consumer market. If price controls were to be implemented, the elderly would likely get care first, which is unlikely to yield practically the needed result relative to current costs curves -- keeping the working population working with preventative and minimizing the cost on the elder bracket. In my opinion, this mispricing is in part due to the ACA, but that's neither here nor there.
2 would require Norway style controls of Ozembic and similar. I don't think Americans would ever tolerate "your money, you aren't allowed to buy it". Prices are high because Americans can pay in dollars more than other nations and are willing to do so.
There is a very real perception that medicine can fix poor health choices and we should spend arbitrarily large amounts of money to fix it. It's a fantastic business to be in -- people insist "healthcare is a human right" and are willing to tax others to pay it.
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yeah, blood in the street and mass death and destruction. Everyone killing everyone.
No way. Humanity since the dawn of time has always had the potential to mob when things became dire. We still have it today, only it is more controlled via technology and rationality. This killing will not start anarchy. But it does have the capability to start a resistance against existing power structures, and that is what everyone is actually (consciously or unconsciously) worried about. We are only conditioned to…
Maybe I'm sensitive because I have been reading about the french revolution, and how mob rule lead to mass murder which left everyone worse off.
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> Murder should not be normalized or endorsed. Sure. That includes the US health care system too. The company that person was the key decision maker for has apparently been murdering people for years legally. So, karma?
No, I disagree. We have a system of laws and courts to decide what is criminal. People should not kill law abiding citizens they disagree with because everyone has a different opinion.
also people should most definitely NOT kill law abiding citizens! we do have laws for that
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So why are we putting jerseys on and taking the field against the insurers when virtually all of the actual money is going to providers? We could zero out all insurance costs, putting insurers into literal de jure indentured servitude, and get nothing more than a grocery store circular coupon discount on health costs, because insurers are not in fact where the costs are.
They are an integral part of the mess we're in, and they have a vested interest in the status quo. Otherwise, I agree with you.
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Want what? I dont think the majority of Americans endorse vigilante murder of law abiding citizens. That is just a vocal and bloodthirsty segment of the online population.
Literally everyone I know IRL was like, “nice. More please.” I was actually surprised and heartened to see the initial HN thread, even, was overwhelmingly supportive. This is top of my list for conversation topics to steer things toward when I’m around Republican relatives, so we’ll have something we can agree on. Law-abiding doesn’t mean much when you can kill lots of people for money and remain within the bounds of…
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Realistically, the big cost differential in absolute terms in healthcare are borne in the elder group (65+). See this: https://pmc.ncbi.nlm.nih.gov/articles/PMC7411536/ . This is exactly where the "government social safety net" takes effect (medicare and medicaid) and, in my opinion, the real spending bazooka of US subsidies take effect. I say this as someone who wound up owning one business in this area (health insu…
Look at the ratios though. US spending is about double in every age bracket. The really isn't anything special about the over 65 group.
Health "insurance" companies in the US are not actually, primarily insurers. For the most part, they are not in the business of insuring rare events. Maybe they were primarily in the insurance business at some point in the past, but today they are mainly in the business of entrenching themselves in the middle of all interactions between patients, doctors, and hospitals, and extracting rents from all of them. Health "…
A lot of private "health insurance" at large companies is just: - the company pays out-of-pocket for all employee health expenses - they don't want to directly deal with bills from doctors and hospitals, so they contract that out to a third-party administrator (TPA), which purely handles paperwork and has no financial role at all but this doesn't remove the tension between the employer wanting to pay less, and the pa…
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Well that and people finding the idea repellant and voting against it.
Yes, there is a lot of money behind that position.
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The "banality of evil" was originally used to describe the bureaucrats who enabled the mass-murder of Holocaust victims (Godwin's law strikes again!). Their actual goal , the primary outcome they were trying to maximize, was murdering Jewish people and other "undesirables". I don't think this guy was trying to do anything on that level. I don't think he sat down every day and said "how do we kill more people?" Rather…
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