The American Healthcare Conundrum • Hacker News Board

Re: The American Healthcare Conundrum

#231

Post by lotsofpulp » Tue, Mar 17, 2026, 3:42 AM UTC

nradov wrote: post #197

lotsofpulp wrote: post #160

Earlier quoted context omitted.

> Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with zero denials. It would be less work for them. But naturally employers don't want to pay for that, so the HR departments have the insurance carriers impose more restrictive coverage rules to hold down medical expenses. This is not my experience as a buyer of health plans on healthcare.gov, or as a buyer of health plans a…

Your experience is irrelevant. Insurance carriers have some standard default policies but they'll write whatever custom policy that a group buyer is willing to pay for.

Your claim was

> Commercial insurers would be happy to sell plans that pay every claim that comes in at 100% with zero denials.

And yet I have never seen one of these after buying insurance in 3 different states.

Again, the grandparent claim was that insurance companies can increase profits simply by increasing their expenses. Yet there is no evidence of this, and the fact that everyone has to deal with approval and denial of healthcare coverage means it cannot be true.

Re: The American Healthcare Conundrum

#232

Post by conductr » Tue, Mar 17, 2026, 3:42 AM UTC

Dylan16807 wrote: post #166

nradov wrote: post #120

Earlier quoted context omitted.

Japan also has the "Metabo Law" (aka fat tax). Do you think Americans would go for that?

"Obesity costs the US healthcare system almost $173 billion a year." So that's about 6% of the difference? I'm not immediately saying no, but it sounds like that's not the real problem.

Social reasons it would never work. I hate to mention anything race related online but simple truth is America has complicated history and African Americans are 30% more likely to be obese than White Americans and also earn approximately 60% of income that whites earn. A fat tax, especially one that properly allocated the cost burden to the individual, would erode race relations.

Re: The American Healthcare Conundrum

#233

Post by edgarvaldes » Tue, Mar 17, 2026, 3:43 AM UTC

As a non-American, I find it interesting that so many comments in the thread insist that "No, American healthcare is not that expensive compared to that of other countries; no, the costs of the American healthcare system are not high due to greed and capitalism; and no, the American healthcare system cannot be cheaper or better, it is not perfect, but it works as it is."

Re: The American Healthcare Conundrum

#234

Post by IdiocyInAction » Tue, Mar 17, 2026, 3:44 AM UTC

soared wrote: post #141

WarmWash wrote: post #132

Firey take, but health insurers are not the problem they are made out to be. They're on your team and benefit from lower prices just as much as you do. They don't make any money either, don't argue with me, buy their stocks if you are so convinced and see how that goes over. Health care providers carry immense blame. It's full of passionless people in it for the outsized paychecks, who once inside will just seek what…

[flagged]

Nurses in the US are actually very highly paid. Ask anyone how their week was. They'll all say it was crap.

Re: The American Healthcare Conundrum

#235

Post by raw_anon_1111 » Tue, Mar 17, 2026, 3:44 AM UTC

nradov wrote: post #224

raw_anon_1111 wrote: post #177

Earlier quoted context omitted.

Costa Rica purposefully got rid of its military so it could provide services. It didn’t feel a need to fund three unnecessary wars in two years. Guess which other country has universal healthcare - China. They are just slightly more populous than the US. > This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and l…

Please stop spreading lies and propaganda. China does not have "universal healthcare" in any meaningful sense. They may claim to have it, but it's not something that poor people can actually access for expensive treatments. Patients have to pay out of pocket for most services.

So let’s talk about Canada, Great Britain, every country in the EU…

Re: The American Healthcare Conundrum

#236

Post by [deleted] » Tue, Mar 17, 2026, 3:48 AM UTC

niij wrote: post #206

WarmWash wrote: post #132

Firey take, but health insurers are not the problem they are made out to be. They're on your team and benefit from lower prices just as much as you do. They don't make any money either, don't argue with me, buy their stocks if you are so convinced and see how that goes over. Health care providers carry immense blame. It's full of passionless people in it for the outsized paychecks, who once inside will just seek what…

Insurers are only allowed to keep a % as profits. Higher spending increases the absolute amount of profit that can be retained.

