Private healthcare makes industries less innovative. It's time for change • Hacker News Board

Re: Private healthcare makes industries less innovative. It's time for change

#101

Post by dudul » Thu, Jul 23, 2026, 3:38 PM UTC

Schlagbohrer wrote: post #61

abeppu wrote: post #25

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point - except when subject to some kind of union negotiated contract, the employer can…

And in the US a new worker can only join the healthcare plan during certain times of year! New workers often have to wait months with a health insurance gap before they can get on the new plan.

That is incorrect. When you start a new job you have a few weeks to enroll.

However, you sometimes have to wait for the plan to begin coverage. Something like "after 30 days of employment", or "on the first day of the first full month of employment". These are indeed idiotic limitations.

Worst case scenario, if you are changing job and something really bad happens during these 2 weeks where you don't have coverage you can retroactively enroll in COBRA.

Re: Private healthcare makes industries less innovative. It's time for change

#102

Post by reticulates » Thu, Jul 23, 2026, 3:45 PM UTC

maerF0x0 wrote: post #85

reticulates wrote: post #51

Earlier quoted context omitted.

The U.S. has waitlists too? The U.S. makes people wait based on how much money they have, socialized healthcare systems make people wait based on an assessment of need. The latter is obviously better, even though it is not perfect. You’ll find that most everyone living with socialized healthcare believes it to be adequate when compared to the U.S. system. Adequate does not mean without flaws, adequate doesn’t mean av…

> You’ll find that most everyone living with socialized healthcare believes it to be adequate when compared to the U.S. system This is not true for Canadians. Many have to travel to the US, India, or otherwise abroad to purchase the healthcare they desire which is not available to them in Canada. In Canada you have to get sick enough for the system to triage you into the quotas. But maybe you want to stay healthy bef…

The conclusion you're drawing does not follow. Canadians can be frustrated with the Canadian healthcare system and also believe it to be adequate when compared to the U.S. healthcare system. Canadians who are surveyed about healthcare typically say: the system is broken and needs to be fixed AND the socialized nature of it must be protected. Canadians are unhappy with underfunding, Canadians want more funding, they do not want the U.S. system.

Re: Private healthcare makes industries less innovative. It's time for change

#103

Post by rjmunro » Thu, Jul 23, 2026, 3:48 PM UTC

natsucks wrote: post #63

Ajedi32 wrote: post #54

Earlier quoted context omitted.

Yes, the title gave me whiplash because I went in expecting an argument for socialized healthcare, then read a couple paragraphs and realized the article was actually presenting an argument against government meddling in the healthcare industry, then read further and realized it was actually using the problems created by government meddling in the healthcare industry to argue for more government meddling.

"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it." really it could not be because government is bad at managing massive programs and provides no inc…

The NHS is known for being pretty efficient when compared to other healthcare systems, especially the US. The problem is that there is no money and healthcare is getting more expensive.

There are incentives for high performance and efficiency. GPs are private partnerships contracted to treat patients. They can keep profits.

There's been attempts to do more private outsourcing (with the NHS still paying), but they tend to work out less efficient when you consider the whole system, because, for example they might only treat the easy cases and leave the hard ones to the normal hospitals.

Re: Private healthcare makes industries less innovative. It's time for change

#104

Post by reticulates » Thu, Jul 23, 2026, 3:49 PM UTC

lII1lIlI11ll wrote: post #90

reticulates wrote: post #68

Earlier quoted context omitted.

The Dutch system and the U.S. system are not comparable. Health insurance in the U.S. is a “free market” that the government dabbles in with a little policy here and there. Health insurance in The Netherlands is controlled by the government, it is heavily regulated.

Still it is worth highlighting on this forum since many Americans believe that healthcare is "free" across Europe.

Healthcare is "free" across Europe, including in The Netherlands. The choice of The Netherlands' to structure their system as mandatory insurance doesn't change the nature of it, it is free at the point of service with the mandatory insurance costs paid for by the government when someone is unable to pay themselves.

Re: Private healthcare makes industries less innovative. It's time for change

#105

Post by rjmunro » Thu, Jul 23, 2026, 3:51 PM UTC

therealdrag0 wrote: post #84

natsucks wrote: post #63

Earlier quoted context omitted.

"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it." really it could not be because government is bad at managing massive programs and provides no inc…

Socialized programs require strict definitions and firm hands on drawing lines of inclusions and limits to balance the budget.

So do insurance based ones. And if you aren't 100% insured, that limit depends on how rich you and your parents are, and the balancing is often between health and other things.

Re: Private healthcare makes industries less innovative. It's time for change

#106

Post by sarchertech » Thu, Jul 23, 2026, 3:51 PM UTC

maerF0x0 wrote: post #79

sarchertech wrote: post #60

Earlier quoted context omitted.

