Health care is turning into a consumer product • Hacker News Board

Re: Health care is turning into a consumer product

#271

Post by virgilp » Mon, Jan 10, 2022, 6:54 PM UTC

nightski wrote: post #233

netizen-936824 wrote: post #200

Earlier quoted context omitted.

That's assuming that the methods used to undercut are beneficial when in reality they're just optimizing for profits over health outcomes. People don't have enough of a choice for it to matter, most people can't just find new providers. Same with ISPs

Yet we have cities with multiple ISPs which have incredibly cheap internet at blazing speeds. In my city we have 1Gbps fiber for $70/mo and the price goes down quickly as you reduce the speed. That's better than some areas of SF I think, and we only have 2 major ISPs here. Amazing what a little competition can do. The city was smart enough when the competitor moved in to install the capacity for more ISPs to utilize…

In Romania competition + initial lack of regulation and lucky timing led to incredible speed + cost (my ISP just launched 10Gbps fiberlink for 10EUR/mo; 2.5Gbps is 9EUR/mo, 1Gbps is 8EUR/mo, 500Mbps is 6EUR/mo and the slowest option). That said, I think we just got incredibly lucky and I wouldn't advocate "lack of regulation" in general.

Re: Health care is turning into a consumer product

#272

Post by wbsss4412 » Mon, Jan 10, 2022, 6:56 PM UTC

arethuza wrote: post #267

vel0city wrote: post #265

Earlier quoted context omitted.

Many (most? I always take employer-sponsored, not an expert on all plans) health insurance plans in the US have a concept of out-of-pocket max. This is a yearly amount that is essentially your maximum yearly liability. That amount can vary from plan to plan and year to year. Usually a lower out of pocket max means higher premiums, similar to the idea of having a lower car insurance deductible usually means higher pre…

Thanks for answering - one last question! Is that a hard limit and you'll never have to pay more than that?

Though the practice is now largely prohibited, there are instances where insurers will have caps on how much they will pay out, either over a lifetime or within a year.

So it is not an absolutely hard limit in all cases, no.

Edit: originally wrote year twice.

Re: Health care is turning into a consumer product

#273

Post by majormajor » Mon, Jan 10, 2022, 6:57 PM UTC

hamter wrote: post #261

majormajor wrote: post #251

Earlier quoted context omitted.

Surely you aren't suggesting that having more hospital beds per capita in the US is causing more deaths? Capacity is hardly the only factor in how Covid is hitting the population (and having more hospital capacity reducing pressure to lock things down will itself affect the rate of spread). For instance, per https://ourworldindata.org/grapher/total-covid-cases-deaths-... Canada has seen 66K cases per million and 807…

no im suggesting that 'yolo lol we have more beds' is meaningless if u end up with worse outcomes. and let me be clear that 66k per 1M cases and 807 deaths per 1M is better than 180K per 1M And 2515 per 1M.

You won't really know which is better until 2025, 2030, sometime like that for total deaths due to COVID numbers. Canada is hardly out of the woods. Push the date to 2040, 2050 if you look at things like what were the long-term impacts on different policies on people who didn't die of COVID.

You still aren't engaging with the point under discussion, though, which has become publicized due to COVID but exists independently of it. Spending more on healthcare contributes to having an overall better health care system, but the US suffers due to large problems of access and distribution. Regardless of payment structure, I would argue in favor of continuing to spend more on health care than other nations; we have the money, it's a good use of it.

Re: Health care is turning into a consumer product

#274

Post by nopenopenopeno » Mon, Jan 10, 2022, 6:58 PM UTC

dragonwriter wrote: post #230

pg_bot wrote: post #226

Earlier quoted context omitted.

It's not Eisenhower's administration that's to blame, it's FDR's. Employer based healthcare is a result of the stabilization act of 1942. Health benefits were offered as incentives to workers because employers could not raise wages.

> Employer based healthcare is a result of the stabilization act of 1942. Health benefits were offered as incentives to workers because employers could not raise wages. Employers can raise wages, and have been able to for some time, so that's not why we still have it. We still have it because of tax and other incentives, and because government keeps making policy decisions to protect, and even extend it (e.g., the AC…

Employers love employer-based healthcare because it gives them insane amounts of control over their employees’ livelihoods. And as a result, wage competition is far less influential.

The fear of losing healthcare coverage a severe fear that people in other countries don’t have to worry about.

Re: Health care is turning into a consumer product

#275

Post by arethuza » Mon, Jan 10, 2022, 6:58 PM UTC

virgilp wrote: post #84

zimpenfish wrote: post #70

Earlier quoted context omitted.

> a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from) That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

Why wouldn't a private system suffer from the same price pressures?

