The Amish health care system • Hacker News Board

Re: The Amish health care system

#281

Post by throwaway894345 » Thu, Apr 23, 2020, 3:56 PM UTC

elithrar wrote: post #248

throwaway894345 wrote: post #239

Earlier quoted context omitted.

> Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. How large are these OOP maximums and deductibles on average? I’ve always kept an emergency fund that’s well in excess of my OOP max. Is this unusual? Also, I’m off the impression that you can get onto payment plans if you can’t pay your bills right aw…

> I’ve always kept an emergency fund that’s well in excess of my OOP max. 29% of households have $1000 disappears almost immediately given deductibles, and $11,700 isn’t that far off either. People just don’t have the chance to “get ahead” when making [1]: https://www.google.com/amp/s/www.cnbc.com/amp/2018/09/27/her...

I agree with this, but we're not talking about <$15/hour; we're talking about the middle class.

Re: The Amish health care system

#282

Post by zaarn » Thu, Apr 23, 2020, 4:01 PM UTC

josinalvo wrote: post #269

zaarn wrote: post #216

Earlier quoted context omitted.

Sadly in germany it's rather difficult to switch between public and private or no insurance. Or rather, it's very difficult to get back on a public insurance once you're private or self-insured. The best you can hope for is pulling it off once, maybe twice.

I'd wager that is by design, and one of the ways they keep people from avoiding insurance when young and healthy, and then getting it when old

It's possibly one intention, though there are already laws that prevent you from going back to public insurance if you're over 55 years old as well as if you're over a certain income limit.

The only universal way to switch is to marry someone in public insurance.

Re: The Amish health care system

#283

Post by zaarn » Thu, Apr 23, 2020, 4:03 PM UTC

AndrewDucker wrote: post #244

zaarn wrote: post #216

Earlier quoted context omitted.

Sadly in germany it's rather difficult to switch between public and private or no insurance. Or rather, it's very difficult to get back on a public insurance once you're private or self-insured. The best you can hope for is pulling it off once, maybe twice.

That doesn't seem unreasonable. If you're avoiding paying into a system because you don't want to claim from it then letting you hop back on whenever you need it would destroy the system very quickly.

It's not that easy, luckily, if you're self-insured and have to take the service of a doctor, you can't switch just like that. It takes about a year of paper exchange with everyone involved to switch cleanly. Even then, any costs you started paying for from before will still have to be paid unless you're below a certain income bracket (or declare bankruptcy).

So if you were self-insured and broke a leg, then decided to switch back to insurance, you'd still be on the hook for the costs of the ongoing physiotherapy until it is healed back up. The insurance doesn't have to actually pay anything that happened before a switch (switching from public to public insurance or private to private doesn't have this limit, private to public and the other way round but you don't pay, your old insurance pays).

Re: The Amish health care system

#284

Post by Noos » Thu, Apr 23, 2020, 4:09 PM UTC

kwhitefoot wrote: post #197

One of the most striking things in this article for me was the remark about Amish women having five to ten children. If this is the case and if all women have children then the Amish population should be increasing rapidly. Is it? This page: https://amishamerica.com/how-fast-are-the-amish-growing/ says that the doubling time is about 19 years. How do they find enough suitable land to practice their way of life?

I think the problem is that a lot of those amish children become non-amish very quickly. Leave the community.

Re: The Amish health care system

#285

Post by pmiller2 » Thu, Apr 23, 2020, 4:18 PM UTC

bmelton wrote: post #253

pmiller2 wrote: post #104

Earlier quoted context omitted.

It's a slight misstatement to say that any of the M4A plans would have "banned private insurance." None of them prohibit supplemental coverage that would be secondary to Medicare.

I didn't say that any of the M4A plans would ban private insurance. That doesn't change the fact that Bernie has stated that his M4A plan would, even where the plan he's put forward doesn't show that. I think it's fair (if a bit naive) to take politicians at their word on occasion. Moreover, I think it's more than a bit disingenuous to assert that plans that are disallowed by law from competing with Medicare services…

Your analogy is false, though. A more correct one would be "Netflix is allowed to show all initial movies in a franchise, but sequels are fair game to anyone."

Do you understand the difference between primary and secondary / supplemental insurance coverage?

Re: The Amish health care system

#286

Post by pmiller2 » Thu, Apr 23, 2020, 4:20 PM UTC

bmelton wrote: post #264

int_19h wrote: post #193

Earlier quoted context omitted.

This doesn't apply to procedures that are covered, though, does it? Like, a private plan that provides higher-quality / reduced wait times for all services you'd normally get from the public system.

