People Lose Their Employer-Sponsored Insurance Constantly • Hacker News Board

Re: People Lose Their Employer-Sponsored Insurance Constantly

#111

Post by clairity » Wed, Apr 17, 2019, 6:45 PM UTC

davidw wrote: post #21

aNoob7000 wrote: post #5

Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.

Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'. As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives. I mention Italy because 1) I lived there and 2) it's not some perfectly…

i'm keen on the idea that such a model of a government entity (or two) in competition with an open market would provide the most favorable outcome, because a truly free and fair market (one where competition leads to efficiency and low prices) seems mythically distant at this point.

government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-competitive practices. if bureaucrats can get thrown out for not being competitive with the private companies, and private companies can go out of business for not being efficient and serving customers well, we might get decent service-oriented entities in the market.

many goods that don't fit the simple paradigm of commerce (e.g., housing) can benefit from such a model.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#112

Post by ajross » Wed, Apr 17, 2019, 6:46 PM UTC

tomp wrote: post #100

ummonk wrote: post #57

Earlier quoted context omitted.

That actually sounds like the high deductible plan is functioning as it should though. Causing consumers to price-shop and avoid price-gouging providers.

That's not the purpose of deductibles though... it's to put people's skin in the game - if you use insurance, you also pay for it, so it's not free for you. On the other hand, if a provider is charging too much, they shouldn't be included in the plan in the first place, as they're simply a bad option.

No... the grandparent had it right. "Skin in the game" is just a colloquial restatement of the earlier point. The purpose isn't to make people needlessly suffer more by having to pay!

The principle idea is that because they have to pay some, they'll be more sensitive to pricing and more willing to shop for an affordable provider, which is exactly the efficiency argument.

And in this particular case I agree, even. Though the fact that this has to be done by individuals (who are sick!) sort of makes a hash of the moral notions of "the market" being the solution here. We're buying efficiency at the cost of individual grief, and that has value too.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#113

Post by jimmy1 » Wed, Apr 17, 2019, 6:46 PM UTC

dwater wrote: post #88

jimmy1 wrote: post #42

Earlier quoted context omitted.

I think your phenomena might be due to startups? Obviously this is a startup focused board so I am not saying this to mean go one way or another, but I ditched the startup, job hopping life a little while ago, and had to deal with "insurance bs" roughly two times in 7 years. I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenu…

My partner has been employed with the same large international company for 8 years. She had an elected procedure done that is required by law to be fully covered by insurance. She had 3 calls leading up to the procedure with her health insurance company each time asking them if they were certain it would be covered 100%. I thought that this was overkill but she was worried to the point of being paranoid about it. The…

I am fortunate to have had the experience of growing up with a rabid Greek mother who would get to the bottom of any shenanigans with any sort of insurance agency, bill collector or anything. I now have my own experience. Yes the first time was stressful, but reading your story, trying to put myself in your partner's shoes this would not have ended up causing me any stress, especially if I knew the law is on my side. I certainly wouldn't paid any bill until it was all sorted out. I also have experience where a medical charge that was suppose to be covered as a legitimate procedure was not and charged off onto my credit (because again, I refused to pay). I was easily able to negotiate with the credit reporting agency to remove this negative mark on my credit. (Negative marks due to medical bills affect your credit much less than say missing a credit card payment, IIRC, I was still able to obtain credit cards, get loans, and generally had decent overall credit).

My father currently undergoing treatment for lung cancer. He has medicare and supplemental coverage through Humana. Bills are still in excess of 150,000, so I definitely understand the other side of it.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#114

Post by dv_dt » Wed, Apr 17, 2019, 6:48 PM UTC

aantix wrote: post #104

dv_dt wrote: post #45

Earlier quoted context omitted.

