Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger • Hacker News Board

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#161

Post by vidarh » Wed, Aug 17, 2016, 7:18 PM UTC

QuarterReptile wrote: post #154

danielweber wrote: post #98

Earlier quoted context omitted.

The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player. http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it…

Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with.

The difference is that with most socialised systems there are two system in parallel:

A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years".

And a private system, whose priorities are, like in the US, based on how deep your pockets are.

For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator:

If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up".

If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers).

The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#162

Post by Frondo » Wed, Aug 17, 2016, 7:19 PM UTC

sweettea wrote: post #142

Frondo wrote: post #35

Earlier quoted context omitted.

Obamacare has had one significant, lasting effect: culturally, the idea is now that everyone should have access to health care. That's the default. Bringing in a public option will be an easy, natural next step, if not for Clinton, then for whoever succeeds her.

I believe statistics say that expanding Medicaid added 8 million covered folks, about 15% of uninsured Americans, and otherwise Obamacare has only gotten an additional few percent of uninsured Americans to become insured. I don't think the norm is that everyone should have access to health insurance any more than it was before due to Obamacare's negligible increases in coverage. [ http://www.heritage.org/research/rep…

Oh, I'd agree completely that, as an implementation of universal health care, Obamacare falls far short. I always say, it's better than what preceded it, but that is a pretty low bar to achieve.

(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)

But while the implementation is pretty poor, the idea behind it is significant: everyone should have access to health care. Not just tied to a job, not just if you've got lots of money. It isn't working great, but that's the goal at least.

I know there are still lots of people who come back with opposition to that idea (even in these comments a few people are trotting out the whole "universal health care is slavery" junk), but whatever, there are people who oppose all kinds of things. Obama shifted the playing field of expectations, and good things will come as a result of that. That's all I'm trying to say.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#163

Post by ende » Wed, Aug 17, 2016, 7:21 PM UTC

im_down_w_otp wrote: post #120

eridius wrote: post #34

Earlier quoted context omitted.

There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.

It wasn't Republicans that removed the "Public Option" or the Drug re-importation initiatives from the ACA. FWIW.

I wonder how many people would trade individual mandate for public option.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#164

Post by QuarterReptile » Wed, Aug 17, 2016, 7:24 PM UTC

seibelj wrote: post #2

Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

First of all, it makes no sense if you've mandated the specifications of the product being sold via legislation. Having said that, a huge benefit would be the ability to buy insurance: actual insurance, in which you're paying a subscription fee for the service of protecting you from the risk of a huge surgery bill, rather than a payment plan that covers everything inside the walls of a hospital. As a young adult, I would be happy to pay for a service that would insulate me from risk I can't handle, because it would make me financially stable. But if the plan also covers predictable things like obese people needing diabetes meds, children being delivered, and obscenely expensive cancer treatment that only slightly extends a low-quality end of life, that's a different question. Suddenly (probability of medical emergency) X (expected cost) Everything outside of those complicated, expensive procedures would suddenly be susceptible to price sensitivity, since the users would also be the people paying. Faced with that pressure, routine procedures would fall to prices that don't look like typos.

Having said that, what I've read about the British system seems like it could be effective, if it were politically feasible: procedures have to stay below the cost per unit of increase in life expectancy or quality of life, or else you have to fund it yourself. When the current American system was being battled into law, it seems like that number was about 30kpounds per year of life.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#165

Post by vidarh » Wed, Aug 17, 2016, 7:26 PM UTC

Spooky23 wrote: post #153

derekp7 wrote: post #118

Earlier quoted context omitted.

I would really like to see a breakdown of the actual costs to provide a given service. Take something simple like removing an appendix or gall bladder. You have one surgeon, one or two surgical assistants (typically med students / interns), plus a couple nursing staff, and the anesthesiologist, for about an hour. 6 people, assume 200K per year, that's $100 per hour, so $600 in people salaries. (Throw in another coupl…

The anesthesiologist alone will be $5k. They are the person most able to kill you when they screw up, so a significant portion of that bill is insurance. They also make $300-500k. Also recovery room or ICU time is very expensive -- something like $1000/hr in some cases. That type of procedure (gall bladder) will cost something like $15-20k. When I had a spinal fusion, it was a 4-5 hour procedure involving a neurosurg…

Yikes. In that case it'd be cheaper to fly to London and have it done privately here. It should typically be less than $8k for a gall bladder removal.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#166

Post by harryh » Wed, Aug 17, 2016, 7:33 PM UTC

Frondo wrote: post #162

sweettea wrote: post #142

Earlier quoted context omitted.