Regarding the implementations I was talking about, the private market would exist exclusively for elective procedures "like cosmetic surgeries." [0] For any of the services covered by Medicare. Quoting the Kaiser Family Foundation, "private insurance would be prohibited from duplicating the coverage under Medicare." [0] The full quote here is "If you support Medicare for All, you have to be willing to end the greed o…

> For any of the services covered by Medicare. Quoting the Kaiser Family Foundation, "private insurance would be prohibited from duplicating the coverage under Medicare."

That's correct. Supplemental insurance can still cover copays and other out of pocket expenses. It can also cover procedures not covered by Medicare.

Now, tell me, how is that "banning private insurance" if insurance companies can still sell those policies?

Re: The Amish health care system

#287

Post by pmiller2 » Thu, Apr 23, 2020, 4:25 PM UTC

throwaway894345 wrote: post #239

pmiller2 wrote: post #4

Earlier quoted context omitted.

That inequality is still present, except that now, the system is: * Poor people either get hit with huge bills because they're uninsured, or, if they know how to navigate the system, sometimes get these bills written off through "financial aid." * Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. * The…

> Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. How large are these OOP maximums and deductibles on average? I’ve always kept an emergency fund that’s well in excess of my OOP max. Is this unusual? Also, I’m off the impression that you can get onto payment plans if you can’t pay your bills right aw…

OOP maximums can be up to $8200 for an individual plan or $16400 for a family plan. But, that doesn't tell the whole story. Because health insurance is tied to employment in the US, getting seriously sick can not only easily trigger those maximum amounts, but also lose you your insurance.

Unfortunately, it is unusual among Americans to have an emergency fund this large.

Re: The Amish health care system

#288

Post by bawana » Thu, Apr 23, 2020, 4:28 PM UTC

solveit wrote: post #171

pasquinelli wrote: post #164

Earlier quoted context omitted.

So what's up then? Or if you can't say what's up -- fair enough, you're not an oracle -- what slight scrutiny in particular topples this particular root cause hypothesis?

It doesn't cost 3k to have an MD do stitches. That money's going somewhere else (Actual experts may or may not know where).

I ama surgeon in MA. I get less than $800 for a hernia repair. That includes all the face time with the patient, explaining everything, doing the procedure and taking care of him after. The hospital gets $8000 and lets me use a 'special' room for an hour and another 'special' place for a few hours for the patient to 'sleep off' the anaesthesia. The doctor who provides anaesthesia gets The concept of 'efficiency of scale' does not translate to service industries. The only efficiency that happens is efficiency of funneling more money to higher salaries of higher executives. Hospitals are driven by profit and their incentives do not align with the precepts that led to their formation.

Re: The Amish health care system

#289

Post by maxcan » Thu, Apr 23, 2020, 4:32 PM UTC

pmiller2 wrote: post #4

_fq4v wrote: post #2

I thought the most interesting part was the commentary on non-Amish care in the past > I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, b…

That inequality is still present, except that now, the system is: * Poor people either get hit with huge bills because they're uninsured, or, if they know how to navigate the system, sometimes get these bills written off through "financial aid." * Middle class people frequently have insurance, but get hammered by deductibles and out of pocket maximums, rarely qualifying for "financial aid." This can be ruinous. * The…

> if they know how to navigate the system, sometimes get these bills written off through "financial aid."

Yes. I have a friend in tech (contractor, bay area) who doesn't have insurance. his plan is to just show at the ER without an ID if he needs anything and give a fake name.

^ why we can't have nice things..

Re: The Amish health care system

#290

Post by arkades » Thu, Apr 23, 2020, 4:47 PM UTC

motohagiography wrote: post #277

arkades wrote: post #266

Earlier quoted context omitted.

Yes to both of the latter, but no authority to do so. Academics ain't legislators.

So, I've spent over a decade consulting to public sector health agencies in charge of delivering everything from electronic health records to cancer research to chronic disease management, long terms care, mental health, and privacy, among many other areas. Before you call someone ignorant and say that the bureaucracy disagrees and so what possible standing could I have, consider a little bit of charitable reasoning…

Oh, I didn't judge you on your professional history. I judged you on the content of your comment - that is to say, on the merit of your statement rather than an appeal to authority.

That you've done consulting to the healthcare sector doesn't mean much of anything to me, one way or another. Heck, the IT consultant for our CTO in my health chain can say the same, and all he does is EMR rollouts. He has about 0% understanding of healthcare policy, or how the system actually works. He understands EMR implementations. The financial analyst consulting to our COO has been in the hc sector for about a year and his knowledge of actual hc policy outstrips the EMR guy by at least an order of magnitude.

As a physician and healthcare policy expert, I don't much need any credibility, outside of that provided by the contents of my posts. I'm happy to let them speak for themselves, rather than appeal to authority - the latter of which is essentially non-existent in this pseudonymous context.