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

#111

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

stult wrote: post #73

megaman821 wrote: post #12

This is less about private healthcare and more about how employer-provided healthcare is tax advantaged. Credits and tax breaks should go to the individual so they can choose and keep their insurance through different jobs.

I don't get why decoupling insurance from employment isn't a bigger part of the healthcare reform discourse. It's the most obvious, easiest, lowest hanging fruit for improving the US healthcare system, and almost uniquely politically acceptable to both Democratic and Republican voters. Decoupling also doesn't entail disrupting any of the established incumbents (pharma, AMA, insurance companies, etc.) who typically ki…

> The Republicans have utterly failed to offer any alternative at all to Obamacare after 16 years

That’s because before Obama picked it up, it was the Republican free market compromise plan in the face of a growing for socialized healthcare.

And now the Republican Party has been taken over by Trump. To the extent any political party has real principles they have given up theirs completely. Their principles are whatever Trump says they are this week.

So the question is “why hasn’t Trump pushed for separating healthcare from employment?” And the answer to that could be as simple as because he doesn’t think it’s exciting enough.

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

#112

Post by dsr_ » Thu, Jul 23, 2026, 4:05 PM UTC

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…

My workplace has made health insurance a competitive point: zero employee premium, zero copays except for an ambulance call which does not result in an admission, zero Rx costs. Full family coverage.

The dental coverage was screwed up for the first 4 months of the year. An assumption was made that all dental plans were basically the same in terms of payments to dentists. This turned out not to be the case.

Everyone should have this, but until we do, it will be a reasonable negotiating point. Why should non-health-care employers be in the healthcare business?

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

#113

Post by Aurornis » Thu, Jul 23, 2026, 4:06 PM UTC

ryandrake wrote: post #88

Aurornis wrote: post #47

Earlier quoted context omitted.

> job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point Health insurance has been a primary topic in every job offer I’ve had, my entire career. If a company won’t discuss the insurance situation or provide details about the employee contribution, that’s a warning sign. This is a routine topic for negotiations and any company hiding this data is not…

Are there really employers who negotiate this? Every job I've ever had in tech had a single "medical benefit" package that everyone just got. You couldn't negotiate your particular health insurance premium or what portion the employer paid for. Everyone gets the same thing. The only choice I've ever seen was a menu of two options: PPO or high-deductible plan. So it's good to know the details of the plan (so you know…

They don't negotiate the terms of your health insurance.

It's presented as part of the negotiation for total compensation.

You have to know the benefits to be able to understand the total compensation, which is what you're negotiating.

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

#114

Post by DrScientist » Thu, Jul 23, 2026, 4:10 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.

Yes and no.

While there are some centralized decisions ( we are paying only for one round of IVF, or this drug isn't good value for money ), most of it is delegated to front line doctors - by the simple mechanism of faced with a fixed time/budget they triage based on medical need.

Note that the UK system is actually a rather odd hybrid of public and private due to historic reasons. It's quite easy to queue jump the waiting for an initial consultant by going private, and then be referred back to the public system for treatment.

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

#115

Post by akramachamarei » Thu, Jul 23, 2026, 4:11 PM UTC

cdrnsf wrote: post #33

I'd love to decouple insurance form employment and I'd also love to do away with the private insurance system in the US. I've always had insurance and the experience has been as uniformly poor, regardless of provider, as it is continuous. Any positive interactions and outcomes have felt like happy accidents, not the system working. Remove the private actors, the adversarial billing, the friction with providers. It, a…

> the experience has been […] uniformly poor […] Any positive interactions and outcomes have felt like happy accidents

Which is to say, not uniformly poor?

> I'd also love to do away with tax prep — the government knows what is owed

Sometimes! We would probably have to simplify the tax code first. Otherwise instead of spreading out the work of identifying income and tax credit eligibility amongst taxpayers and such upon them who are most proximal to this knowledge, we would have a centralized body need to know all of the things that you and I know about ourselves, such as how many kids we have, what kind of car we drive, whether we use solar power, whether we invest in crypto, whether we earned money from gifts or gambling or dividends or farming. Or we could just simplify the code, which I would like.

