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Employees who decline genetic testing could face penalties under proposed bill

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Re: Employees who decline genetic testing could face penalties under proposed bill

#141

Post by wyager »

int_19h wrote: post #63
wyager wrote: post #33

Earlier quoted context omitted.

> By essentially any metric, state provided (single-payer) healthcare is the best-known solution to the healthcare problem. Except things like, you know, quality of care or satisfaction. Single-payer healthcare beats the American implementation, which is not a high bar to clear. There's a reason medical tourism to Mexico and India is so prevalent. Totally deregulated private doctors seem to kick the ass of state heal…

> There's a reason medical tourism to Mexico and India is so prevalent Yes, and it's because labor is cheaper in these countries than in yours, because their standard of living is lower, and therefore living costs are cheaper. So it's cheaper for you , because you come from a country with a higher standard of living, and your income is much higher than average in those countries. So for you, their prices are cheap. B…

Nope, this is clearly wrong. Cost of labor and standard of living alone can't account for the cost difference. Average net-adjusted household disposable income is (per OECD) only 3x higher in the US than Mexico. GDPPC is 5x higher. Medical care in the US is drastically more expensive than these numbers would suggest. Claiming "it's because Mexico is poor" is a lazy argument that falls apart very quickly.

> doctors will want to be paid US wages, not Mexican or Indian wages. And then you'll find the cost of their services much less affordable.

Doctors already get paid US wages. Not really sure what you were thinking when you wrote that.

You're also wrong on two counts here; one, the primary cost sinks in the US that they don't have in Mexico are increased regulatory costs (meaning huge administrative staff), red tape (mostly around excessive malpractice and CYA requirements) leading to incredibly overpriced line items (e.g. $1500 to hook you up to an oxygen tank), and a weird incentive scheme where it makes economic sense for doctors to waste money on pointless CYA tasks like uneccesary medical scans and specialist consultations. Two, fully private doctors in the US are actually vastly cheaper if you pay in cash. I have shitty major medical insurance, so I just pay in cash for routine medicine (checkups, prescriptions, etc.). It ends up being a fraction of the cost of what I would pay with insurance at a public hospital. There are a lot of reasons it's so much cheaper, but the biggest is that getting money out of insurance companies is itself a huge money sink for doctors. Insurance companies can't afford to be good or easy anymore.

Re: Employees who decline genetic testing could face penalties under proposed bill

#142

Post by mantas »

wyager wrote: post #136
mantas wrote: post #71

Earlier quoted context omitted.

The reason is that what you pay for "cheap" service is actually the premium service over there. Super expensive private hospital in US would provide as good customer service.

That doesn't make sense. The cost of goods doesn't magically scale linearly with GDPPC, even service-heavy goods. Even if it did, that wouldn't be a valid explanation. According to the OECD, average net-adjusted household disposable income is only 3x higher in the US than Mexico, but our medical care is many times more expensive than that.

US medical care is much much more expensive than most, if not all, developed world. I'm too lazy for google for source, but there was statistics that US gdp/capita medical expenses are like 2x next country. Even in super expensive countries doctors don't earn as much which is part of the issue.

I'm from rather cheap European country. We're on the receiving end of medical tourism. To cut costs, private hospitals save wherever they can. Nurses (as well as junior doctors) are paid less (gdp-adjusted) than in richer countries. Corners are cut in non-essential (parts of) procedures. Behind-the-scenes equipment is outdated. Anything customer-facing is top notch though.

Source: ex-gf was a nurse in private hospital

Re: Employees who decline genetic testing could face penalties under proposed bill

#143

Post by lmz »

chongli wrote: post #131
lmz wrote: post #114

Earlier quoted context omitted.

Sounds like a good argument to not let even one of them in.

You must must've missed the part where I mentioned that they are already here. They are us . We aren't going to be able to pull up the ladder. People will try, though, and it will get very ugly, very fast.

If by "here" you mean North America and Western Europe then yes, they will pay the price for their diversity. Places like Japan and China that people say are "xenophobic" might turn out to have the better survival strategy.

