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

#121

Post by preg_match » Thu, Jul 23, 2026, 4:38 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…

The main reason health insurance matters so much is it can't be bought. No amount of money can "upgrade" your employer plan to a good one if it sucks. If you have a nice PPO with a low deductible and low out of pocket max, that's a diamond in the rough. If you switch to an HMO, now you can't arbitrarily see specialists. Yes you could maybe cover the deductible cost or whatever, but your actual care will be impacted. And money can't fix that.

Most people don't care, including me. Until I got cancer, then I cared, because suddenly this was the stuff that could make the difference between me living and dying.

While I am incredibly privileged, it shouldn't be this way. Beyond the waste it's horribly anti-competitive for consumers. Consumers want better plans, and they have the money. They can't get them. That's a huge smell for "the market is fucked". And fucked it is, beyond belief.

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

#122

Post by giovannibonetti » Thu, Jul 23, 2026, 4:38 PM UTC

kevincox wrote: post #39

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…

Not to mention that tying your insurance to your job is a *huge* pain. If you switch jobs or get fired you need to deal with coverage gaps, considering individual coverage for the duration, and you may need to switch care providers depending on what your new coverage is. It is just a really awful system overall.

> It is just a really awful system overall.

You mean for the user. It is great for the insurance companies, though, since tying health insurance to employment indirectly keeps the average user age lower, thus making the overall scheme more profitable.

As a general rule, people use health benefits more as they age.

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

#123

Post by preg_match » Thu, Jul 23, 2026, 4:44 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?

US healthcare is very expensive because it's horribly inefficient. There's lots of insurers, lots of providers, and lots of treatments. The intersections of all of that are complex and requires huge amount of overhead to resolve.

Not to mention, the entire point of insurance is to provide that overhead. They want to deny coverage, obviously, so they're going to waste doctor's time on peer-to-peer and force their own customers to aggressively advocate for their own care. It's a huge waste of time for everyone involved, but the insurance company wants that waste of time, that's what they're optimizing for. They've gotten really good at both calling all the shots and wasting time.

Your doctor is more or less a vessel for the insurance company. The insurance company is your doctor: they decide how long visits are, what you can visit for, what medications you can take, which procedures you can get, when you can get those procedures, how much they will cost, and how you will have to pay. Your doctor gets a tiny bit of freedom. Maybe they can prescribe you a medicine out of, like, 3 predetermined choices. After, of course, you've completed all the testing. And after you've tried medicines A through C. And after you've been monitored for whatever time period the insurance decides.

Yes, that's all very expensive.

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

#124

Post by preg_match » Thu, Jul 23, 2026, 4:46 PM UTC

rootusrootus wrote: post #65

Grombobulous wrote: post #49

Earlier quoted context omitted.

I see a bunch of comments with this same theme but to me it’s splitting hairs. The term “private healthcare” is mostly referring to the fact that there is no such thing as non-private healthcare for the majority of Americans.

> is no such thing as non-private healthcare for the majority of Americans We're up to about a third now.

The current administration is hell-bent on changing that, both by nerfing Medicaid and making it much harder to qualify for. Medicaid is already mega-nerfed, you get de-facto lower quality healthcare on Medicaid.

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

#125

Post by ajmurmann » Thu, Jul 23, 2026, 4:49 PM UTC

tdb7893 wrote: post #45

ajmurmann wrote: post #5

Good article in general but such a misleading headline and framing. The problem, as described in the article's body, is employer-provided health insurance, not private healthcare.

You can get healthcare outside of employers and it's incredibly expensive. The cost of private healthcare (either employer sponsored or not) is what is responsible for what the article is talking about, it's certainly not just employer provided plans. Are you saying that if employers didn't provide health insurance that it would help the situation somehow?

The article says that lower mobility is caused by insurance being coupled to your employer. Yes, you can get health insurance on your own but there are a lot of issues with quitting and getting your own insurance or even moving to a different employer. If you get your own insurance you don't get the same tax breaks employers get. They also have not bargaining power with the insurance. Your new insurance, at your new employer might not have your current doctor covered. There is so much at stake with changing health insurance that it's quite frankly a little scary. Nobody wants to risk accidentally not having coverage for a few weeks because you filled in some form wrong. So it's easiest to just stay at your employer who carries most of the cost and you keep what you have already.

