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

#131

Post by Grombobulous » Thu, Jul 23, 2026, 5:07 PM UTC

maerF0x0 wrote: post #86

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).

Single payer maybe, but single provider? Never.

While I agree that there’s probably a benefit of diversifying providers in most situations, I would take single provider over “I can’t afford care at all.”

Also, single provider countries like the UK still have private healthcare. A LOT of private healthcare. This idea that single provider/single payer will make most people’s care worse and remove everyone’s options has felt to me a lot like industry propaganda.

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

#132

Post by reticulates » Thu, Jul 23, 2026, 5:07 PM UTC

lotsofpulp wrote: post #128

reticulates wrote: post #120

Earlier quoted context omitted.

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 inabilit…

You're just flat out wrong, it was not "basically inaccessible". Tens of millions of people had individual health insurance prior to the ACA, over 30 million in 2010, averaging 10% of all insured people from 2000 to 2010. The ACA, while very important and valuable legislation, only increased the number of individually insured people by around 25%.

https://www.census.gov/data/tables/time-series/demo/health-i...

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

#133

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

jmyeet wrote: post #93

> 1 in 4 American workers stay in their jobs because of the healthcare. It suppresses wages and working conditions - and prevents innovators from heading out on their own. Yes. That is the point . This is how capitalism works. Just look at the story of Tetris as the pefect example of capitalism in action. Some Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What d…

> Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add?

Capitalism created the computers whose Soviet copies were Tetris' native platform, it made the languages Pajitnov used and the machines he ported it to. It incentivized people to bring Tetris to the rest of the world, and who knows, it might have spread on its own eventually, just for free, but maybe not.

> All of the inflation we've seen from the pandemic has been the "raising prices" part.

Superficially true, but vacuous. In anyway that matters this is flagrantly and amazingly false. But maybe you weren't aware of the $931 billion US dollars of stimulus paid to individuals, or you may not be familiar with the principle of supply and demand. More dollars in supply, the less the value of each dollar. Prices change to match the devalued currency.

> Being expensive to access out of employment is a feature not a bug.

I think this may qualify as a bug, to which you can credit the Revenue Act of 1954 for codifying the tax break given to companies who provide healthcare directly rather than pay that money as income to the employee. Classic example of a stale law. Now, vested interests may be keeping it in place, but I also see no significant awareness on the voter side of this issue nor the will to reform this discriminatory tax policy.

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

#134

Post by akramachamarei » Thu, Jul 23, 2026, 5:27 PM UTC

cdrnsf wrote: post #127

akramachamarei wrote: post #115

Earlier quoted context omitted.

> 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.

...What do you mean "cap"?

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

#135

Post by lotsofpulp » Thu, Jul 23, 2026, 5:31 PM UTC

reticulates wrote: post #132

lotsofpulp wrote: post #128

Earlier quoted context omitted.

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 inabilit…

You're just flat out wrong, it was not "basically inaccessible". Tens of millions of people had individual health insurance prior to the ACA, over 30 million in 2010, averaging 10% of all insured people from 2000 to 2010. The ACA, while very important and valuable legislation, only increased the number of individually insured people by around 25%. https://www.census.gov/data/tables/time-series/demo/health-i...

But that was not the same "health insurance" that was sold post-ACA. The product itself was completely different, due to the pre existing condition clauses and benefit maximums. Paying $x premiums to only receive a maximum of $y of healthcare and only in certain cases is not what people refer to as the health insurance available in various European countries, which is ostensibly what the situation is compared to.

Even now, when I write health insurance, I mean "ACA complaint health insurance", because the limitations in other kinds of products labeled "health insurance" are useless to the point of not being worth discussing.

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

#136

Post by ajmurmann » Thu, Jul 23, 2026, 5:34 PM UTC

snarf21 wrote: post #29

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.

It is also frustrated that this was meant to be a temporary hack during WWII that never went away. People should just get $$ into their HSA from their employer and but whatever plan they want.

AFAIK it's even worse and want never really "meant" to be anything but it was a workaround of mandated salary caps to compete for workers. Pretty much every time someone tries to limit the market, unintended consequences result. We are still paying for this one.

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

#137

Post by AlexandrB » Thu, Jul 23, 2026, 5:52 PM UTC

999900000999 wrote: post #34

We could easily do this and it would actually be significantly cheaper. But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance. So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.

The reason the "myth" persists is because there are some folks who take advantage of the system like this. In fact, many people personally know someone who's doing this. We can debate what percentage of recipients it is and whether we should worry about it or not, but it's a non-zero number. Framing it like some kind of racist trope is disingenuous and only works because of America's existing racial tensions. In Canada, for example, folks I've known doing this kind of thing are all white.

At the most basic level, this shows up as folks avoiding working more than a certain amount to avoid losing some government benefits. This is a result of "benefit cliffs"[1] that actually reduce net income as you work harder. It's "lazy" in the sense that you're maximizing your earnings at others' expense by working less than you otherwise could, but it's also a perfectly rational decision given the incentives.

My preferred solution is to have all benefits taper off gradually with income instead of having hard "cut offs". Done right this ensures there's never a financial penalty for working more. It does make the tax system more complicated though.

[1] https://en.wikipedia.org/wiki/Effective_marginal_tax_rate

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

#138

Post by ajross » Thu, Jul 23, 2026, 5:54 PM UTC

mattmcknight wrote: post #56

ajross wrote: post #19

Earlier quoted context omitted.

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,…

> It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA. 100% untrue. There were affordable catastrophic coverage plans available, and many were made illegal by the ACA and the requirement to provide boutique services for "free" (i.e., forced to pay for even if you don't use).

> There were affordable catastrophic coverage plans available

Not for anyone who needed them! If you were already sick, you would die poor without coverage. Are we really continuing to have this discussion?[1]

The market failed in this case. We all know it.

[1] Just to short circuit: you'll want to deflect to a non-economic discussion of whose "fault" it was that they were stuck with a pre-existing condition. But my point is: who cares? There was a product and a consumer which could not be exchanged at a reasonable price in an unregulated environment. And that's bad regardless of fault (doubly or triply so because it's a really important product).

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

#139

Post by ajross » Thu, Jul 23, 2026, 5:55 PM UTC

akramachamarei wrote: post #107

ajross wrote: post #19

Earlier quoted context omitted.

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.

Arguments about words are a little woke for my taste. Fine fine, pretend I said "convince" and then reply to that. Thanks.

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

#140

Post by ajross » Thu, Jul 23, 2026, 5:56 PM UTC

Taikonerd wrote: post #30

ajross wrote: post #19

Earlier quoted context omitted.

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,…

My point was there are lots of models available, not just 2. My post above wasn't endorsing one in particular. I would say that the ACA is on the free market-ish side of the design space: individuals purchasing (subsidized) insurance from private companies.

> My point was there are lots of models available, not just 2. My post above wasn't endorsing one in particular.

Yeah, so... my question stands: name one you're thinking of, even if you qualify that it isn't an "endorsement". I contend there isn't one and you're fooling yourself.