Iowa insurance market collapse could ground young entrepreneurs' dreams • Hacker News Board

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#31

Post by GiorgioG » Fri, Jun 23, 2017, 4:04 PM UTC

awareBrah wrote: post #5

Obamacare, the proposed trump care, its all a failure. Get rid of the employer sponsored plans, that makes no sense at all and makes me hesitant to lose my job because my health relies on it? That is simply absurd. Get rid of this. I'm so frustrated with the healthcare here and I don't understand how Washington can't come up with any real solutions

It's easy to understand - the rich continue to get richer because that's how politicians stay in power. As a father of a chronically-ill 5 year old I can't tell you how frustrating it is. Should I change jobs? Depends on the healthcare plans they offer. What do I do if I lose my job? COBRA adds insult to injury.

How will he take care of himself when he gets out of college (assuming he goes of course)? Will it consume half of his paycheck?

Through me, my son will have citizenship in France...maybe it's time to teach him French and consider steering him to moving to France when he's done with school.

We need to shift the conversation away from single-payer, insurance, etc and focus on either: universal healthcare or strict price controls. Until these options are shoved down the throats of our politicians, they're going to keep distracting us with b.s. 'solutions' like the ACA, its "replacement", etc.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#32

Post by toomuchtodo » Fri, Jun 23, 2017, 4:05 PM UTC

shard972 wrote: post #26

toomuchtodo wrote: post #23

Earlier quoted context omitted.

Great for pharma stockholders, terrible for American citizens. Let's stop subsidizing drug R&D for the world on the backs of US citizens who are being squeezed to death by Washington and a for profit healthcare system.

That's a fair argument but I'm more interested in how much R&D happens under single payer systems.

Does the NIH and NSF not provide a pipeline for drug research in the US?

Did you know the CEO of Mylan, the company that makes epipens made $98 million last year? Is that reasonable?

http://money.cnn.com/2017/05/31/investing/epipen-mylan-chair...

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#33

Post by avs733 » Fri, Jun 23, 2017, 4:06 PM UTC

anovikov wrote: post #7

s73ver wrote: post #2

Basically, do we want to send the signal that entrepreneurship is for everyone, or just the rich and healthy?

Entrepreneurship is not for everyone. It is for people who take risks. And yes it takes being healthy, because it is a stress which even most absolutely healthy and young people can't endure. And preferably rich because it sucks being left at the mercy of investors.

Risk tolerance is neither a useful proxy/predictor for entrepreneurial activity or entrepreneurial success [0,1]. Instead, it is more appropriate to say that entrepreneurs have a higher tolerance for ambiguity [2]. The most current/best research on entrepreneurial ways of thinking suggests that successful entrepreneurs tend to look for systematic exploits that exist within current market conceptions by assessing the ambiguity in markets and products [3]. Within a pure conception of risk, risk is not the right term but rather uncertainty/ambiguity. However, it is very easy for that uncertainty to look very risky when existing models of risk are employed. That is how the competitive advantage is created...finding a new business model/prouct to address market uncertainty that is low risk by relying on a different conceptualization of the underlying risk model and its assumptions. This is why entrepreneurship so often results in creative destruction of existing solutions and markets...because the new risk model is more efficient and/or lower risk and it had yet to be pursued because existing models (for whatever reason...e.g., technological progress) made the new model look extremely risky.

[0] http://journals.sagepub.com/doi/abs/10.1177/1476127004047617 [1] https://www.inc.com/kimberly-weisul/weve-got-the-relationshi... [2] https://www.forbes.com/sites/acton/2012/05/17/the-one-key-tr... (or you could just cite Schumpeter/Knight...this is just more readable) [3] Sarasvathy, Saras D. Effectuation: Elements of entrepreneurial expertise. Edward Elgar Publishing, 2009.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#34

Post by avs733 » Fri, Jun 23, 2017, 4:07 PM UTC

s73ver wrote: post #2

Basically, do we want to send the signal that entrepreneurship is for everyone, or just the rich and healthy?

While your point is well made...it assumes that the objective function in these decisions is entrepreneurship. It isn't, in fact it is almost the opposite. Because of the way our elections work the objective function is entirely focused on increased/optimizing ROI for existing businesses that contribute to campaigns.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#35

Post by creaghpatr » Fri, Jun 23, 2017, 4:07 PM UTC

avs733 wrote: post #17

coldpie wrote: post #8

Earlier quoted context omitted.

Single payer has been proposed many times and works well in the rest of the first world. Edit: Don't forget to vote every November.

Single payer works well in the US. Despite claims and the continuously driven narrative of government inefficiency and waste, Medicare and Medicaid are easily the most efficient and effective health care options in America. It would take a one line act of congress...removing the income cap...to make America a defacto single payer state. The only problem is that it would disrupt a huge capitalist market, and our socie…

Medicaid and Medicare are heavily subsidized in practice by private insurance covered patients.