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

#116

Post by DrScientist » Thu, Jul 23, 2026, 4:22 PM UTC

maerF0x0 wrote: post #82

Schlagbohrer wrote: post #59

It also kills many, many people, so, the profit motive needs to be permanently and forever abolished from healthcare. In the US doctors look at patients with dollar signs in their eyes and simply ask, "How much money can I squeeze out of this NPC?" leading to countless abuses, from unecessary and harmful procedures being forced on non-consenting patients (like infant genital mutilation) to denial of needed healthcare…

I agree with you about Infant genital mutilation (circumcision) but disagree the issue is the doctors themselves. I think the shrinking pool of competition is the major issue. (Hospitals being privatized with VC money etc)

> but disagree the issue is the doctors themselves

Who's fault was the opioid epidemic in the US?

I know a lot of blame has been levelled at the pharma involved, and rightly so, however every single one of those patients that got hooked via prescriptions had them from their doctor.

Those doctors aren't suppose to be automatons, just blindly follow Pharma marketing materials, they are suppose to be highly paid experts who's overriding concern is a duty of care to the patient.

There are many reasons the opioid epidemic was an almost uniquely US experience, but the private incentives for doctors was one of them.

Purdue was telling everyone around the world the same thing - but apparently only US doctors were fooled.

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

#117

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

reticulates wrote: post #43

lotsofpulp wrote: post #18

Earlier quoted context omitted.

It’s not connected at all in the US since 2011. The only thing employer provided health insurance gets you is the ability to pay for it with pre-tax income (which is a significant saving). Otherwise, you can go to healthcare.gov and buy it without an employer.

> Otherwise, you can go to healthcare.gov and buy it without an employer. using what money? Most people get their money from their employer.

We don’t describe shelter, food, entertainment as being employer provided, even though those are also acquired with money obtained from an employer.

The distinction in the US before 2011 is that couldn’t buy health insurance as an individual, hence it was a benefit dependent upon being employed. Post 2011, health insurance became attainable without an employer.

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

#118

Post by akramachamarei » Thu, Jul 23, 2026, 4:26 PM UTC

diego_moita wrote: post #15

irdc wrote: post #6

Why is this news? As a European this seems totally obvious.

The European/"Socialist" solutions are never obvious to Americans. It is like parliamentarianism, campaign financing regulations, gun control, multiple political parties, etc. Americans call these things "Socialism" and then freak out about them and refuse to see any good on them.

Are the Americans in the room with us right now?

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

#119

Post by Cyclone_ » Thu, Jul 23, 2026, 4:31 PM UTC

bluGill wrote: post #89

Cyclone_ wrote: post #80

Earlier quoted context omitted.

So how would private healthcare happen without employer provided insurance?

Same way my auto body repairs are done. I have insurance on my car that isn't through my company. I can choose who the provider is. I'm not limited to the two plans my company offers from the same provider. There are dozens of companies who want my business.

Except your company covers a lot of the cost for your health insurance.

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

#120

Post by reticulates » Thu, Jul 23, 2026, 4:33 PM UTC

lotsofpulp wrote: post #117

reticulates wrote: post #43

Earlier quoted context omitted.

> Otherwise, you can go to healthcare.gov and buy it without an employer. using what money? Most people get their money from their employer.

We don’t describe shelter, food, entertainment as being employer provided, even though those are also acquired with money obtained from an employer. The distinction in the US before 2011 is that couldn’t buy health insurance as an individual, hence it was a benefit dependent upon being employed. Post 2011, health insurance became attainable without an employer.

What are you basing that on? The ACA did not make individual insurance legal, it was already legal and widespread, it was not dependent on employment. The ACA made improvements, the ACA made individual insurance more accessible.