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

'A full-blown crisis': Americans brace for a surge in healthcare costs

ft.com

Post reply on HN
Print view View original

251–260 of 269 posts

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#251

Post by ethbr1 »

dogemaster2028 wrote: post #249
ethbr1 wrote: post #228

Earlier quoted context omitted.

It's also important to keep in mind that reforming the US healthcare + insurance system was always going to be an evolutionary, multi-stage process, because of its complexity. You shouldn't change all the parts in an engine to different specifications at the same time. The ACA therefore blended structural improvements (insurer admin cost caps, standardized benefits, no prior condition exclusions, guaranteed access, e…

In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward. Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work…

> Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward.

I'd trend in the opposite direction. The death of bipartisanship (due to changes in media, education, and gerrymandering: none likely to change soon) render democracies incapable of solving large problems over a multi-voting cycle timespan effectively.

Ergo, the best solution is to punt to an independent body, in the same way central bank management was done.

It makes more sense to have democratically-elected government responsible for and deciding the details, but not the strategic arcs.

Healthcare, national debt / budget deficits, military procurement, voting rights enforcement, education policy would all be better off in consistent hands, even if occasionally less capable ones.

Sometimes, it's more important to keep to an approach than have the optimal approach.

Now? Most democracies get the worst of both worlds there.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#252

Post by s5300 »

silexia wrote: post #131

We desperately need to vastly increase the number of physicians in this country to decrease costs. The AMA is the most powerful trade union in history and has locked the number of new doctors a year for many years now. Restricting supply for a service with inelastic demand skyrockets prices and lines their pockets.

[dead]

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#253

Post by marcus_holmes »

almosthere wrote: post #18
pxmpxm wrote: post #7

Earlier quoted context omitted.

It's always cost ~$2k a month, the only difference is the previous administration thought everyone else should be "temporarily" paying for her plan. I feel like we need a perpetual PSA here that moving money from person A to person B obviously doesn't make anything cheaper.

when the gov foots the bill, there's no reason to have competition.

The govt also acts as a monopsony and forces lower prices. Same effect [0] different mechanism.

[0] actually a better effect - the govt actually does force lower prices, whereas competition is subject to all sorts of other effects where it doesn't actually function to lower prices.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#254

Post by trashface »

czhu12 wrote: post #49

One thing that I’ve been trying to understand about this discourse: Is the sum of the increase in costs some people are now paying greater than the subsidies that previously existed? In other words: was there always a massive bill to be paid here, but it was just previously socialized and hidden in the form of taxes/ public debt? Or does the act of subsidizing it actually decrease the total?

The subsidies are going down, but the base price of the plans are going way up. The plan I'm on increased from $800/month to $1150/month next year, and that is a modest increase compared to most others I've heard about. I'm switching to a maybe cheaper plan - if I use less healthcare, but if I use too much it will be more expensive due to much higher deductibles.

Insurers haven't really explained why the base prices of plans are going up so much. Perhaps GLP-1 drugs but that doesn't seem like enough (those drugs often aren't covered by ACA plans anyway due to their brand-name status). It could be a delayed effect from all the inflation a couple years ago - health care contracts are negotiated on the order of years, and a bunch could have just been renegotiated to reflect current market prices.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#255

Post by trashface »

simianwords wrote: post #149
silexia wrote: post #135

Earlier quoted context omitted.

Doctors are by far the highest paid professional occupation in America. The AMA is the most powerful trade union in history and restricts the number of new doctors, pushing up prices.

I have changed my mind on this after looking at the data. Not much cost can be attributed to the doctors.

What data was that? Here is some from the BLS: https://www.bls.gov/ooh/highest-paying.htm

Highest 20 occupations by median annual income, the bottom is pilots, everyone else is a medical specialty.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#256

Post by robocat »

mritterhoff wrote: post #207
robocat wrote: post #162

Earlier quoted context omitted.

> true market price There can be no market clearing price, because healthcare demand is unlimited. In some countries supply is rationed by using different means such as waiting lists, budgets for funding, or even corruption (I witnessed this in Cuba).

