The healthcare market is taxing reproduction out of existence • Hacker News Board

Re: The healthcare market is taxing reproduction out of existence

#381

Post by tptacek » Tue, Dec 02, 2025, 7:26 PM UTC

ceejayoz wrote: post #359

tptacek wrote: post #278

Earlier quoted context omitted.

If that's true, explain surgical center pricing, which often beats health chain prices by over 50%.

That has at least one fairly simple explanation: those centers only take lower acuity patients. If you're complex with a history of complications, it'll be "we'll do this one at an actual hospital". (This is frequently the case for my wife.) They may also not take Medicaid patients; my state publishes lists of ones that actually do because of this. https://www.health.ny.gov/health_care/medicaid/quality/surge...

Right, I know that surgical centers operate with a variety of important limitations (surgical centers as they exist now are not an answer to the US health spending problem, which I preemptive agree is very real). I'm just saying that they're evidence of an at least semi-functioning market; they couldn't exist without that (who would send pts to them otherwise?).

Re: The healthcare market is taxing reproduction out of existence

#382

Post by ceejayoz » Tue, Dec 02, 2025, 7:29 PM UTC

tptacek wrote: post #380

ceejayoz wrote: post #376

Earlier quoted context omitted.

> 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.

> Right but there's no such selection effect for whether or not people have employer-provided coverage…

False. Someone with significant medical issues may well need a higher acuity plan than the employer offers. I, for example, was on the exchanges until last year, for this very reason; my employer's coverage would not have made financial sense.

> There are a lot of chronically ill people with employer-provided coverage…

The chronically ill are less likely to be employed.

Re: The healthcare market is taxing reproduction out of existence

#383

Post by ceejayoz » Tue, Dec 02, 2025, 7:32 PM UTC

tptacek wrote: post #381

ceejayoz wrote: post #359

Earlier quoted context omitted.

That has at least one fairly simple explanation: those centers only take lower acuity patients. If you're complex with a history of complications, it'll be "we'll do this one at an actual hospital". (This is frequently the case for my wife.) They may also not take Medicaid patients; my state publishes lists of ones that actually do because of this. https://www.health.ny.gov/health_care/medicaid/quality/surge...

Right, I know that surgical centers operate with a variety of important limitations (surgical centers as they exist now are not an answer to the US health spending problem, which I preemptive agree is very real). I'm just saying that they're evidence of an at least semi-functioning market; they couldn't exist without that (who would send pts to them otherwise?).

That some pieces of the healthcare market may function is something we can all probably agree on. But /u/Sparkle-san was clearly speaking about something broader than these individual exceptions from the rule.

(And even in the case of a surgical center, your decision is likely to be significantly impacted by who your insurer will agree to cover.)

Re: The healthcare market is taxing reproduction out of existence

#384

Post by giraffe_lady » Tue, Dec 02, 2025, 7:34 PM UTC

greenavocado wrote: post #372

giraffe_lady wrote: post #361

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.

I've been sharing needles for 20 years and I'm fine so far what's your point.

Re: The healthcare market is taxing reproduction out of existence

#385

Post by spo81rty » Tue, Dec 02, 2025, 7:39 PM UTC

And then the hospital charges part of the delivery charges to the baby which has a separate deduction.

At least, that is what they did to me.

It's all a scam.

Re: The healthcare market is taxing reproduction out of existence

#386

Post by csa » Tue, Dec 02, 2025, 8:20 PM UTC

tptacek wrote: post #274

potato3732842 wrote: post #251

Earlier quoted context omitted.

You don't need the insurance industry sticking their dick in most of the business they do. Insurance is for the foreseeable but unforecastable, not for routine things. The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem

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.

> 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.

What are you implying with this comment?

I generally enjoy reading your comments, as they provide some interesting and often unique insight.

But this one…

Either it’s something I don’t understand, or it has the potential to be incredibly misleading in its implications.

The impact of American insurers on direct costs, indirect costs, and opportunity costs of healthcare is much more than a rounding error. The incentives amongst various actors, with insurers in the middle, are massively misaligned. I’m sure you know this.

Ask patio11 about insurance in Japan. It’s incredibly affordable, it’s quite good, and there are both public and private options. It’s not perfect by any means, but I miss the healthcare options in terms of both cost and quality that I had in Japan.

Re: The healthcare market is taxing reproduction out of existence

#387

Post by kmeisthax » Tue, Dec 02, 2025, 8:34 PM UTC

SlightlyLeftPad wrote: post #309

autoexec wrote: post #113

Earlier quoted context omitted.

> but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance. The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans…

> I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance. Did we discover a new kind of monopoly perhaps? It’s not quite full blown corruption as there still (for now) exists a somewhat adversarial relationship between insurance and hospitals. However, at the same time, they seem to be pulling each other into the abyss, and our so…

Pretty much every healthcare business unit - hospitals, pharma, insurance, and so on - are deeply consolidated. It spread like contagion, as anyone who didn't consolidate got their margin eaten. The sum of all those different vectors pulling on the same market is one unified message: "rape the consumer for all they're worth"! Because that's the only source of margin left, and everyone's got hungry shareholders who only make money when the business accelerates profit.

Re: The healthcare market is taxing reproduction out of existence

#388

Post by red-iron-pine » Tue, Dec 02, 2025, 8:34 PM UTC

weregiraffe wrote: post #308

barbacoa wrote: post #300

Earlier quoted context omitted.

Car depend infrastructure is amazing to families. A mom can take her children to the grocery store in a car in relative safety without worrying about mentally ill homeless people on the subway.

Men would rather build a continent-sized car-dependent infrastructure that deal with mentally ill homeless people on the subway...

yeah but i can make money selling comically oversized trucks and suvs to fatass americans

fixing homelessness doesn't make me money

Re: The healthcare market is taxing reproduction out of existence

#389

Post by array_key_first » Tue, Dec 02, 2025, 9:00 PM UTC

octoberfranklin wrote: post #204

rsync wrote: post #183

Earlier quoted context omitted.

"Healthcare shouldn't be a market. That's why you're paying $40k." I see your drill down to fundamental issues and I raise you: Pregnancy is not a sickness. Hospitals are for sick people. If we reserved hospital birth for women and children with actual medical problems we would allocate resources much more judiciously. An added benefit: not exposing otherwise healthy (and capable) women to an almost universally disem…

Yes but hospitals are an essential part of Enumeration At Birth. Government loves anything that assists its people-tracking machinery. It will never ever ever discourage pregnant women from doing something that would make reliable Enumeration At Birth more difficult.

Hospitals are also quite good for giving birth, because human bodies are extraordinarily bad at giving birth.

As fun as it sounds to go back to 25-50% infant mortality, I would prefer we keep this in hospitals and do cesarian sections and other interventions when necessaru.

Re: The healthcare market is taxing reproduction out of existence

#390

Post by tptacek » Tue, Dec 02, 2025, 9:01 PM UTC

csa wrote: post #386

tptacek wrote: post #274

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.

> 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. What are you implying with this comment? I generally enjoy reading your comments, as they provide some interesting and often unique insight. But this one… Either it’s something I don’t understand, or it has the potential to be incred…

I think people mistake me for saying that the American status quo is acceptable. It isn't. We overpay (and overprescribe) wildly above peer countries. It's very bad. The only point I'm making here is that the two most common villains in these narratives --- insurers and pharma companies --- mathematically account for only a small portion of spending. Insurers in particular act as sin-eaters for the providers, who dwarf them in size.