This paper gives pretty interesting breakdown of how private companies are increasingly bad at paying for it. https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p... One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D. Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human n…

Food production is predictable. Finding a safe, effective treatment for Alzheimer’s is not. If you want thin margins, maybe government research wing can take its findings from idea to market (imagine waiting on a cure and that’s your only hope?) But you can’t force a private company to operate on low margins by way of capping prices, you’ll kill them. You can’t taje away their ability to control their risks (cash flo…

If you look at the paper, private drug discovery is creating drugs at a declining rate. I would suggest this is because those private efforts are much less research than development, and it's actually the public system that drives much fundamental research. And the drugs to market rate is in serious decline because of a the widespread application of increasingly austure public funding budgets for medical research causing an early pipeline bottleneck.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#115

Post by arcbyte » Wed, Apr 17, 2019, 6:49 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

Ironically, indirect government interference.

The market is doing its job perfectly well maximizing the value defined by government constraints and influence (since govt is the largest payor).

Re: People Lose Their Employer-Sponsored Insurance Constantly

#116

Post by krapht » Wed, Apr 17, 2019, 6:51 PM UTC

arcticbull wrote: post #90

krapht wrote: post #80

Earlier quoted context omitted.

Not that I disagree, but the majority of health care expenses are not time-critical emergencies. I saw a statistic somewhere where it's around 15%?

IMO the biggest problem is that you're not really qualified to judge medical practitioners. How am I supposed to know if what they're recommending is actually necessary? The market price of an MRI? How do I know they're not skipping care I should have to offer a lower price? Or if they're offering unnecessary procedures? The reality is you need an M.D. to make a reasonable evaluation. This is why at an HMO we have pr…

Same way you evaluate developers. Say you are a manager at a company who needs to hire somebody to develop an application for you. You aren't technical. You have no idea if you need the thing the consultant is saying you need. So you check completed works, existing client testimonials, educational history, recommendations from coworkers or friends, etc.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#117

Post by jjeaff » Wed, Apr 17, 2019, 6:52 PM UTC

ummonk wrote: post #105

leetcrew wrote: post #101

Earlier quoted context omitted.

if I understand correctly, the out of pocket maximum might only apply to in network providers. I think if you end up getting a non-covered procedure or get service from an out of network provider, you can be on the hook for way more than the out of pocket maximum. if so, it would be hard to ensure that this doesn't happen in an emergency.

That was fixed long ago by ACA. Emergency services are treated as in-network regardless of whether they were actually in-network.

Well yes, but you make it sound so easy. You'll have to go multiple rounds with the insurance and aca reps in many cases to get it approved after the fact.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#118

Post by jdhn » Wed, Apr 17, 2019, 6:53 PM UTC

dudul wrote: post #65

pnathan wrote: post #43

One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. It's not just plain $$$ and career risk, it's the "suppose you will go bankrupt and your family has permanent medical issues now" risk. That game is for the wealthy or healthy single people In addition, each insurance plan has slightl…

This is also the reason why I've never looked seriously into starting a company. I wonder how many jobs would almost instantly be created in the US if this factor of uncertainty was lifted.

I think you'd see a bump upwards, followed by a slow fall downwards as people realize that there's a hell of a lot more to running a small business than just healthcare costs.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#119

Post by jjeaff » Wed, Apr 17, 2019, 6:54 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

So you think if we paid more in taxes and turned all of it over to the government, the current level of beurocracy would decrease?

Re: People Lose Their Employer-Sponsored Insurance Constantly

#120

Post by dsfyu404ed » Wed, Apr 17, 2019, 6:54 PM UTC

tialaramex wrote: post #108

majormajor wrote: post #82

Earlier quoted context omitted.

What if the cheaper place is cheaper cause it's not as capable ? How am I supposed to know? In what other scenario are we similarly encouraged to act on price alone? Price transparency is meaningless with quality transparency.

... and assessing quality in this space is way outside of what a normal consumer is capable of anyway. The UK has periodically had a back and forth on whether the outcome ratio numbers which are collected for internal statistical measures should be published. ie should we make it easy to get a number that says 4.6 for Mr Able, 5.2 for Ms Awesome and 3.8 for Mr Good? At one extreme the reality may be that Mr Good isn'…

Also don't forget that Mr. Good might have tougher customers because he's Mr. Good and his prices are low or because he's willing to take on the hardest jobs that are unlikely to leave customers satisfied no matter how good they turn out. If you're the guy that everyone goes to because nobody else is willing to try and fix what you will your success/failure ratio will by abysmal.