Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Health care is turning into a consumer product

economist.com

Post reply on HN
Print view View original

181–190 of 334 posts

Re: Health care is turning into a consumer product

#181

Post by lotsofpulp »

wreath wrote: post #168
dragonwriter wrote: post #149

Earlier quoted context omitted.

> but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance. That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a h…

> leaving you uninsured and uninsurable. This one is pretty messed up indeed. What's the purpose of being insured to begin with if it will fuck you over when you need the insurance?

It has not been true for 10+ years.

Affordable Care Act (ACA) outlawed denying insurance to anyone, regardless of how much their future healthcare expenses will be.

It is one of the reasons that everyone complained about ACA increasing health insurance costs - it had to because more people were getting more healthcare.

ACA also outlaws pricing insurance on anything other than age, smoking status, and location. Even the pricing due to age is capped so that the premium for the oldest (riskiest) age is only allowed to be 3x the young age premium.

ACA also implemented out of pocket maximum for in network care, so that there is a maximum cost per calendar year you would be responsible for. Recent law that went into effect Jan 1, 2022, extends this out of pocket maximum to all healthcare providers in the US if it is an emergency.

Finally, ACA also instructed an appeal process if you think the insurance company is denying payment for treatment justified with evidence:

https://www.healthcare.gov/appeal-insurance-company-decision...

Re: Health care is turning into a consumer product

#182

Post by rkk3 »

avgDev wrote: post #163
rkk3 wrote: post #158

Earlier quoted context omitted.

> the pile of trash that the US healthcare is There are significant problems but whose Vaccine did you take for Covid-19? Pfizer (Us), Moderna (US), Johnson and Johnson (US)...

Do you think universal healthcare would affect pharmaceuticals? I think it would not be relevant to the vaccines as we would still spend money on R&D under the pandemic threat.

> Do you think universal healthcare would affect pharmaceuticals?

Yes, I would think a massive fundamental change in the healthcare system would have an effect on Pharma. But who knows what that would look like

> I think it would not be relevant to the vaccines as we would still spend money on R&D under the pandemic threat.

They would spend money, but it's not hard to envision a world where we didn't have multiple fully tested, safe & effective vaccines in less than a year.

Re: Health care is turning into a consumer product

#183

Post by stremrn8 »

omosubi wrote: post #119
dgb23 wrote: post #76

Earlier quoted context omitted.

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree…

Re: prisons - This isn't necessarily the case. Florida's private prisons have air conditioning and the public ones don't in part because of democratic control and the private ones have fewer deaths from heat stroke as a result.

[dead]

Re: Health care is turning into a consumer product

#185

Post by vorpalhex »

KittenInABox wrote: post #167
bluedino wrote: post #162

Earlier quoted context omitted.

Not basically the same people. Canadian and US culture aren't the same. And the racial makeup is quite different. 57% of the USA is white, compared to 73% of Canada. Nearly 20% of the USA is hispanic, compared to 1% of Canada. There are many more Asians in Canada and much less people of African origin.

I don't reasonably consider that we can attribute black people and hispanic people simply existing to an additional 8% of GDP in healthcare consumption. That seems like a huge claim with no evidence provided. I'd like to first see evidence that people of different race has a causality effect on healthcare consumption.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181672/

Re: Health care is turning into a consumer product

#186

Post by bluedino »

KittenInABox wrote: post #167
bluedino wrote: post #162

Earlier quoted context omitted.

Not basically the same people. Canadian and US culture aren't the same. And the racial makeup is quite different. 57% of the USA is white, compared to 73% of Canada. Nearly 20% of the USA is hispanic, compared to 1% of Canada. There are many more Asians in Canada and much less people of African origin.

I don't reasonably consider that we can attribute black people and hispanic people simply existing to an additional 8% of GDP in healthcare consumption. That seems like a huge claim with no evidence provided. I'd like to first see evidence that people of different race has a causality effect on healthcare consumption.

I'm not blaming races, I'm just saying the people are different. Even white Americans and Canadians are not the same.

Per the CDC:

Among men, the prevalence of obesity was over 8 percentage points lower in Canada than in the United States (24.3% compared with 32.6%) and among women, more than 12 percentage points lower (23.9% compared with 36.2%)

In the United States, the majority of the nonwhite population is black or Hispanic for whom the prevalence of obesity is higher than it is for the white population (3). Among nonwhite Canadians, the largest group is comprised of East/Southeast Asian persons for whom the prevalence of obesity is lower than it is for the white population

Re: Health care is turning into a consumer product

#187

Post by donatj »

What I want is going to the doctor to be more personal, more like it was in the 90s.