[deleted]

Re: The American Healthcare Conundrum

#237

Post by gamblor956 » Tue, Mar 17, 2026, 3:49 AM UTC

Retric wrote: post #78

CWuestefeld wrote: post #58

Earlier quoted context omitted.

This isn't even close to true. Keep in mind that Medicare, together with Medicaid (which operates under much of the same administrative rules), account for nearly half of medical spending. So basically, if a provider doesn't want to play by their rules, they MUST deal with Medicare. That is, the government is nearly a monopsony in this industry. There's a common, misleading, claim that Medicare is more efficient beca…

> nearly half of medical spending > something like 2 FTEs focusing just on the reimbursements from Medicare and Medicaid 2FTE’s vs what? The question isn’t is this free, the question is how large is the total staff including price negotiations, doctors, and IT time spent handling billing issues, and is Medicare more or less than 50% of the total. I am ware of one hospital and 2 medical clinics where the difference is…

2 FTEs vs a department. Most hospitals have entire departments to handle insurer coding and some even have departments just to handle insurer disputes.

Re: The American Healthcare Conundrum

#238

Post by nine_k » Tue, Mar 17, 2026, 3:49 AM UTC

onraglanroad wrote: post #228

sudopsuedo wrote: post #221

Earlier quoted context omitted.

The 9.2% figure is pharma's direct share of NHE, but drugs are a net-positive externality. Cheap statins can stave off cardiac surgeries, GLP-1 can stave off bariatric surgeries, etc. It's ridiculous to conclude we would only save 9.2% on costs--this is not zero-sum. No comment on drug pricing and its incentives, the existence of America's prescription drug markets drives the new innovative drugs that the rest of the…

> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

Mostly not marketing (still large), but the R&D costs and clinical trial costs. The latter are in hundreds of millions to billions range for the entire journey from a promising discovery to an FDA-approved medicine.

Re: The American Healthcare Conundrum

#239

Post by turlockmike » Tue, Mar 17, 2026, 3:53 AM UTC

Unregulate the insurance industries problem solved. Let people actually buy insurance for it's intended purpose. No insurance company would pay these rates willingly, they do it because of all the regulations. They aren't allowed to profit normally, so they find ways around it. Just let them operate normally, like all sorts of other insurance programs.

Re: The American Healthcare Conundrum

#240

Post by mindslight » Tue, Mar 17, 2026, 3:55 AM UTC

crazygringo wrote: post #203

WarmWash wrote: post #132

Firey take, but health insurers are not the problem they are made out to be. They're on your team and benefit from lower prices just as much as you do. They don't make any money either, don't argue with me, buy their stocks if you are so convinced and see how that goes over. Health care providers carry immense blame. It's full of passionless people in it for the outsized paychecks, who once inside will just seek what…

> health insurers...'re on your team and benefit from lower prices just as much as you do You're missing a very, very, very important piece here. Which is that the lowest price of all is to deny treatment entirely . They are not on your team, they are the opposite team. Their revenue is basically fixed, at the level of your premiums. But the more health care they pay for you to receive, the less profit they make . Th…

The several+ times in my life I've had to sort out billing issues, the health "insurance" agents have been helpful and friendly, stating what bills should be in no uncertain terms, even offering to conference call with billing departments to get things resolved, etc... Meanwhile provider billing departments routinely try to defraud me, even going so far as to bully me to pay those fraudulent amounts, don't follow up on things (eg filing claims) that are their responsibility and that they've said they will take care of, and generally make their problems into my problems.

This certainly isn't a defense of health "insurance" companies though! I just think they're better modeled as Lovecraftian horrors animated by paperwork and compelling the creation of ever more paperwork to feed on, rather than money-grubbing cheapskates as the pop-political narrative goes. And the approaches for fixing one are much different than the approaches for fixing the other.