> because healthcare demand is unlimited. How's that? Beyond some level of care I suspect demand drops of a cliff. No one goes to the doctor for the fun of it.

Better answer (and child comment too):

https://news.ycombinator.com/item?id=46115687

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#257

Post by dogemaster2028 »

ethbr1 wrote: post #251
dogemaster2028 wrote: post #249

Earlier quoted context omitted.

In a constitutional republic like the US, it’s simply too risky to execute major improvements in a big bang fashion. It’s not that different from engaging in a multi-decade software migration project. Sometimes, small changes is really the only path forward. Part of the reason why Obama, initially a unifying force, eventually became known as a Divider In Chief (in addition to some racial commentary around police work…

> Maybe starting with principles and making yearly changes that can easily be undone or redone by future administrations is the only path forward. I'd trend in the opposite direction. The death of bipartisanship (due to changes in media, education, and gerrymandering: none likely to change soon) render democracies incapable of solving large problems over a multi-voting cycle timespan effectively. Ergo, the best solut…

The problem, at least in our American mindset, is that since America’s birth, there has been a marked reluctance to have unelected bodies be responsible for anything that impacts the people, ESPECIALLY anything that presumes some globalization intention or some overarching aristocratic ruler (and with good reasons).

Central banking works because problems are instantly catastrophic to the system, whereas healthcare systems are not that fragile. They can survive broken for a long time.

Everybody is okay having a central lender of last resort because the problem is technical, typically unemotional, and in general, benefits every participant equally (because everybody loses is the system collapses).

Healthcare is different in that it affects MY decisions on a regular basis. America is individualistic and self reliant. We never want some government bureaucrat deciding what treatment [I] should or shouldn’t get if [I] can afford it with my own independently earned money. [You] should take care of [Yourself], save your own money, eat healthy, exercise, or not, and live with your consequences.

States have power too. So it does not matter much if some Bernie politician has some fantasy about some central single payer system that has some theoretical average benefit if it restricts ME from making my own choices.

Other countries have other cultures and foundational principles, so Bernie may have better luck there.

But not here.

Is it limiting? Probably for this case. But the fact is the system works for many other things. Everyone wants to come here. It’s the best country in the world etc etc. It does not have to be perfect. But it’s the best we get with the philosophy that made the country what it is.

Does it suck for healthcare? Overall, probably. But not for [ME].

We saw the system has limitations in other cases (think pandemics etc, but even now, many Americans can’t forgive the politicians that kept them imprisoned in their own homes).

You have a right to life, liberty, and pursuit of happiness. But not to anything that must be provided by someone else, like healthcare.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#258

Post by sharts »

ChrisMarshallNY wrote: post #26

Mine has tripled, but last year, I was actually getting some govt help. Not this year. I am fortunate to be able to afford it, but it’s just less than my mortgage. This month is when all hell breaks loose, because people will get their first invoice at the new rate. They already know how much, but seeing it in the form of a demand, will drive it home. Obamacare is like the NHS, in the UK. Everyone likes to bitch abou…

Isn’t obamacare what caused all these problems in the first place? NHS is public. Obamacare was just a blank check to private companies

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#259

Post by nielsbot »

_DeadFred_ wrote: post #214
thallium205 wrote: post #101

Earlier quoted context omitted.

All house and senate GOP members voted "no" on ACA. Obamacare is a lot of things, but a "GOP healthcare plan" isn't one of those things.

Strangely it actually was based on the GOPs 'Romneycare' that was promoted by The Heritage Foundation.

This is exactly what I was referring to. And I pointed that out to contrast with something more leftist, like government single payer.

Re: 'A full-blown crisis': Americans brace for a surge in healthcare costs

#260

Post by mikewarot »

The root cause of this is, in my opinion, that in 2009 instead of getting the Healthcare system that Obama promised, we got the one that Rahm Emanuel substituted for reasons unknown. I will never forgive Rahm for this sin.

Actually socialized medicine would give us better outcomes for less spending. Instead we have a pork barrel project that has become "too big to fail".

Eventually we'll get Medicare for all, but it'll be hell in the meanwhile.

Post reply on HN