Live data from Hacker News

The healthcare market is taxing reproduction out of existence

aaronstannard.com

371–380 of 431 posts

Re: The healthcare market is taxing reproduction out of existence

#371

Earlier quoted context omitted.

Why are you paying to give birth at home when there's a hospital right there, that has all the equipment in case anything goes sideways?

The two biggest benefits are reduction of iatrogenic harm and comfort for the mother delivering. Midwives are medical professionals who have the equipment and expertise to intervene in the most common scenarios that require it.

Okay, that's a fairly interesting take on it.

So - no pain relief, and if anything goes even a tiny bit sideways you just throw your hands up and expect to lose both the mother and child?

And you actually pay for this?

Re: The healthcare market is taxing reproduction out of existence

#372

Earlier quoted context omitted.

It's pure facts. I used to live in a city where me and my wife were terrorized by homeless people on the light rail. Now we live far away from public transportation and no longer have to worry about the safety of ourselves or our children and our neighbors are fantastic people. Car dependency and castle doctrine is essential in a low trust society with a legal system that puts violent offenders right back on the stre…

Moving in a private vehicle is statistically the most dangerous activity an otherwise healthy young person routinely participates in. Your family is almost certainly at higher risk of death and serious injury now because you based this decision on your perception of safety rather than evaluating the reality of it. Speaking of "pure facts."

I have more than 200,000 miles accident free and my kids are doing fine. Living in a city with unhinged maniacs on drugs was way more dangerous.

Re: The healthcare market is taxing reproduction out of existence

#373

The first sentence is your answer. The third word even. The healthcare market. MARKET Healthcare shouldn't be a market. That's why you're paying $40k.

I have the opposite viewpoint, and I lean heavily progressive in most of my views. Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices. Healthcare doesn't function as a market, to our detriment.

yes, "heavily progressive" and advocating that market solutions would address the root causes of the healthcare situation in America. You guys are great

Re: The healthcare market is taxing reproduction out of existence

#374

Earlier quoted context omitted.

I too am nearly universally irritated with my health insurance (due to reasons I’ve had 4 employer sponsored plans in the last year). But I recognize I’m in the minority. And it’s not close. Most people with private health insurance like it. tps://www.kff.org/affordable-care-act/kff-survey-of-consumer-experiences-with-health-insurance/

> Most people with private health insurance like it. Most people don't use it all that much, and in the common case of employer-paid premiums, the actual cost is significantly masked. As your link notes, the more care you need, the less likely you are to enjoy the experience. They dig their heels in more; sometimes egregiously so. https://www.propublica.org/article/unitedhealth-healthcare-i...

Seems like a just-so story given the numbers. Why would heavy users of health services be concentrated in the minority cohort that is dissatisfied with their insurance?

Re: The healthcare market is taxing reproduction out of existence

#375

Earlier quoted context omitted.

You could zero out every dollar American insurers make and not materially alter consumer health care economics; their share of the health care pie is almost literally a rounding error.

They add costs in the form of hospital administration which wouldn't be their books.

In that it represents dollars that don't go to their business, yes, you're right.

Re: The healthcare market is taxing reproduction out of existence

#376

Earlier quoted context omitted.

> Most people with private health insurance like it. Most people don't use it all that much, and in the common case of employer-paid premiums, the actual cost is significantly masked. As your link notes, the more care you need, the less likely you are to enjoy the experience. They dig their heels in more; sometimes egregiously so. https://www.propublica.org/article/unitedhealth-healthcare-i...

Seems like a just-so story given the numbers. Why would heavy users of health services be concentrated in the minority cohort that is dissatisfied with their insurance?

> Why would heavy users of health services be concentrated in the minority cohort that is dissatisfied with their insurance?

"Why would people who drive a lot care the most about gas prices?"

The more you use health insurance, the more chances you have to run into the kafkaesque bits. Someone who sees a GP once a year and thinks their premium is $50/month because that's the bit they have to chip in while their employer covers the rest is largely gonna go "this is fine!"

Re: The healthcare market is taxing reproduction out of existence

#377

Related: Car Seats as Contraception https://www.journals.uchicago.edu/doi/10.1086/731812 > We estimate that these laws [mandating safety seats] prevented fatalities of 57 children in car crashes in 2017 but reduced total births by 8,000 that year and have decreased the total by 145,000 since 1980.