Right now I go to the doctor, and they stare at the computer and take notes for 20 minutes before they can even actually look at me or look at at why I came in.

Just dot the room with mics and record our conversations or something if you need it logged.

Re: Health care is turning into a consumer product

#188

Post by nradov »

andrekandre wrote: post #82
throwaway0a5e wrote: post #57

Earlier quoted context omitted.

Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. Using insurance, government or some other centralizing layer (e.g. the church) for routine activity would raise massive "you're pissing money away" red flags in literally any other context. We shoehorn so much economic activity (healthcare) though a middle man (…

> Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong? just a guess, but it might be because of... Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US. ... one of the reasons most visits in the us is the er is precisely because preventative care is so expensive/hard-to-get in the u.s and people pu…

Preventative care in the US isn't expensive or hard to get for most patients. Under the Affordable Care Act (Obamacare) there are a wide range of preventive services that must be covered at no cost to the patient. While some coverage gaps remain, those plans cover the majority of US residents.

https://www.healthcare.gov/coverage/preventive-care-benefits...

Re: Health care is turning into a consumer product

#189

Post by mumblemumble »

dgb23 wrote: post #76
pjc50 wrote: post #54

Earlier quoted context omitted.

The problem is that "market" is a really bad fit for meeting healthcare needs, and doubly so when it's intermediated by insurers. People get the amount of healthcare they can afford from their discretionary budget and work their insurers for - not the amount they need. So they may get "more" (or at least more expensive) care than they need, or less. Note that many of the European systems are semi-private, so you reta…

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree…

One thing to note about US healthcare is that it seems almost deliberately engineered to not be a market.

I've never received significant health care in another country, so I can't say how the US system differs from others with any expertise. But I can say how US health care differs from just about anything else I spend money on:

1. I don't really get to shop for health insurance providers. My employer picks one, maybe two plans, and I can take it or leave it. If I leave it, I am leaving at least $10,000/year on the table, so I generally take it.

2. Even when I am on the market, the phenomenon in #1 does weird things. Once upon a time, when I was choosing my own health insurance, I started a new job with health insurance benefits that I did choose to take. But my start date was toward the beginning of the month, my old insurance wouldn't let me do a partial month, and the new employer wouldn't let me delay opting for coverage. So I was essentially forced to own two health insurance plans simultaneously for a period of time.

3. Nobody knows what care will cost ahead of time, which makes it impossible for me to make any informed economic decisions. I need to see a physical therapist. I called a few places to shop for prices. They all know what the rate for uninsured people is, but the only way we can find out what it will cost with my insurance is if I receive care, they submit a claim, and then we all find out together what the price was, after the fact.

4. #3 creates a situation where they can hide all sorts of excessive charges. When my first child was born, I got lessons on how to give him a bath and change his diaper. Both of which I already knew; I was really just going along with the lessons to be polite. I certainly wouldn't have said yes if the hospital had been transparent and up-front about the price tag on this lesson: about $2,000.

5. And sure, insurance covered most of it... but that didn't make it free; it just means the price was amortized over a large number of health insurance premiums. Unfortunately, I think that this setup makes it all too easy for us to think of these things as free, which, in turn, reduces public scrutiny over where the money comes from or where it goes.

And it just keeps going like that. Compare with signing up for cell phone service. It's a famously sleazy business, but, even with all the hidden fees they like to tack on, at least they're up-front about the basic price of service. With US health care, every fee is a hidden fee. That makes it impossible for consumers to make free, informed decisions, which is the most fundamental precondition that must be satisfied in order for a capitalist market to form.

Re: Health care is turning into a consumer product

#190

Post by vorpalhex »

dragonwriter wrote: post #149
wreath wrote: post #145

Earlier quoted context omitted.

> Another point is that US healthcare is considered the most expensive and worst-performing in terms of outcomes compared to the other developed countries. In what way is it the worst-performing? I mean, what are the outcomes that are measured to determine its performance? Yes, healthcare is a lot cheaper in Europe (even if your employer wouldn't pay their part) compared to the US, but the quality of the service is r…

> but the quality of the service is rather poor with very long waiting lists, stubborn doctors who don't want to perform certain tests (as simple as a Vitamin D or a testosterone test) so they don't have to justify it to the insurance. That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance; we just pay twice as large a share of GDP and even a h…

> That's exactly like US healthcare if you aren't either a wealthy private-pay client or someone with top-flight private insurance;

My local very not fancy clinic schedules within 48 hours (within 8 hours if you pay the $10 convenience fee) and has always done a very good job.

Do you have any citation that US healthcare typically has very long waits?

Post reply on HN