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What Startups Need To Know About Health Insurance in 2013

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Re: What Startups Need To Know About Health Insurance in 2013

#141

Post by jgon »

wissler wrote: post #115
jaaron wrote: post #55

Earlier quoted context omitted.

I'm likely going to regret getting into this conversation. > Our system is the final consequence of people who want safety guaranteed by the government. That's quite a statement and I expect you intended unjustifiable hyperbole. Yet, for a moment, let's jump down the rabbit hole of political philosophy debate. There are no guarantees in life (aside from death) and on this we agree. Accepting this fact does not requir…

Likewise, I decide to live in a community in which we reject the idea that we are all barbarian animals, fighting for scarce resources in a dog-eat-dog world. Your world is one where you point a gun to my head (using the government of course) and tell me what kind of medical care I can trade with some guy you don't even know. So don't talk to me about "barbarian animals", OK? Your only means of doing what you think i…

No one is pointing a gun to your head. Okay someone is "pointing a gun to your head" in the same sense they are "pointing a gun to your head" to prevent you from murdering someone.

But unless you are posting from North Korea you live in a country with the world's longest undefended border (aka the Canadian border). You can leave at any time and renounce your citizenship and literally no one will stop you.

Seriously, "pointing a gun at my head" is child talk for "making me follow the rules that I have implicitly agreed to obey by living in society", and you can at any time stop agreeing with those rules by leaving the society. Living in the society, enjoying its benefits and then crying about having to follow the rules is childish and hypocritical. If you don't like it, leave.

No one will try to stop you from leaving at gunpoint.

Re: What Startups Need To Know About Health Insurance in 2013

#142

Post by beagle3 »

tptacek wrote: post #132
beagle3 wrote: post #129

Earlier quoted context omitted.

Indeed, and that is perhaps one of the two coherent claims made by republicans against a decent public options (single payer or otherwise). Coherent Claim 1: The existence of a public option harms the viability and structure of a private option Coherent Claim 2: A healthy, careful individual should not be forced to subsidize an individual who does not take care of their own health - but is forced to by a public optio…

Those two "coherent claims" are so broad that they capture most of the the individual specific arguments made against public health insurance; a conservative could reply that there are only a few "coherent claims" for public insurance too. And, obviously, Republicans aren't big fans of public schools either. In fact, unlike private health care, which is out-executed by Medicare, public education is generally outperfo…

> two "coherent claims" are so broad that they capture most of the the individual specific arguments

That's not been my experience (I linked to a discussion from a month ago, but you can find the same points reiterated in this discussion by others). Those "other points" are not remotely covered by these two claims, and are touted far more often.

> a conservative could reply that there are only a few "coherent claims" for public insurance too.

That's true; perhaps it's just one claim - but it's a matter of fact, rather than opinion:

1. Every western country that implemented single payer spends significantly less for comparable or better results (normalized by just about every attribute you want)

(corollary) 2. Medical bankruptcies (that is, attributable directly to cost medical treatment, rather than, say, the inability to produce income due to sickness) are essentially nonexistent in any other part of the world, yet are the reason for more than 25% of US bankruptcies http://www.factcheck.org/2008/12/health-care-bill-bankruptci...

re: education - I'm with you on that. That's also something that the US can learn from other western countries - where generally, public education (at all levels, including preschool and academic levels) outperforms private education.

Re: What Startups Need To Know About Health Insurance in 2013

#143

Post by jaaron »

wissler wrote: post #115
jaaron wrote: post #55

Earlier quoted context omitted.

I'm likely going to regret getting into this conversation. > Our system is the final consequence of people who want safety guaranteed by the government. That's quite a statement and I expect you intended unjustifiable hyperbole. Yet, for a moment, let's jump down the rabbit hole of political philosophy debate. There are no guarantees in life (aside from death) and on this we agree. Accepting this fact does not requir…

Likewise, I decide to live in a community in which we reject the idea that we are all barbarian animals, fighting for scarce resources in a dog-eat-dog world. Your world is one where you point a gun to my head (using the government of course) and tell me what kind of medical care I can trade with some guy you don't even know. So don't talk to me about "barbarian animals", OK? Your only means of doing what you think i…

No, I don't point a gun to your head.

Instead, we agree on a mechanism by which to make decisions and reach compromise. As everyone has different opinions and agendas, compromise is required. Not everyone, no one perhaps, will get their full agenda realized. Via those mechanisms (voting, representation, legislating, enforcement), we establish the rules of the society.

If you don't like the rules of the society, you can choose to engage the mechanisms in an effort to change the rules. Or you can choose to leave and find a society more appropriate for you. Or you can choose to incite rebellion and expect appropriate resistance if the majority of the population do not support you.