Car seats as contraception is just a specific enumeration of the general. "busybodies as contraception" problem wherein the "has so few real problems they stop minding their business and mind other's business" classes try to force priorities on the rest of society that the rest of society can't yet afford to have. And it's not just contraception or kids. Pretty much everything in our economy gets shot in the foot by…

But babies going through car windows is bad. I don't want that. Not even just for the baby, but for me. We don't need projectile babies. Ballistic babies, if you will.

Re: The healthcare market is taxing reproduction out of existence

#378

Earlier quoted context omitted.

Moving in a private vehicle is statistically the most dangerous activity an otherwise healthy young person routinely participates in. Your family is almost certainly at higher risk of death and serious injury now because you based this decision on your perception of safety rather than evaluating the reality of it. Speaking of "pure facts."

I have more than 200,000 miles accident free and my kids are doing fine. Living in a city with unhinged maniacs on drugs was way more dangerous.

Right, except it wasn't, like objectively. Like factually. As in its not up to your opinion.

Driving is more dangerous, and it's not even close. For example, in NYC you're over 100x more likely to die in a car on the roads above the subway than on the subway.

Re: The healthcare market is taxing reproduction out of existence

#379

Earlier quoted context omitted.

Currently insured Americans would likely be worse off under any plausible M4A plan.

Based on what? Why even leave this comment if you’re just going to say “would likely be worse off” without giving literally any evidence or even suggestion of why. Insurance is a pool. The bigger your pool the more you spread the risk/load. It’s brain dead simple. Medical care is a human right, beyond that. Nothing about our system makes any sense and it is built to pad so many pockets in entirely opaque ways between…

I think it's telling that people are shocked at the assertion I just made, which is not complicated or outlandish or hard to understand and is in fact backed up by referendum and attempted implementation results for state-level programs. I think two big things are happening that fog people's understanding of this issue:

First, there's a widespread belief that M4A is popular, based on public opinion polling. The problem is that you can make almost anything popular in public opinion polling, and a lot of public opinion polling is deliberately run by interest groups to generate narratives about popularity. It's true: the "M4A" that poll respondents support would be enormously popular: it's proposed as abstraction with no clear tradeoffs. When you confront voters with the prospect of increased taxes and the loss of their current insurance policies, the wheels come off the wagon.

The second big factor is that the demographics of people with employer-provided coverage --- the majority of all non-Medicare covered people in the US --- are not what you'd expect. As soon as you stipulate employer coverage, the cohort you're describing excludes basically all fixed-income and Medicaid-eligible households. The median household income of a family with employer-provided health insurance is closer to $120k than it is to $50k.

For those households, M4A is not a very compelling deal:

* There is a very clear trend in the data for them to already be satisfied with their existing health care.

* The visible component of their insurance spending (their out-of-pocket, excluding employer side payments) is usually quite small compared to total spending.

* M4A would mechanically eliminate the availability of existing plans (unless you came up with a truly weird and distortionate system of tax incentives to keep Anthem and United and Aetna policies going).

Best case: costs that are hidden from those households today become visible, and you hope people are chill about that (in sort of the same way we hoped that people would be chill about inflation given wage increases outpacing it --- see how that went). Worst case, a lot of these households would lose their existing, favored insurance plans and pay more.

Useful here to note that broad taxes on the middle and especially upper-middle class are how Europe funds generous social service packages; you can't get there by taxing the bejeezus out of billionaires. You should do that anyways, just because it's a good idea, but there aren't enough of them to pay the absolutely gobsmacking cost of a single-payer health system in one of the wealthiest large countries in the world.

I'll cop to this: what I wrote last night, about "currently insured" people, was way too vague. I should have said "households with employer-provided health coverage" (again: that's most non-Medicare households). I plead strep throat; you're going to have to give me a break on clarity today.

Re: The healthcare market is taxing reproduction out of existence

#380

Earlier quoted context omitted.

Seems like a just-so story given the numbers. Why would heavy users of health services be concentrated in the minority cohort that is dissatisfied with their insurance?

> Why would heavy users of health services be concentrated in the minority cohort that is dissatisfied with their insurance? "Why would people who drive a lot care the most about gas prices?" The more you use health insurance, the more chances you have to run into the kafkaesque bits. Someone who sees a GP once a year and thinks their premium is $50/month because that's the bit they have to chip in while their employ…

Right but there's no such selection effect for whether or not people have employer-provided coverage, and the cohort of households that do strongly approve of their current insurance coverage. I don't see how the argument you're making could hold up statistically. There are a lot of chronically ill people with employer-provided coverage; in fact, most non-senior chronically ill pts fall into that bucket.
Post reply on HN