I believe statistics say that expanding Medicaid added 8 million covered folks, about 15% of uninsured Americans, and otherwise Obamacare has only gotten an additional few percent of uninsured Americans to become insured. I don't think the norm is that everyone should have access to health insurance any more than it was before due to Obamacare's negligible increases in coverage. [ http://www.heritage.org/research/rep…

Oh, I'd agree completely that, as an implementation of universal health care, Obamacare falls far short. I always say, it's better than what preceded it, but that is a pretty low bar to achieve. (My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.) But while the implementation is pretty poor, the idea beh…

(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)

Probably you were denied personal health insurance not for BS reasons, but because the insurance companies knew they would (probabilistically) lose money insuring you. But now under Obamacare, if they participate on the exchanges, they are obligated to sell to you. So, shockingly, we see that most companies operating on the exchanges lose money doing so.

Your inability to get coverage before and the problems that Aetna is having today are very closely related.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#167

Post by holdenk » Wed, Aug 17, 2016, 7:33 PM UTC

mhurron wrote: post #84

jasonlotito wrote: post #39

Earlier quoted context omitted.

> For the citizen, none. Actually, that's false. I can assure you that having lived in Canada and having moved to the US because of health care, having options beyond "deal with it" when not getting any sort of care or service is wonderful. Single-payer is great if you are actually getting the care you need. But when it fails, you are left with little to no alternative. What's worse is that because of the perception…

You must be pretty healthy or never actually had to pay for care in the US. You also probably shouldn't assume you're the only one in the room who moved to the US from another country. I moved to the US from Canada, thankfully I am pretty healthy and don't need the healthcare system beyond my yearly checkups. The first place I lived had someone who lived down the street who will be paying off a $100k bill until they…

So I agree the US health care system is pretty crap - but as a trans person it was still better than my options in my home province (and by options I mean option). I think we can all agree that there are corner cases for each system where they outperform the other.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#168

Post by harryh » Wed, Aug 17, 2016, 7:35 PM UTC

tptacek wrote: post #158

rayiner wrote: post #106

Earlier quoted context omitted.

What corporate chicanery? They took a loss on exchange plans last year. They have every right to pull out of the exchanges until the government makes them stay. I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-su…

You're a supporter of single payer? Health care is something like a fifth of the whole US economy. You're comfortable with the USG setting prices for it?

I don't know about single payer, but health care is tricky. What do we do (as a society) about this guy: https://news.ycombinator.com/item?id=12307526

He has his gallbladder out and all of a sudden he's a super risky person to insure. How do we get him in a risk pool where his premiums won't be unaffordable?

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#169

Post by ruste » Wed, Aug 17, 2016, 7:36 PM UTC

vidarh wrote: post #161

QuarterReptile wrote: post #154

Earlier quoted context omitted.

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it…

Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with. The difference is that with most socialised systems there are two system in parallel: A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years". A…

Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government.

Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.

Re: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

#170

Post by jlmorton » Wed, Aug 17, 2016, 7:37 PM UTC

pseingatl wrote: post #130

This is precisely why single payer is desperately needed. And proof that Obamacare is a Rube Goldberg machine. I remember listening to a Kentucky senator who said they were gobsmacked that no insurance company signed up in his state. The program is based on wishes, not good practices. Having Justice tinker with antitrust to keep it alive will never work. Insurance companies could give a F about their policy holders,…

This is not proof at all that "Obamacare is a Rube Goldberg machine." This is a major insurer pulling out the markets, but over trivial amounts of losses.

I don't know what you mean about Kentucky. There are plenty of health insurance companies with offering on the Kentucky exchanges (Anthem BCBS, CareSource Kentucky, Humana, Aetna, and Bluegrass Family Health). And in any event, even if there truly were no insurance companies with offerings on the Kentucky exchanges, I find it very implausible that either Mitch McConnell, or Rand Paul would have claimed to be "gobsmacked." They were leaders in the fight against ACA, and they certainly claimed before passage that the law would destroy the health care industry.