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

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

#171

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

ChuckMcM wrote: post #44

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?

In theory? As I understand it ... A market allows for innovators to find ways to deliver better service for less money and thus offer a more competitive product and gain market share. This competition forces all players to improve, or be forced from the market. A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.…

> A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.

In the UK, the NHS has the incentive to improve its operational efficiency that it simply gets told regularly "we're cutting X billions of your budget. Deal".

The NHS is also split up into a range of trusts that have independent management teams. While there's a lot of cooperation and shared resources, this means there is a lot of opportunity to compare cost and outcomes, and so they can't just hide behind "but that's how much it costs", because the government will know it if there are other trusts delivering similar outcomes at a much lower cost.

And they have the incentive to respond to complaints in service that the NHS Trust in questions board of director will find campaign groups talking to MPs and cabinet ministers, tabloids calling them murderers and the like if they don't keep quality under control, and if they don't respond appropriately, the trust will get put under special measures which can include letting another trust take over management.

There are plenty of ways to apply pressure in addition to markets.

But you have some points: You can certainly make things better by e.g. requiring more transparency.

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

#172

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

nappy-doo wrote: post #137

VonGuard wrote: post #117

Earlier quoted context omitted.

If Clinton brings us single payer, I will worship at her altar forever. She used to promise this stuff in the 90's, but basically gave it all up when she actually went into politics and gained public office, later saying single payer will not work. If she does get us single payer, she's the greatest trojan horse ever in American politics.

> If she does get us single payer, she's the greatest trojan horse ever in American politics. Arguably, that'd be Trump instead of Clinton.

I think Trump is more of an infected pot of filth catapulted over the walls... Not sure he's hiding much.

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

#173

Post by ruste » Wed, Aug 17, 2016, 7:42 PM UTC

brightball wrote: post #89

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?

The benefit vs how they happened are very different things. Initially, the benefit was that people paid all medical expenses out of pocket and could purchase insurance in case of extreme medical issues. Businesses started offering health insurance as a perk to attract employees and would negotiate a group rate. This benefits the business by both helping to attract / retain employees as well as helping to keep those e…

This is the best explanation I've seen so far.

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

#174

Post by vidarh » Wed, Aug 17, 2016, 7:44 PM UTC

mschuster91 wrote: post #102

ChuckMcM wrote: post #44

Earlier quoted context omitted.

In theory? As I understand it ... A market allows for innovators to find ways to deliver better service for less money and thus offer a more competitive product and gain market share. This competition forces all players to improve, or be forced from the market. A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.…

> If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database. Well, there's a couple of problems here: 1) People who fail to pay their bills cause financial losses, which have to be covered by the hospital. Therefore, given identical personnel/equipment/etc costs, a hospital in a "poorer" (= more unpaid bills) area will always be higher in…

Case 1 and 2 are the same whether or not you tell people up front, and if so it is downright unethical not to, as e.g. in scenario 1, poor people end up being charged more for something they might have been able to save massive amounts on by travelling to a different hospital for non-emergency treatment. Yes, you'd need to include other information, like information about outcomes.

Regarding #3, I find that peculiar. Yes, for major operations there are always potential outliers, and you need to give a range and there may be potential large exceptions. But e.g. UK private providers will happily give you a quote in advance for most non-emergency care, and for anything with a straighforward diagnosis they will be willing to give you a fixed fee quote with certain exceptions. Not least because they have the volume to either self-insure, or get insurance to cover exceptions.

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

#175

Post by harryh » Wed, Aug 17, 2016, 7:45 PM UTC

jlmorton wrote: post #170

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…

I don't think it's fair to categorize Aetna's annual loss of ~300M as trivial. That represents about 12.5% of their profits. If someone cut your salary by 12.5% I don't think you would think that was trivial.

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

#176

Post by lbotos » Wed, Aug 17, 2016, 7:45 PM UTC

snsr wrote: post #31

lettergram wrote: post #19

Earlier quoted context omitted.

The main issue with healthcare in the u.s. actually has to do with Medicare, Medicaid, and social security. All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices. Private insurance options pay larger percentages: 12 - 50%. People without insurance usually will pay either 100% or 0%, with some people…

> Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates. Bullshit. This isn't an easy problem, and you're casually dismissing systems that support millions of people.

I think the point was if everyone had to pay "full price" the full price would be lower, but right now the prices are inflated so 10% of the price is what they actually hoped to make.

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

#177

Post by british_india » Wed, Aug 17, 2016, 7:45 PM UTC

Single Payer.

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

#178

Post by vidarh » Wed, Aug 17, 2016, 7:46 PM UTC

ruste wrote: post #169

vidarh wrote: post #161

Earlier quoted context omitted.

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 g…

Yes you can. In the UK people sue the government, or specially the NHS, over treatment decisions all the time. Including over things like denied coverage of specific drugs etc. (usually when there's no proven benefit from a given drug).

And as I pointed out: If you think they are too strict, then you can pay for a private insurer to cover things the NHS doesn't cover or won't do fast enough for you.

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

#179

Post by parasubvert » Wed, Aug 17, 2016, 7:47 PM UTC

Randgalt wrote: post #82

loteck wrote: post #75

Earlier quoted context omitted.

For example, in Canada (until recently) Until recently. This means that all people can obtain health care regardless of their ability to pay, and that the system is flexible enough to continue to experiment with the ideal implementation. Are public schools better than private schools? Public schools are exactly 100% better than private schools for students who can't afford to attend private schools. Is the US postal…

1. Try getting an MRI in Canada. Canada rations care via wait lists. 2. Your argument implies that there wouldn't be low cost schools in the absence of public schools. The evidence is overwhelming that the opposite is true. 3. I live in Panama. When I need something mailed here I use FedEx or DHL. The USPS is unreliable and takes far too long. If there weren't laws against private first class mail in the US they'd be…

Canadian here.

Firstly, diagnostic care is often privately managed throughout the provinces, so if you don't want to wait, you can often pay to expedite. It's about $900 for a joint MRI.

Secondly, if you really need an MRI for a critical diagnosis, as I once did in 2012 as a hospital inpatient, I got it within 2 days.

Canada's health system is a point of national pride.

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

#180

Post by onewaystreet » Wed, Aug 17, 2016, 7:49 PM UTC

Apocryphon wrote: post #133

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…

It's more about opposing their attempts to thwart antitrust law. After AT&T's merger failed, T-Mobile used the money and the public fallout as an opportunity to reinvent themselves as a company that caters to the public. I'm wondering if this could be a similar opportunity for Aetna's competitors. If the government is unable to prevent monopolies, then consumers should step in by punishing companies that seek to mono…

The headline is misleading. Aetna didn't threaten to pullout if their merger wasn't approved, they said that they would be forced to do so because they would be losing too much money. That isn't "attempting to thwart antitrust law," it's simply stating the facts.