People Lose Their Employer-Sponsored Insurance Constantly • Hacker News Board

Re: People Lose Their Employer-Sponsored Insurance Constantly

#41

Post by davidw » Wed, Apr 17, 2019, 5:28 PM UTC

dv_dt wrote: post #25

davidw wrote: post #21

Earlier quoted context omitted.

Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'. As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives. I mention Italy because 1) I lived there and 2) it's not some perfectly…

All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the c…

The Economist did a nice comparison of different systems a few years back:

https://www.economist.com/united-states/2017/08/10/the-fix-f...

Re: People Lose Their Employer-Sponsored Insurance Constantly

#42

Post by jimmy1 » Wed, Apr 17, 2019, 5:30 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

I think your phenomena might be due to startups? Obviously this is a startup focused board so I am not saying this to mean go one way or another, but I ditched the startup, job hopping life a little while ago, and had to deal with "insurance bs" roughly two times in 7 years.

I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenue producing organization, but I don't seem to encounter what seems to be the well-represented insurance pains documented here (probably a little bit of both, in my guess).

Re: People Lose Their Employer-Sponsored Insurance Constantly

#43

Post by pnathan » Wed, Apr 17, 2019, 5:33 PM UTC

One of the fundamental reasons why I haven't really bothered doing startups or running a small business myself is the radical uncertainty over health insurance for myself and my family. It's not just plain $$$ and career risk, it's the "suppose you will go bankrupt and your family has permanent medical issues now" risk. That game is for the wealthy or healthy single people

In addition, each insurance plan has slightly different doctors that sign on, so when there are changes, you might wind up needing to use different doctors or worse, health systems.

It'd be much better for me, personally, to require providers to all accept some US Public Single Payer plan (or whatever you call it) as part of opening a practice and seeing patients.

(I don't speak in any sense for my employer, who is in the health care space: this is just an engineer's personal musings)

Re: People Lose Their Employer-Sponsored Insurance Constantly

#44

Post by jvagner » Wed, Apr 17, 2019, 5:33 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

We have a high-deductible health plan and live in Reno. When my gf recently had the need for a CAT scan, the first choice was here in Reno, and it was priced at over $800. She cancelled her appointment, called over in Carson City (20 minutes south of Reno), and got one done, by someone in our network, for $400. The doctor's office who referred her said, "$800? Really!?"

The Reno specialist made her a follow-up appointment in June. The Carson City specialist saw her in 4 days.

Etc, etc.

We're our own LLC, and we got our own group health plan, as a function of being self-employed and having experienced the employment-related gaps in health insurance coverage.

None of this is interesting, but it's stupid and risky. This system has to be changed.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#45

Post by dv_dt » Wed, Apr 17, 2019, 5:35 PM UTC

aantix wrote: post #40

dv_dt wrote: post #25

Earlier quoted context omitted.

All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the c…

Without the U.S. subsidizing the drug research R&D, who pays for it? You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding. But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed. The money has to come from somewhere. I think countries take for granted the progress we've made. No progress is made withou…

This paper gives pretty interesting breakdown of how private companies are increasingly bad at paying for it.

https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p...

One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D.

Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human need like healthcare. Other sectors for human basics like the grocery industry, run on margins of 1-5%.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#46

Post by Glyptodon » Wed, Apr 17, 2019, 5:35 PM UTC

Employer sponsored health insurance is an outpost of neofeudalism. Swear your fealty to a lord or go without.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#47

Post by jimmy1 » Wed, Apr 17, 2019, 5:36 PM UTC

aNoob7000 wrote: post #5

Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.

I don't mean this to be snarky, but if what you are saying is true (Congress can't do anything), why do you think the governmental disfunction will not carry over to an expanded medicare-for-all program? Medicare is not without issue and is wrought with fraud that needs decisive congressional action to help fix, yet they have shown inability there as well.

Re: People Lose Their Employer-Sponsored Insurance Constantly

#48

Post by dv_dt » Wed, Apr 17, 2019, 5:38 PM UTC

akhilcacharya wrote: post #38

dv_dt wrote: post #20

Earlier quoted context omitted.

After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats. It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung…

> as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, The problem being that none of their candidates won competitive seats . Now, some like Kara Eastman came close..but candidates closer to the Obama/Hillary mold, veterans, and pro-gun control candidates in suburbs made up the bulk of the wins in the midterms.

I doubt your data. Just one counter example, in Orange County CA, Katie Porter, a democrat, won a competitive seat in a district that has been Republican for a long time (maybe 30+ years?).

Re: People Lose Their Employer-Sponsored Insurance Constantly

#49

Post by pavel_lishin » Wed, Apr 17, 2019, 5:38 PM UTC

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

Isn't it pretty cost-effective and efficient to keep you on the phone for three hours in the hopes that you just give up and don't undergo a medical procedure?

Re: People Lose Their Employer-Sponsored Insurance Constantly

#50

Post by Glyptodon » Wed, Apr 17, 2019, 5:41 PM UTC

jimmy1 wrote: post #42

helen___keller wrote: post #37

The point of health insurance is to pay into a risk pool as a collective so that the small percentage of people who end up needing the largest percentage of health care, nobody dies or goes into monumental debt. This can be done via taxes but insurance is a private market solution which should in theory make it more efficient for the sake of maximizing profit. So then if it's supposedly more efficient, why do I waste…

I think your phenomena might be due to startups? Obviously this is a startup focused board so I am not saying this to mean go one way or another, but I ditched the startup, job hopping life a little while ago, and had to deal with "insurance bs" roughly two times in 7 years. I am either the luckiest person alive, or maybe there is additional benefits not obviously well represented here to working for a stable, revenu…

I'm not at a startup and have better than average insurance, however it's still a clown show.

For example, I recently got prescribed a medical device, but was then told that if I didn't have a follow up appointment between certain dates I'd be billed out of pocket for the device.

The prescribing physician, of course, has no open appointments until a couple months after the given follow up interval, despite knowing the potential issue and prescheduling the followup.

And of course the device provider, the physician, and the insurance company all tell me completely different things about the situation.

The current "solution" is "just see your primary care instead," not sure how it'll go.