Greg Knauss's 10-year-old son's $23,800 bug bite • Hacker News Board

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#191

Post by brazzy » Sun, Sep 02, 2012, 3:32 PM UTC

lutusp wrote: post #182

brazzy wrote: post #181

Earlier quoted context omitted.

"I personally, won't support anything that makes me pay for your health insurance." Um, that's kinda the point of any kind of insurance.

> "I personally, won't support anything that makes me pay for your health insurance." > Um, that's kinda the point of any kind of insurance. No, the point of insurance is not to buy into or share the risk of others, but to amortize one's own risk over time. An insurance policy can have a single applicant and still function as it should -- the issuer is betting that the applicant won't suffer a loss, the applicant is…

No, the point of insurance is not to buy into or share the risk of others

Yes, that is exactly the point of insurance. Everything you wrote is wrong, sorry.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#192

Post by tptacek » Sun, Sep 02, 2012, 3:33 PM UTC

dwwoelfel wrote: post #119

tptacek wrote: post #111

Earlier quoted context omitted.

Oh, so you mean, "only if you don't live and work in one of a prohibitively small number of major metro areas in the US". For all intents and purposes, auto insurance is effectively mandatory for most Americans. It's for a similar reason that many states revoke driving privileges for parents who don't comply with child support.

You have to own a car, though. The state makes you buy car insurance because you can do a lot of damage to other people and their property with a car. They own the roads, so they're responsible for making sure you can pay for that damage. Texas, for instance, doesn't actually make you buy insurance. You only have to prove that you can be financially responsible for the damage you could cause [1]. Why is this relevant…

The laws making the rest of us responsible for the uninsured aren't really optional, so it's probably better to just reason about this problem as if the uninsured were just intrinsically a financial risk to us.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#193

Post by tptacek » Sun, Sep 02, 2012, 3:43 PM UTC

tzs wrote: post #184

tptacek wrote: post #85

Earlier quoted context omitted.

Worth noting that the US leads Europe in outcomes for serious illnesses (particularly cancer), and the US provides access to specialists in days where other countries often have multi-week or even multi-month delays.

Careful--the US does more early cancer screening than is typically done in Europe. This boosts the US score on 5 year survival rates, but it doesn't necessarily mean we actually get better outcomes. E.g., if an American and a European each get a cancer that will eventually kill them in 7 years, and the American finds out in 1 year and the European doesn't find out for 3 years, then the American will show up in the 5…

By what measure do European countries have better health outcomes than the US? We're seeing in this thread why the most obvious metrics don't work well:

* Cancer survival rates, because of the 5 year survival heuristic, capture people who's illness is detected early but isn't actually cured.

* Life expectancy captures the fact that people drive more and faster in the US, that the US has more violent crime, and that more people in the US kill themselves

Intuitively, "high cost" plus "shortest wait time to specialist" plus "problematic overprescription" (a problem common to all first-world health systems) plus "earliest cancer detection" just doesn't add up to "worse outcomes than Europe".

But, it does make sense that despite the money we pay, our outcomes are not different enough to justify the expense.

I strongly agree: the way we finance health care in the US, primarily through a system of employer-provided health insurance policies that give way to a single-payer socialized system that kicks in right when patients are most engaged with the health care system, all without giving patients control or a stake in the cost of their care --- this system makes no sense.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#194

Post by tptacek » Sun, Sep 02, 2012, 3:46 PM UTC

Nitramp wrote: post #179

tptacek wrote: post #85

Earlier quoted context omitted.

Worth noting that the US leads Europe in outcomes for serious illnesses (particularly cancer), and the US provides access to specialists in days where other countries often have multi-week or even multi-month delays.

> the US provides access to specialists in days where other countries often have multi-week [...] This is a view that's strongly distorted by the UK. It's seems to hold there, and the wait times sound terrible, but it's definitely not the case in the majority of countries, by a long shot. As far as I can tell from personal experience, wait times are not an issue in The Netherlands, Sweden, Germany, or France; outside…

For procedures that aren't time sensitive, like eye surgery, wait times in France are upwards of 2 months.

I don't know what Germany's wait times are, but Germany isn't a pure single-payer system like France, the UK, and Canada; it's guaranteed-issue mandatory-coverage.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#195

Post by brazzy » Sun, Sep 02, 2012, 3:50 PM UTC

tylee78 wrote: post #128

TheAmazingIdiot wrote: post #17

Earlier quoted context omitted.

Insurance companies make more money if they refuse payment. I've always liked the old Chinese medicine system. You find a doctor who is willing to take you as a client. You pay the doctor money per month when you are well. If you are sick, you do not pay. Of course, refusing treatment is acceptable to get you disqualified, as are a few other things.

nice system! sounds like it has a market principle built into it...

Except it breaks down completely when there are expensive drugs and procedures.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#196

Post by brazzy » Sun, Sep 02, 2012, 4:08 PM UTC

javert wrote: post #156

tptacek wrote: post #87

Earlier quoted context omitted.

Exactly what part of an emergency room visit is going to change in 2014, when PPACA is fully implemented? Please be as specific as you can, while limiting the detail you provide to the "amount of time taken to see someone at an emergency room" example you've used in this comment.

I expect the continued growth of socialized medicine to continue the trend of less and less competence among medical professionals, and less and less medical professionals period (particularly doctors--which seem to be in acute shortage already). So, nothing will change overnight, but this certainly isn't going to allow things to get _better_, which would eventually happen in a more free-market medical system. Americ…

"Medicine could, and should, be a lot like going to the vet."