Re: Health care is turning into a consumer product

#276

Post by hitpointdrew » Mon, Jan 10, 2022, 6:59 PM UTC

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> the fact that healthcare is already a consumer product in the US

I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then:

  1. It wouldn't be tied to or dependent on my employment.
  2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers.
  3. Insurance providers wouldn't be restricted by arbitrary/geographical boundaries.

I think the debate over weather healthcare is a human right is an interesting one, and I personally haven't come to any conclusion on that yet.

If you think healthcare is a basic human right then a single-payer system is probably the most reasonable solution, although I don't think single payer isn't without it's share of problems.

If you think healthcare is not a basic human right then I think a real free-market solution is the most reasonable solution, again I don't think this is without problems either.

I don't believe there is a "perfect" solution. But I think either a true free-market system, or a single-payer system would both undoubtedly be 100x better than the current system in the US. I would be in favor of moving to either of these solutions as my political stance isn't D or R but "lets make improvements" regardless if those improvements are seen as left or right.

Re: Health care is turning into a consumer product

#277

Post by virgilp » Mon, Jan 10, 2022, 7:00 PM UTC

ben_w wrote: post #218

virgilp wrote: post #84

Earlier quoted context omitted.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

Long term everything fails, Malthusian pressure gets us all. But in the medium term, the NHS was doing pretty well until Austerity became the dominant U.K. policy: https://fullfact.org/election-2019/ask-fullfact-nhs-waiting-... https://ifs.org.uk/publications/15557 (That said, I don’t have longer graphs to hand, and I am slightly concerned by the convenient start date on the graph in the second link).

NHS was a great initiative and idea!! I'm not advocating against public healthcare, at all. I'm saying is that it's not surprising it became underfunded - there needs to be constant effort to prevent (or compensate) that tendency, because it _is_ the natural tendency of such systems.

Re: Health care is turning into a consumer product

#278

Post by nopenopenopeno » Mon, Jan 10, 2022, 7:01 PM UTC

ch4s3 wrote: post #231

nopenopenopeno wrote: post #217

Earlier quoted context omitted.

You’re right. It was earlier than I thought. I updated my comment per your reply. Heaven forbid “wage inflation!” Was the AFL pushing for employer-based and the CIO pushing for national? I don’t even know where to find history like this. It’s virtually impossible for an average person to learn about the history of the American labor movement.

> Heaven forbid “wage inflation!” I realized after double checking that it was actually a 1942 Roosevelt bill, and they were trying to figure out how to keep a lid on rising prices during the war. It's also not uniformly good if prices also rise quickly. Inflationary spirals are real, and very bad for regular people. > Was the AFL pushing for employer-based and the CIO pushing for national? I'd have to double check.…

Blaming employer-based healthcare on the stabilization act sounds suspicious to me.

Re: Health care is turning into a consumer product

#279

Post by arethuza » Mon, Jan 10, 2022, 7:01 PM UTC

majormajor wrote: post #246

dr_orpheus wrote: post #222

Earlier quoted context omitted.

> Well, I guess it is more efficient if the expected outcome is a larger profit for different private companies and middlemen and not the well-being of the rest of the population. My favorite example of this is when I had to get an MRI. The lab imaging said it would be $800 if they billed it through insurance, or it would be $600 to just pay for it directly out of pocket. So the cost of having to deal with my insuran…

This is always extra annoying because it might be a false savings to pay cash there. Let's say your MRI says you need a $5500 procedure, and your plan's deductible is $3000, 90% coverage after, and out of pocket max is $6000, and there's nothing else you've spent on the plan this year. Pay $800 for MRI with insurance, you'll then pay $2200 for the procedure to hit the deductible + 10% of the remaining $3300, so $2530…

Do you folks have to perform these calculations every time someone in your family gets sick or injured?

Re: Health care is turning into a consumer product

#280

Post by syshum » Mon, Jan 10, 2022, 7:04 PM UTC

CraigJPerry wrote: post #172

syshum wrote: post #128

Earlier quoted context omitted.

"better outcomes" when talking about health should be things like 5 year cancer Survival rates, Wait time for Surgery, Wait time for Heart Stints, 5 year heart Attack Survival rates, Wait time for Specialist Care, etc Not bankruptcy statics, or costs

You’re assuming universal access to healthcare then, which is not the case. What is the 5 year survival rate for someone who cannot afford cancer care?

I am not assuming anything at all, people that attempt to inject affordability into the care debate are doing so for disingenuous reasons.

The question of affordability is different from the question of quality care, we can solve the affordability problem with out having to lower the over all standard of care which is what you are advocating for, the bringing down of the overall quality of care in an attempt to increase accessibility of care. Ironically putting that faith in the US Federal Government will only result in 1 of those happening.