Re: Employees who decline genetic testing could face penalties under proposed bill

#144

Post by Exofunctor »

electricEmu wrote: post #59
Exofunctor wrote: post #49

While I think health insurance shouldn't be attached to employers, I don't really have an objection to insurance companies using genetic testing. This is certainly an unpopular opinion here, but as someone who believes that medical care is a service, not a right: I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used. When you have car insurance, the insuranc…

> I think it's unfair to force people to subsidize the healthcare of other people, regardless of the mechanism used. This is literally car insurance in the United States. You buy insurance, put money up front for your own health, or risk paying a penality. It's also literally the ACA. > If let health insurance companies do this, then yes, healthcare would get substantially more expensive for very risky/unhealthy peop…

I can't imagine how people have such an incorrect view of how insurance works.

No, car insurance is not you subsidizing other people. Car insurance is you paying in proportion to your own estimated risk. That means if your expected costs are 5x higher (nicer car, young driver, etc.) you pay 5x more.

Medical insurance in the US emphatically does not work this way. More expensive people don't pay proportionately more than cheap people, meaning that the expensive people are being subsizidized. You should be alarmed at the fact that you apparently fundamentally misunderstood the way insurance works in an open market, or what the ACA is. The only part of the ACA that is even reminiscent of car insurance is the individual mandate, which is actually way worse than car insurance because you don't need to buy car insurance just for being alive. You only need car insurance if you drive on public roads.

It's too bad that your friend has a disease, but I'd rather have them pay for it than pass the bill off to a bunch of innocent people who aren't sick. If you choose to have tunnel vision and focus on health alone, it's worth noting that the second-order effects of making other people's lives more expensive will also include worsened health from poorer nutrition, increased stress, less frequent medical consultation, etc.

Re: Employees who decline genetic testing could face penalties under proposed bill

#145

Post by mantas »

wyager wrote: post #138
DanBC wrote: post #97

Earlier quoted context omitted.

US healthcare is expensive and, by some measures, not that good. http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com... > Despite spending, by far, the largest amount on healthcare, the USA was among the 10 OECD countries with the lowest life expectancy. What you propose will make it more expensive, and doesn't seem to address anything around patient safety or efficiacy of treatment. You will end up with nic…

Yes, as I said multiple times, US healthcare is bad. > What you propose will make it more expensive Do you have any evidence for this, or are you just going to drop the claim and walk away? I have some constructive evidence to the contrary, which I've already mentioned; the medical systems of Mexico and India. > The US medical system is currently risk averse Which is one of the many reasons that substantially deregul…

Mexico health care is doing very poorly [1] and they've switched to single-payer euro-style system recently [2]. India is switching to single-payer too [3]. Their current numbers don't look nice either.

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

[2] http://commonhealth.legacy.wbur.org/2012/08/mexican-universa...

[3] http://international.commonwealthfund.org/countries/india/

Re: Employees who decline genetic testing could face penalties under proposed bill

#146

Post by eru »

hocuspocus wrote: post #140
eru wrote: post #137

Earlier quoted context omitted.

I was only an intern. The food was good, but the work was boring. German law says that union representatives can get an almost equal say in company matters. SAP had a vote, most people were against union representation, but by German law any nine (9!) employees in favour in the whole company is enough. So SAP got some people from IG Metal (ostensibly a metal workers union!) on their board. Most of my coworkers saw th…

Electrical and mechanical engineers are in high demand too, and afaik they don't complain too much about their strong unions. And I know SAP is a decent company. Anyway the comparison with the situation in the US is a bit pointless. More than unions, they need basic workers' rights.

The US has enough poisonous unions. (The German and Scandinavian ones tend to be more bearable on the whole.)

The US has a lot of problems, but what makes you think they need more workers' rights? A saner tax system would be a good start---so that eg health insurance and employment can decouple. (Right now, their employer provided health insurance is subsidized, so individuals are rationally stuck with that model.)

Re: Employees who decline genetic testing could face penalties under proposed bill

#147

Post by hocuspocus »

eru wrote: post #146
hocuspocus wrote: post #140

Earlier quoted context omitted.

Electrical and mechanical engineers are in high demand too, and afaik they don't complain too much about their strong unions. And I know SAP is a decent company. Anyway the comparison with the situation in the US is a bit pointless. More than unions, they need basic workers' rights.

