Money Won’t Buy You Health Insurance • Hacker News Board

Re: Money Won’t Buy You Health Insurance

#231

Post by rdouble » Tue, Feb 22, 2011, 3:01 AM UTC

muhfuhkuh wrote: post #228

tptacek wrote: post #206

Earlier quoted context omitted.

This is an utterly nonresponsive comment. If the economics of providing healthcare don't work out, they don't work out. It's not as if "go into debt" means "fat cats make less money". No, it means that the skilled labor and capital that drives the insolvent health care system will simply migrate somewhere they can deliver it profitably. Say goodbye to hospitals for rural and poor areas.

"Say goodbye to hospitals for rural and poor areas." That was happening anyway, if it weren't for Medicaid, that is. There was a definite brain drain of doctors (especially specialists) who choose to go to affluent suburbs and urban areas simply because they get more (and better quality, AKA rich) patients. You think if we _further_ privatized the market, those in rural areas would be _better_ served? Isn't that the…

Few doctors want to live in a rural area for lifestyle reasons more than salary. A GP or surgeon can make more money in a rural area.

Re: Money Won’t Buy You Health Insurance

#232

Post by joe_the_user » Tue, Feb 22, 2011, 3:05 AM UTC

muhfuhkuh wrote: post #110

Groxx wrote: post #22

Earlier quoted context omitted.

> to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation. This fits a fair number of cost complaints I hear over healthcare. Who wouldn't like to pay $50-100/month to have something better than emergency healthcare support? But thi…

Japan forces their doctors to charge only what's published in a book that the government issues and negotiates prices periodically. Simple price fixing in an otherwise private healthcare market. In return, Japanese doctors and hospitals (FYI, there are more private hospitals in Japan than the US) are allowed to set whatever prices for ancillary services (like private or semi-private rooms) that they want. BTW, the av…

Yeah,

In fact, forcing US hospitals and doctors to publish a price of any kind would be a simple improvement.

It is amazing with all the other twiddling that this approach never appears - at least not much.

Re: Money Won’t Buy You Health Insurance

#233

Post by SoftwareMaven » Tue, Feb 22, 2011, 3:06 AM UTC

Health insurance is broken because the people who pay the bills (the insurance companies) are not the people receiving the services (patients).

If patients were actually paying the bills, they would be much more price-conscious and you would see price competition on that stupid-expensive MRI (for evidence, look at how much cheaper LASIK surgery has become and how much better it has become, yet insurance does not cover it).

Doctors, on the other hand, are far more concerned about making sure the people paying the bills are taken care of. The proof that you aren't the customer is the 90 minute wait that is expected when you see a doctor. What other industry would force their customer to wait that long after making an appointment? But, since you are not the customer, that's OK, isn't it.

Having had a gastric bypass, I will never be able to get insurance outside of a group plan. My wife can't get coverage for other reasons. One of my four kids can't get coverage, either. I'm 9 months into my COBRA for the start-up I'm working on. If we don't have a group plan in the next 6 months, I will have to bail on the company.

And our government can't even bother to have a real dialog on the subject. Pisses me off.

Re: Money Won’t Buy You Health Insurance

#234

Post by prodigal_erik » Tue, Feb 22, 2011, 3:08 AM UTC

kooshball wrote: post #128

rapind wrote: post #53

Earlier quoted context omitted.

As a group you have more leverage purchasing pretty much any service. I wonder what it would take to put together a group buy app for health insurance.

> As a group you have more leverage purchasing pretty much any service although this is true, the leverage gained through group is different for other services, where a bulk order is much cheaper. Assuming everyone's making rational decisions, the only people that would want insurance would be the high risk ones. Insurance companies would loss money regardless of the rates they charge because the only rational people…

Even healthy people are made out of meat, which is the ultimate pre-existing condition. Are there really a significant number of people who think it's rational not to seek insurance, as opposed to not having enough income to meet the market price?

Re: Money Won’t Buy You Health Insurance

#235

Post by euccastro » Tue, Feb 22, 2011, 3:10 AM UTC

nostrademons wrote: post #171

MaysonL wrote: post #115

Earlier quoted context omitted.

Fat content has virtually nothing to do with obesity. I get 20-30% of my calories from fat (mainly butter and cheese), weigh about 155 lb., 6-1, lipid levels good.

You could tax calories instead. Calories in - calories out seems to be a pretty good proxy for weight gain. And I bet I wouldn't drink quite so much soda if it couldn't be had for 75c per 2-liter bottle.

Calories in-calories out is a pretty bad proxy for weight gain and health in general. Google Gary Taubes; he's done a great job of digging up and deconstructing a century's worth of research on the matter.

Re: Money Won’t Buy You Health Insurance

#236

Post by maguay » Tue, Feb 22, 2011, 3:10 AM UTC

kgrin wrote: post #24

krschultz wrote: post #6

The subtle but crazy part about this is at the bottom when it details the author: "Donna Dubinsky, a co-founder of Palm Computer and Handspring, is the chief executive of a computer software company." I'm going to go out on a limb and say money is not an issue for Donna, yet she still can't even buy insurance if she wants to. I've always thought healthcare access was a bigger hurdle for entrepreneurs than tax rates.…

I've said it before and I'll say it again - the MA health care law ("RomneyCare", which is functionally very similar to "ObamaCare") is really what let me start a startup - the money wasn't the issue, but the ability to get an individual policy at a reasonable (not at all subsidized, just group-negotiated) rate was.