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

#126

Post by preg_match » Thu, Jul 23, 2026, 4:49 PM UTC

ed312 wrote: post #32

diego_moita wrote: post #15

Earlier quoted context omitted.

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.

... and "Chat Control" and Digital ID and forcing digital currency and persistent digital surveillance and conceding your national sovereignty to a council that can pass binding laws without your consent and .... Let's not pretend either system is perfect, or that the _underlying principles_ that both systems hold are the absolute correct way to organize a society. Americans have be primed with _decades_ of rugged in…

While Americans have been primed, it's still relatively new. If any of the new deal proposals were proposed today, everyone would lose their mind.

The dirty secret: half of what makes living in America tolerable comes from new deal policies. Everyone knows it, nobody will say it.

A similar thing goes for the ACA. Republicans hate it, but at the end of the day Americans don't want to be dropped from their insurance plans for having cancer or some genetic defect. Literally nobody wants that, only out-of-touch political talking heads want that.

That's not to say any of these policies are perfect, they all have flaws. But if you ask the American people what they want but carefully never name policy names, it becomes obvious everyone is on the same page.

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

#127

Post by cdrnsf » Thu, Jul 23, 2026, 4:50 PM UTC

akramachamarei wrote: post #115

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 u…

Perhaps mountains of frustration punctuated by relief that soon vanishes?

I’d cap income at $5 million a year and strip the tax code down to something devoid of exceptions, but I’m in no position to do that.

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

#128

Post by lotsofpulp » Thu, Jul 23, 2026, 4:52 PM UTC

reticulates wrote: post #120

lotsofpulp wrote: post #117

Earlier quoted context omitted.

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.

I’m basing that on reality. While health insurance for an individual was legal, it was basically inaccessible. Also, there were pre existing condition clauses and benefit maximums that made the insurance pretty worthless without a well funded employer willing to pay the costs.

ACA made it so anyone can get it, with standardized metal levels to make comparing plans possible, and out of pocket maximums and the inability to use health risks to deny insurance coverage to ensure one can actually buy and use it as long as premiums were paid. There were even generous tax credits to help pay the premiums.

Obviously, it is still very expensive, but the situation is far different than pre-2011. There would have been no “bank a few million at a tech company and be financially independent at 40” people without ACA.

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

#129

Post by jgon » Thu, Jul 23, 2026, 4:58 PM UTC

AlexandrB wrote: post #35

cwillu wrote: post #27

Earlier quoted context omitted.

You're describing a provincial issue, not a national one.

This is like the Canadian version of "no true Scotsman". When the province in question has 1/3 of the population of the country, what's the difference?

Its also described as a provincial problem but all of the provinces receive a substantial amount of funding, particularly for healthcare, via the federal government. People say "oh its the provinces fault, they just need to spend more", and then don't reflect on how much room there is for increased taxation, and particularly how much taxation the federal government currently applies. By far the most tax I pay as a Canadian is in the form of federal taxes. Of course, a bunch of this money does find its way back to the province, so the waters are a little muddy, but the federal government has been repeatedly downloading costs onto the provinces, while doing very little about its own spending. The Chretien government in particular did massive downloading of costs to the provincial governments, although their hand was forced by Canada's fiscal situation at the time. So simply saying, oh well the provinces need to step up, is an easy deflection from what is a pretty thorny problem. If the responsibility really is up to the provinces, then why does the federal government need all this money? If the feds are going to continue scooping up the lion's share of tax revenue then they need to continue helping to fund the various provincial responsibilities.

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

#130

Post by ajmurmann » Thu, Jul 23, 2026, 5:00 PM UTC

Cyclone_ wrote: post #119

bluGill wrote: post #89

Earlier quoted context omitted.

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.

They can just give you that money instead.

The current situation is even worse than it might seem: Employers must provide the same plan options to all employees. A high-earner might prefer a more premium plan over a barbones, catastrophic coverage-only plan while a low-earner at the same company might prefer the extra cash in their pocket. Even if some of the cost of the premium plans is forwarded to the employee the cost to the employer is still higher and they must price that case into their calculation of the overall comp package. The market is more competitive, by definition for high-earners. So the employer will offer plans that cater to them. But this cost still impacts the comp package of the low earner. For many years this dynamic has eaten up most raises to take home pay got low income earners. See: https://www.econtalk.org/mark-warshawsky-on-compensation-hea...