Hospitals that have too high of a proportion of Medicare patients get a bonus subsidy from the government to cover up the fact that the coverage alone can't financially sustain the provider.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...

If we implemented single-payer in the form of Medicare as it is now, the healthcare industry would quickly collapse.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#36

Post by davidw » Fri, Jun 23, 2017, 4:08 PM UTC

This is all such bullshit. Single payer has problems, but it works well and is a whole lot cheaper in terms of % of GDP as implemented in places like Italy. Also in Italy you have a decent, parallel private system where you can simply call up and ask how much basic stuff is. I once got some chest X-rays and a consultation with an ear-nose-throat doctor for 150 Euros out of pocket (oh, and I got to do both the day after I called). They apologized because it was so expensive. I barely kept a straight face.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#37

Post by greggeter » Fri, Jun 23, 2017, 4:08 PM UTC

Health cost sharing cooperatives are a tenth of the cost, are cash based, and skip all the insurance requirements. They require you take a more proactive role in your care. If you struggle with the cost of healthcare, take a close look. Ex., https://www.libertyhealthshare.org/

Edit: I'm not affiliated with this group, it's just an example. There are several.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#38

Post by jt2190 » Fri, Jun 23, 2017, 4:08 PM UTC

rbritton wrote: post #20

The part in all of this that has bothered me more than anything is that it's a diversion to mask the real problem: healthcare service and products are unsustainably expensive. Casinos use chips and vouchers to distract gamblers from actually grasping just how much money they're playing with. Health insurance sure feels like the same thing, but it's even worse in that when you're in need, you're not always in a state…

Just to meta-riff on this a little bit... The issue here is that the mechanisms we have for price signaling are too crude to easily account for the things you're alluding too (i.e. an unconscious patient needing urgent medical treatment can't really negotiate; fluffy concepts like quality of life or the lifetime cost to manage an illness are hard to quantify monetarily, etc.) Yet in the U.S. we still try to use market forces jury-rigged with Medicaid, Medicare, Private Insurance, public hospitals, the Veterans Administration, etc., as a means to allocate health resources.

Note that I'm not saying that we can't eventually devise a market-like system for allocating medical resources. I do wonder if we have the technology today for building such a system though. After all, we'd ideally have very good information very quickly so that we can make decisions about where to spend. I'm just not sure we have anything close to such a thing yet, and perhaps we should stop pretending that we've got one.

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#39

Post by jrowley » Fri, Jun 23, 2017, 4:09 PM UTC

creaghpatr wrote: post #6

Iowa has only one ACA insurer left and they are raising their rates 43.5%. Basically providing Obamacare was hemorrhaging so much money that Wellmark and BCBS left, leaving a single payer, that ACA users are forced to use. http://www.thegazette.com/subject/news/health/medica-to-stay...

I heard this morning that in Iowa 94 out 99 counties will have no offering in the insurance exchange. We need single payer.

Source: President of the AMA, 4:50 seconds in http://www.npr.org/2017/06/23/534056758/the-amas-take-on-gop...

Re: Iowa insurance market collapse could ground young entrepreneurs' dreams

#40

Post by kaitai » Fri, Jun 23, 2017, 4:10 PM UTC

rbritton wrote: post #20

The part in all of this that has bothered me more than anything is that it's a diversion to mask the real problem: healthcare service and products are unsustainably expensive. Casinos use chips and vouchers to distract gamblers from actually grasping just how much money they're playing with. Health insurance sure feels like the same thing, but it's even worse in that when you're in need, you're not always in a state…

Healthcare services and products are unsustainably expensive in the US. This is not quite true in the rest of the world. Part of this is economic and structural, and part of it is American psychological and societal problems with letting people die when they are going to die (end-of-life care is hugely expensive and we even love treatments that do not necessarily lead to increased lifespan, because we'd rather feel like we're doing something medically than actually take evidence-based steps that might include doing nothing). Part of it is that "healthcare service" in the US includes the amazing overhead charged by private insurance.

Certainly before Obamacare, private insurance companies spent about 30% on overhead (enrolling & dropping people, advertising, dealing with referrals, arguing with hospitals and doctors, auditing people, hiring lawyers to get someone else's insurance to pay for treatment). That's a lot of money and it figures into "healthcare costs" in the US.

We spend so much more than any other country on healthcare, so much more.

You are absolutely right that "the current system needs to collapse under its own weight before a new approach even stands a chance". I believe it will take people dying publicly to make the US consider a change. First we will be bamboozled by the "freedom" and "choice" we'll get with the new plan, foremost the choice not to have coverage or care at all :)