You can deduct some of your medical expenses. I think it’s over 7.5% of your AGI. But tax deduction or not isn’t what makes individual health insurance so expensive. When you have employer provided health insurance you’re in a completely different risk pool than people buying on the open market.

> completely different risk pool And that's the issue, we need regulation to break the quid pro quo system we have right now, and an innovative enterprise to design and sell a realistic risk pool for the public. That might look like the government requiring freedom of choice in your employer healthcare plan -- eg: the employer has to allow you to port a defined contribution amount to any healthcare plan you prefer, i…

I agree we need to do more. I do wonder if just providing a public option to compete against private insurance is the way to go though.

>profit caps

We have profit caps on health insurance. It has many downsides though. The first is that it removes incentives for health insurers to reduce healthcare costs. It actually incentives them to want higher healthcare costs because 15% of a bigger number is more money.

Second, it incentives things like spinning out your insurance division into separate company and then buying an urgent care clinic to run as a sibling company to the insurance company.

Then when the insurance company spends their required 85% on healthcare costs, they just make sure a big chunk of that is spent on services from the sibling provider company.

United Healthcare does exactly this.

Of course functional regulators could stop this, but it’s hard and they don’t. Which is why I think offering a public instead of some of these direct regulations of private companies might work better.

Re: Private healthcare makes industries less innovative. It's time for change

#107

Post by akramachamarei » Thu, Jul 23, 2026, 3:52 PM UTC

ajross wrote: post #19

Taikonerd wrote: post #7

Earlier quoted context omitted.

Yeah, the article sort of conflates the two. It's funny that he (accurately) quotes the Cato Institute as being opposed to employer-provided health insurance... and then implies that the sole alternative is the NHS. Um, I'm pretty sure that's not what the libertarian Cato Institute was suggesting!

With all respect: what exactly is the alternative you're imagining? The market emphatically did not provide accessible private health care to individuals, largely because of the wellness trap (no one buys insurance until they need it). It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA. Employer health care may have bad externalities,…

> You can force insurers to cover folks they wouldn't want to otherwise by bringing more customers (employees) to the table.

The word you're looking for is "convince," not "force." This whole discussion is replete with misuses of words like "free" and "force," and it's a little worrying.

Re: Private healthcare makes industries less innovative. It's time for change

#108

Post by ed312 » Thu, Jul 23, 2026, 3:52 PM UTC

Grombobulous wrote: post #44

Universal single-payer healthcare is one of the most pro-business and traditionally conservative with a lower case C thing you can imagine. It’s pretty much a no-brainer cost reduction for everyone. This doesn’t even mean you need to get rid of private insurance companies (see: Germany).

The cost reduction alone from everyone paying the same price (for the same service at the same facility of course) must be staggering. I agree - I don't see any need to ban any private insurance or providers and that's also aligned with a traditionally (lower case c) conservative free market view too.

Re: Private healthcare makes industries less innovative. It's time for change

#109

Post by DrScientist » Thu, Jul 23, 2026, 3:54 PM UTC

Ekaros wrote: post #77

natsucks wrote: post #63

Earlier quoted context omitted.

"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it." really it could not be because government is bad at managing massive programs and provides no inc…

Real truth is that health care just is massively expensive. Any efficiency gains that are also somewhat limited have been overshot by more "products". Nurses and doctors can only handle so many patients. This has not increased that much compared to say farming or most other areas. And while there has been some gains. There is also lot more produces and costs of those.

Indeed. It's been argued that people intensive activities, like healthcare, thus become relatively more expensive as other, more automation friendly, industries become highly optinised.

ie the relative price of a new car versus a heart transplant is going to continually drop such that we spend more and more as a percentage of GDP on things like health ( and social ) care.

So it's not sure much that health care has become more expensive, as much as relatively more expensive.

The other strong effect is nobodies life is saved, death is simply delayed, and the older you get the more problems you have.

So as well as historically being relatively resistent to automation, success breeds more need.

Re: Private healthcare makes industries less innovative. It's time for change

#110

Post by tzs » Thu, Jul 23, 2026, 4:03 PM UTC

ryandrake wrote: post #91

Ekaros wrote: post #77

Earlier quoted context omitted.

Real truth is that health care just is massively expensive. Any efficiency gains that are also somewhat limited have been overshot by more "products". Nurses and doctors can only handle so many patients. This has not increased that much compared to say farming or most other areas. And while there has been some gains. There is also lot more produces and costs of those.

Why is healthcare so uniquely expensive in the USA, but nowhere else?

One answer is it is more expensive compared to most of the rest of the first world countries because it was more expensive compared to them 50 years ago, and over that time the growth rates in health costs have been fairly similar for us and them.

The question then is why was it more expensive then? I've not seen much on that.