Yeah, and patients whose cures are more expensive than they can afford should be put down painlessly, eh?

There are some aspects of health care where free market mechanisms can improve efficiency, but efficiency is not by itself the ultimate goal a health care system should have.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#197

Post by brazzy » Sun, Sep 02, 2012, 4:12 PM UTC

retillit wrote: post #11

joni123 wrote: post #7

Silly americans... in my country, it's obligatory to have health insurance and if you cannot afford it, the government will pay your insurance, for god's sake. Not even the most conservative and right-wing politicans who see our freedom in danger when we can't keep fully automatic assault rifles at home anymorehere question this system, because it just makes sense.

Can someone please explain to me the purpose of an insurance company when participation in the pool is mandatory? A policy like this seems like it creates a legislated middle-man that just wastes money.

Mandatory participation (of insurance clients) is the necessary other side of mandatory acceptance (of clients by insurance companies).

For health insurance to work as insurance you need the young and healthy to participate and pay more than they'll ever get out of the system, otherwise it's impossible to cover the costs for the old and chronically ill.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#198

Post by lutusp » Sun, Sep 02, 2012, 5:01 PM UTC

Confusion wrote: post #190

lutusp wrote: post #182

Earlier quoted context omitted.

> "I personally, won't support anything that makes me pay for your health insurance." > Um, that's kinda the point of any kind of insurance. No, the point of insurance is not to buy into or share the risk of others, but to amortize one's own risk over time. An insurance policy can have a single applicant and still function as it should -- the issuer is betting that the applicant won't suffer a loss, the applicant is…

the issuer is betting that the applicant won't suffer a loss, the applicant is betting that he will. An actuary sets the rate based on his best guess about the possibility of a claim. Emphatically: no! The issuer is betting that in the entire group of clients the total loss will be smaller than the rates they set. Almost nobody can ever financially deal with the greatest risk health insurance insures against. Health…

> When you need the insurance, it's the money of the other clients, that with hindsight never needed the insurance, that pays for your costs.

This is the normal approach, but it's a coincidence -- the insurance system doesn't collapse if it's not the model. Insurance can equally be a case of one policy, one client, all depending on what's being insured -- see below.

> Emphatically: no! The issuer is betting that in the entire group of clients the total loss will be smaller than the rates they set.

My point is that system works with one client the same way as with 10,000. It's a matter of accurately assessing the risk of a claim. Insurance doesn't suddenly stop working because there are few clients or only one client.

Multiple clients is the usual case, but it's not required for the system to work. Large insurance houses will very happily write a policy that only applies to one person:

http://voices.yahoo.com/bizarre-insurance-policies-famous-ce...

A quote: "America Ferrera is the newest addition to the list of stars who have some of their body parts insured. Famous for her role as Betty Suarez in the top-rating ABC sitcom "Ugly Betty", Ferrera has had her smile insured for 10 million dollars by Lloyds of London."

One person, one smile, one client, one policy.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#199

Post by lutusp » Sun, Sep 02, 2012, 5:06 PM UTC

brazzy wrote: post #191

lutusp wrote: post #182

Earlier quoted context omitted.

> "I personally, won't support anything that makes me pay for your health insurance." > Um, that's kinda the point of any kind of insurance. No, the point of insurance is not to buy into or share the risk of others, but to amortize one's own risk over time. An insurance policy can have a single applicant and still function as it should -- the issuer is betting that the applicant won't suffer a loss, the applicant is…

No, the point of insurance is not to buy into or share the risk of others Yes, that is exactly the point of insurance. Everything you wrote is wrong, sorry.

The model where there are many clients and one policy is the norm, but that doesn't mean the system requires it. If insurers went to the trouble of making it work, you could have individual policies written up for each and every client, and sell the risk to subscribers (as is done with mortgages). Example:

http://voices.yahoo.com/bizarre-insurance-policies-famous-ce...

A quote: "America Ferrera is the newest addition to the list of stars who have some of their body parts insured. Famous for her role as Betty Suarez in the top-rating ABC sitcom "Ugly Betty", Ferrera has had her smile insured for 10 million dollars by Lloyds of London."

One person, one smile, one client, one policy.

> Everything you wrote is wrong, sorry.

It's generally thought good form to offer some evidence for your position, as I have for mine.

Re: Greg Knauss's 10-year-old son's $23,800 bug bite

#200

Post by yummyfajitas » Sun, Sep 02, 2012, 5:46 PM UTC

ysopex wrote: post #122

russell wrote: post #114

Earlier quoted context omitted.

Anesthesiologists are the worst offenders. My experience is that none of them are in network. You think you have everything covered and along comes this bill that is as big as everything else. Woe to you if you are uninsured. I had minor heart surgery nearly two decades ago. The bill was something over $80K. The insurance company disallowed most of it, bringing it down to $20K of which I had to pay $2K. Except for th…

Why is it that you can't go to a medical facility and tell the intake nurse or admin person you're not agreeing to any procedure that's not covered by your insurance. Wouldn't that put the onus back on them? Anything not covered instantly becomes a freebie or a lawsuit? Why do hospitals and clinic get away with this crap when auto mechanics and plumbers can't?

You can. I've done exactly this.

Some shady anesthetologists (and others) often try to bill you out of network. In-network charges are subject to insurance company price controls while out of network charges are not.

Once you make it clear you are paying in-network, as you kindly explained to the receptionist (who told you it was all covered), they back down real quick. It's just a scam they try to pull on the uninformed.