What you don't get to choose is to enjoy the benefits of the society and ignore the rules, requirements and responsibilities of the society. You can be a sore loser, take your toys and go away, but you can't be a freeloader by enjoying the benefits but not taking on the burden of responsibility.

Now, that's an idealized version of civilization, I understand. The rules are often broken, twisted, manipulated. These are the injustices we must resist and fight to overturn. Yet I argue that the imperfect nature of civilization is not an excuse to reject it, but rather a call, or even a responsibility, to participate.

Re: What Startups Need To Know About Health Insurance in 2013

#144

Post by protomyth »

onetwothreefour wrote: post #124
protomyth wrote: post #60

Earlier quoted context omitted.

Since the US acts as a safety valve for Canada (look at the number of Canadians getting treatment in the US) and the USA's version of public health care for a small subset of the population is a disaster (google: don't get sick after june), I would much rather we pick some solutions other than public health care. I really wish the US had started with better Health Savings Accounts, Catastrophic Insurance[1], tort ref…

Ah, the age old "tort reform" line. Haven't heard that one in a while. Your stats about Canadians is total BS.

"Ah, the age old "tort reform" line. Haven't heard that one in a while."

I would guess that your not following all of the issues. Tort reform is going to have to be on the table or we are going to lose more general practitioners (not terribly popular now) and OB/GYNs. Insurance costs are not just a patient issue.

"Your stats about Canadians is total BS."

Not really sure how to respond to this one. If you mean the waiting list times, then you are wrong. If you mean the cancer survival rates, that you are wrong. These are not exactly in dispute and are very much related.

Re: What Startups Need To Know About Health Insurance in 2013

#145

Post by beagle3 »

prostoalex wrote: post #135
astrodust wrote: post #35

Earlier quoted context omitted.

Here in Canada, if you want "better than basic" health-care you can pay for it yourself. The net cost is under $1,000 a year for a typical individual who wants the deluxe treatment.

Net cost of what? Pregnancy with complications, chemotherapy, spinal surgery or teeth cleaning is all <$1,000 with deluxe package?

net of teeth cleaning, it is included in the $0 basic packages (paid by taxes, so of course you pay for it if you pay taxes. But you get it even if you never worked and are unemployed and never paid taxes. Also, the taxes are independent of any "pre-existing condition" or anything like that).

Dental is not included in the $0 package. A dental package likely includes cleaning, for less than $1000 a year, yes.

Re: What Startups Need To Know About Health Insurance in 2013

#146

Post by IanDrake »

beagle3 wrote: post #139
IanDrake wrote: post #67

Earlier quoted context omitted.

Total BS. Have any figures to support your first point? Here's CIGNA: http://yhoo.it/TLkvyd increase in Net Income: 2010 - 3.3%, 2011 - (1.3%) >the more they will be able to dictate our choices Private companies can't force you do to anything, only government can do that. http://bit.ly/Q4lj1s http://nbcnews.to/rK90ox >government control is that we actually have some say in how the government controls us because at th…

> As it is there is a shortage of nurses and doctors. Partly because it costs a lot of money and effort to enter that profession. In the not-so-distant-past (less than 10 years ago!) mostly because the AMA tightly controls the influx of new people to the field, in an attempt to make sure that the salaries remain high: http://skeptics.stackexchange.com/questions/4561/does-the-am... (Although now they are trying, so fa…

>And yet, the US system is the most expensive system for what it gives...

I was making a generalized comment. As you said, the US healthcare industry is extremely regulated, which is what I believe is the root of the problem we face.

People who want a the government to control health care are pointing at a system with a ton of government interference and saying "Look that isn't working well, we must need more government."

>How do you think that affects choice? Poorly. But they're exempt because they're also force to take all comers. It's a water fall of faulty logic and regulation.

I'm not defending the current system. I'm advocating a free market system, which isn't anything like what we have right now.

Re: What Startups Need To Know About Health Insurance in 2013

#147

Post by beagle3 »

IanDrake wrote: post #140
te_chris wrote: post #138

Earlier quoted context omitted.

You say that as if socialised medicine is somehow novel and untested? Look at most of the Commonwealth countries, there are no shortage of students applying to study medicine and they still get paid well. Take your blinkers off - or leave them on to be honest, I'm super happy with my socialist healthcare (which I supplement with cheap private cover for faster elective procedures).

Look at most of the Commonwealth countries. Which one specifically? >I'm super happy with my socialist healthcare Net consumers are typically very happy in socialist environments, no shock there.

> Net consumers are typically very happy in socialist environments, no shock there.