Amazing. I just looked over MA's health care info, and it's much more affordable (and covers much more) than the average insurance plan in other states. Congress, THIS is what we need for all of America (or something that's at least that level of coverage for that price...)

Re: Money Won’t Buy You Health Insurance

#237

Post by joe_the_user » Tue, Feb 22, 2011, 3:15 AM UTC

tptacek wrote: post #207

damoncali wrote: post #201

Earlier quoted context omitted.

What people don't like to admit is that free markets don't work for healthcare. What is the price you're willing to pay for curing that tumor in your gut? Everything you have. There is no supply vs. demand. Only supply vs infinity. What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty. Because of that, some sort of non-market intervention is simply unavoidable.…

This is a weird summary of how "free markets" and "supply and demand" work. Yes, you will pay everything you have for a cure. But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your doctor is known. And he knows he's got by the genitalia and will charge accordingly since with even a thousand unknown providers, your real choices are very limited.

Just as much. Presently, no American hospital publishes its price list. I believe there's no regulation about this. Why hasn't "the market" impelled these providers to publish their prices.

Re: Money Won’t Buy You Health Insurance

#238

Post by muhfuhkuh » Tue, Feb 22, 2011, 3:15 AM UTC

tptacek wrote: post #223

muhfuhkuh wrote: post #219

Earlier quoted context omitted.

"More importantly, the 'price fixing' approach to health insurance simply isn't going to happen in the US." Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund? Th…

No, there won't be riots in the streets, because it would take amendments to the Constitution to institute price-fixed health care. Clinton's wildest single-payer fantasy (which, coincidentally, is one of my wild fantasies) would be easier to accomplish, and it, too, is D.O.A. My objection to your point is twofold: (1) It is total wishful thinking. (2) It's wishful thinking in the face of pragmatic solutions that cou…

"Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance"

Guaranteed-issue meaning "you have to get it, but we [the insurer] can charge whatever the hell we want. So, you, small biz of 10 employees with one person who had cancer, you premium is now more money than the GDP of Haiti, per month. Thanks and come again!"

That kind of practice can be fixed by either 1) price-fixing or 2) subsidies forever, the latter of which is really, REALLY expensive.

"an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today)"

The one that the Obama administration just gave $240 million to 7 states (Kansas $31.5 million, Maryland $6.2 million, Massachusetts $35.6 million, New York $27.4 million, Oklahoma $54.6 million, Oregon $48.1 million and Wisconsin $37.8 million) to implement as part of the healthcare overhaul passed last year? I think it'll work, too. Funny how that needs federal dollars, though. Shouldn't the free market sort this stuff out without the magic hand of socialism?

"Broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics."

That I'll agree with, big time along with EMR mandates. That with HIPAA are a big step toward alleviating alot of the administrative burdens in healthcare management, especially tracking and billing.

Re: Money Won’t Buy You Health Insurance

#239

Post by dasil003 » Tue, Feb 22, 2011, 3:21 AM UTC

Groxx wrote: post #22

acabal wrote: post #2

This really highlights how utterly insane our system is. I'm living off of my own business, which means that I don't have an employer to cover me under group insurance. But I really only make enough to live frugally and save a tiny amount each month--to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the…

> to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation. This fits a fair number of cost complaints I hear over healthcare. Who wouldn't like to pay $50-100/month to have something better than emergency healthcare support? But thi…

> $227 per month, per person, comes from the government, which means it comes from taxes. And an additional $100 per person is spent per month on average ($324.58 per month). Far in excess of $50-$100.

Still, $324 is a pretty nice average, when you weigh in the mix of young and elderly, and of course if it comes out of taxes, presumably someone who is only able to afford $100 a month is going to have a lower tax burden as well.

Re: Money Won’t Buy You Health Insurance

#240

Post by Groxx » Tue, Feb 22, 2011, 3:23 AM UTC

joe_the_user wrote: post #230

Groxx wrote: post #155

Earlier quoted context omitted.

Part of the rapid and sustained rise in costs comes from that a) more things are being treated that existed before but got no treatment, and b) more availability of new drugs, because we're now able to create ones which were impossible / inconceivable back when costs were 5%. Would you rather go back to colloidal silver someone sold you as a wonder-drug out of the back of their wagon? Or use the significantly more te…

Not that it accounts for all of the change. Or even a large portion. Then what is your argument?? Just that the rise isn't entirely due to waste. No one argued that. Even the most egregious health insurance policy abuses are generally something more than waste. Often, there's been an effort to enhance "choice" and "responsibility" but generally without understand that the average person simply has limited horizon for…

Not a whole lot of an argument, admittedly. A bit of a jump to a conclusion based on your 5% starting point, which was in a very different world than today. Since the rest of the G8 seems to be around 10-ish%, start comparing there; I'm not sure why America is so much higher than that, but higher than 5% is pretty easy to account for.

Not that 10% is the best it can be, but I find it unlikely to go significantly lower as long as people refuse to do what's best for themselves, health-wise. ie, ever. (maybe Americans are worse at preventing health problems? no idea, just musing)