The US has enough poisonous unions. (The German and Scandinavian ones tend to be more bearable on the whole.) The US has a lot of problems, but what makes you think they need more workers' rights? A saner tax system would be a good start---so that eg health insurance and employment can decouple. (Right now, their employer provided health insurance is subsidized, so individuals are rationally stuck with that model.)

Besides health insurance: retirement pensions, short-term/long-term disability/incapacity, unemployment benefits, reasonable notice periods and severance pay, parental leave, ... all these things are a given in Germany and in most 1st world countries.

Re: Employees who decline genetic testing could face penalties under proposed bill

#148

Post by marchenko »

randyrand wrote: post #21

If two consenting adults want to make a agreement that includes exchange of their own genetic information, I really don't see the issue. There are plenty of employers that don't require genetic information. If you don't want to give your genetic information to your employer it's simple, don't work there. Companies that can't hire employees go out of business. This is a self correction 'problem'. We don't need legisla…

The other problem is that it is impossible to contract to give solely _your own_ genetic information: your DNA necessarily informs on your relatives in a predictable, probabilistic manner. Should they be informed that a third party can reasonably infer salient features of their genome? Should they have to consent?

Re: Employees who decline genetic testing could face penalties under proposed bill

#149

Post by icebraining »

pdkl95 wrote: post #128
icebraining wrote: post #107

Earlier quoted context omitted.

It seems like many people implicit assume that a union must involve a list a of traditional practices. It's not an assumption that it must, it's a recognition that very likely, it will. Organizations aren't created in a vacuum, they require bringing in others, and if you're starting an union, you'll attract people who are already predisposed to all the ideas of what makes up a union, and you'll attract offers of help…

> no valid reason to believe that you'll be able to control that process People aren't interested in small-scale organizing for specific purposes because strong, traditional unions are too popular? Why aren't the same people you claim will "control [the] process" making a union now? Yes, just like every other type of organization, a union - or business - can evolve beyond it's original purpose. There are no guarantee…

Look, we weren't discussing whether unions were good or bad; we were discussing why people don't believe it's in their best interest to form or join one. I'm telling you why I think you are mistaken about their motivations, not that you are mistaken in your belief that a union would in fact be a positive thing for tech workers.

Re: Employees who decline genetic testing could face penalties under proposed bill

#150

Post by eru »

hocuspocus wrote: post #147
eru wrote: post #146

Earlier quoted context omitted.

The US has enough poisonous unions. (The German and Scandinavian ones tend to be more bearable on the whole.) The US has a lot of problems, but what makes you think they need more workers' rights? A saner tax system would be a good start---so that eg health insurance and employment can decouple. (Right now, their employer provided health insurance is subsidized, so individuals are rationally stuck with that model.)

Besides health insurance: retirement pensions, short-term/long-term disability/incapacity, unemployment benefits, reasonable notice periods and severance pay, parental leave, ... all these things are a given in Germany and in most 1st world countries.

All those benefits have to be paid for. (And the US does have quite a lot of people on long term disability benefits.)

Restrictions on firing just make companies less likely to hire.

People can negotiate reasonable notice periods, and parental leave, severance pay etc, if they rather want that than more money every month. (But that negotiation / demand only works if the economy is humming along fine. So that is way more important.)

Germany and the US could both become more like Singapore. That would be a step forward.

I find it a very weird streak in Germany that they have a lot of mandatory `insurance' that mixes up some actual insurance aspects with welfare and redistribution. I think it would be cleaner to separate these two aspects.

(And Germans do have quite a high appetite for redistribution via their taxation and benefit systems, and vote accordingly. Nothing wrong with that preference in a democracy.)

I am more sympathetic to the nordic countries that marry their social safety nets with reasonable free economies.

And I'd really like to see a country try and rely on Land Value Taxes instead of taxing labour and capital. An LVT can raise an enormous amount of revenue without any deadweight losses to the economy. So you could run a lavish welfare state, and have a dynamic economy without a large wedge between gross and net pay for workers.

Henry George in America was a major proponent of these. In Germany Silvio Gesell wrote some interesting books a hundred years ago.

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