99.9% are net consumers when it comes to healthcare. So you're saying we shouldn't do something that makes everyone happy?

The 0.1% providers should be made happy. Apparently, despite the claims laid by many Americans who argue this, almost every other western country has managed to make those providers happy enough to not all quite en masse and leave everyone without access to healthcare.

Re: What Startups Need To Know About Health Insurance in 2013

#148

Post by paulhauggis »

rprasad wrote: post #25
paulhauggis wrote: post #6

Earlier quoted context omitted.

Issues I have with public health care: 1) The government hasn't been able to run anything efficiently as long as I've been alive. It's not like we can just go back if UHC doesn't work out. 2) The more the government runs our lives (especially something like health care), the more they will be able to dictate our choices (what we eat, risky behavior, etc). 3) I haven't seen one person that supports public health care…

Issues with private health care: 1) Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives. 2) The more private companies run our…

"Private health insurers haven't been able to run anything efficiently as long as I've been alive. My premiums go up by double digit percentages every year because "costs" keep increasing, but at the same time, insurers' profits go up by double digit percentages every year. It seems like this is simply a money transfer to health care executives."

If they could compete across state lines, this would be different. You also seem to leave out the government regulations in place, which many times hurts the consumer rather than helps (see: Obama care).

"The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc). Oh wait... corporations already do dictate what we eat, what sort of medicine we use, where we work, how we communicate, how we move around, what we wear...The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government."

So you are saying because all of the people here on HN and in the US that want MJ legalized, it's magically legalized? That's not how the government works.

What about the TSA and all of the control they have over us? We have a say..right?..right??

"The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government."

The government can send you to prison for not doing what your are told. A corporation can do no such thing. If you don't agree with what a corporation is doing..you can just stop giving them money. Is there an opt-out with taxes? or following the law?

"And the downsides to private health care: all of the above"

With private health care, you have no choice. Yes, there may be private care, but it's so expensive..only the truly wealth can afford it (see: the UK). I still want a choice.

Re: What Startups Need To Know About Health Insurance in 2013

#149

Post by davidmr »

caseysoftware wrote: post #107
mrbird wrote: post #83

Earlier quoted context omitted.

David Goldhill wrote an excellent piece in The Atlantic a few years ago on this topic. The fix is quite simple, but nearly impossible to implement: Stop using insurance for health care, and buy actual insurance (you know, for catastrophes). How often do you use your car insurance? Fire insurance? That's because insurance is designed to never be used, by most people. Health insurance has been unfortunately recast into…

That's the core concept behind a Health Savings Account and has been excellent in my case. If you think of it as a 401k - put money when you're young before you need it - I think it is viable for many people under in their 20's and early/mid 30's. But HSA's were eviscerated until Health Care "Reform" so it probably doesn't matter now anyway..

I'm sure that you're aware of this (and is why you used the word "many"), but the fundamental problem with this is the assumption that you're saving when young for what you need when old. There are those of us who aren't particularly healthy through no fault of our own.

While I'm sure no system under the sun could be made universally fair, it seems particularly unfair to saddle people with vastly different costs based on purely external factors. With nearly every other expenditure I can think of, a person has a choice whether to pay it or not, or at the very least whether to pay more or pay less. If I wind up in the hospital, there are a certain number of things that need to be paid for no matter what. My employer gives me an option for a regular PPO and an HSA-based PPO. The latter would have cost me several thousand more a year.

And all of this notwithstanding, this methodology of health care payment doesn't appear to me to work for people who actually have no or very little money. I'm fortunate enough to not be one of those people at the present, so I couldn't say for sure how an HSA-based health care system would be any better or worse for them than our current system.

Of all the things I'm thankful for, being thankful that it's not my job to try to figure this stuff out is near the top of my list.

Re: What Startups Need To Know About Health Insurance in 2013

#150

Post by grecy »

protomyth wrote: post #101
grecy wrote: post #45

Earlier quoted context omitted.

1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that. 2) This is a naive line of reasoning. The (socialist) FDA already stops you from buying food with lead in it. The (socialist) DMV forces you to wear a seat-belt and wear a motorbike helmet and the (socialist) Police stop you beating people up on the street whenever…

"1) Given that the health insurance companies in America make billions in profit every year, I'm confident the government can be more efficient than that." Given this theory, explain Indian Health Service. Point 1 is bad reasoning and demonstrated to be false. On point 2, rules are not inherently socialist (Capitalism actually requires a strong rule of law).

I have no idea what Indian Health Service is.

I know rules are not inherently socialist, what I was saying is you already live with a ton of them, and thinking that adding a few more will drastically decrease your "freedoms" is delusional at best.

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