The Affordable Care Act is flawed, why not public pricing? • Hacker News Board

Re: The Affordable Care Act is flawed, why not public pricing?

#11

Post by maxerickson » Sun, Dec 18, 2016, 9:57 PM UTC

beowulf_cluster wrote: post #10

maxerickson wrote: post #9

Earlier quoted context omitted.

I think we need an official roadmap. I think the public deserves a direct voice in guiding the direction of the country. At the very least, I think we need to set in stone a clear vision of what milestones we want to achieve as a nation. My entire lifetime, our leadership has repeatedly demonstrated it is incapable of moving us in any single direction long enough and far enough to be meaningful (aside from war, perha…

Sure, there's never going to be unanimous agreement. Put it to a vote. I'm mainly just talking about letting the public choose which issues the leaders should focus on, and holding them accountable if they don't.

How would that be different than what we have now?

I think there are things that would be incremental improvements (like having more members in the House of Representatives) and maybe better districts, but most elections have the candidates crafting a message based at least partly on what they hear from people and pretty high desire to get reelected (so they have to at least appear to follow through on their message).

There's a lot of things I see people proposing that end up boiling down to wishing that others would 'vote better'. That's a tough problem to solve.

Re: The Affordable Care Act is flawed, why not public pricing?

#12

Post by commentzorro » Sun, Dec 18, 2016, 10:30 PM UTC

If you allow the young and healthy to purchase plans at one third the price then the old and ill are going to have to pay three or more times more. How are they supposed to afford that after a lifetime of working just above minimum wage?

Without the young paying in during the early years they're going to have annual premiums of $40-50,000 as they approach their 60s.

Re: The Affordable Care Act is flawed, why not public pricing?

#13

Post by omonra » Mon, Dec 19, 2016, 1:02 AM UTC

Reading the comments below, I am guessing that most people simply don't understand the terminology you are using. Ie you have to define what are:

1. Public service 2. Lock in a price 3. What are the prices (vs margins) 4. What's a starting price

I understand your question because I get regular bills from my insurance company that say "Doctor usually charges $1,000 for the procedure you had but we have negotiated price $100, so that's what you owe, as you are still below your deductible."

Re: The Affordable Care Act is flawed, why not public pricing?

#14

Post by poorcedure » Mon, Dec 19, 2016, 7:01 AM UTC

omonra wrote: post #13

Reading the comments below, I am guessing that most people simply don't understand the terminology you are using. Ie you have to define what are: 1. Public service 2. Lock in a price 3. What are the prices (vs margins) 4. What's a starting price I understand your question because I get regular bills from my insurance company that say "Doctor usually charges $1,000 for the procedure you had but we have negotiated pric…

As I understand the current system, medical institutions negotiate different prices with every insurance company. They start high and the size of the insurance company's patient pool helps them get better price per service.

It seems weird, because it is weird. I can not think of another industry that works like this, where prices can be unknown until it goes to billing. Forcing them to fix a price and publish it to a government registry could possibly allow market forces to drive lower prices than even the largest insurance companies can negotiate.

Re: The Affordable Care Act is flawed, why not public pricing?

#15

Post by poorcedure » Mon, Dec 19, 2016, 7:18 AM UTC

commentzorro wrote: post #12

If you allow the young and healthy to purchase plans at one third the price then the old and ill are going to have to pay three or more times more. How are they supposed to afford that after a lifetime of working just above minimum wage? Without the young paying in during the early years they're going to have annual premiums of $40-50,000 as they approach their 60s.

Might seem backwards, but the goal here would be to turn patients back into customers. Right now, there is no visibility for the individual into prices for services. Without it there is no competition at all to find common, realistic prices for services.

Lower prices should reduce premiums for everyone, since insurance companies have strict margins per the ACA. Lower premiums should increase those that are covered by insurance, hopefully.

Re: The Affordable Care Act is flawed, why not public pricing?

#16

Post by commentzorro » Mon, Dec 19, 2016, 3:17 PM UTC

poorcedure wrote: post #15

commentzorro wrote: post #12

If you allow the young and healthy to purchase plans at one third the price then the old and ill are going to have to pay three or more times more. How are they supposed to afford that after a lifetime of working just above minimum wage? Without the young paying in during the early years they're going to have annual premiums of $40-50,000 as they approach their 60s.

Might seem backwards, but the goal here would be to turn patients back into customers. Right now, there is no visibility for the individual into prices for services. Without it there is no competition at all to find common, realistic prices for services. Lower prices should reduce premiums for everyone, since insurance companies have strict margins per the ACA. Lower premiums should increase those that are covered by…

Nothing wrong with turning patients into customers. Lower prices will only happen for the young and healthy. Higher prices will be the only possible future for the old and those with pre-existing conditions. The insurance companies are not going to cover a particular class at a loss. They'll just walk away, as they should.

The ACA is going away. Please don't use it as a crutch.

Lower premiums mean higher deductables. We see that now and we saw it before the ACA. Healthcare costs $18,000 per person this year regardless of how you divide the premium and deductable. Take away the young and the price goes up for everyone else. And this is with a cap in place by the ACA. Only going to get worse with the regulations removed.