What I learned from reading a thousand emergency room bills • Hacker News Board

Re: What I learned from reading a thousand emergency room bills

#551

Post by nybble41 » Thu, Dec 20, 2018, 8:57 PM UTC

vec wrote: post #138

ademup wrote: post #103

Earlier quoted context omitted.

Although most humans are perfectly ambulatory, there are innumerable reasons why they don't get to "choose where to live". Income levels, employment availability, schooling, racial pressure, and many more factors come in to play. Not everyone can physically fit into the best areas. The best areas for emergency services don't necessarily align with the best education (although very high income levels tends to align wi…

> If the private system provides value, it will likely survive. And if it doesn't survive, good ! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.

You haven't rendered private health care "obsolete", you've just forced people to join your public system. Obviously people aren't going to pay for two health providers (unless the public system is completely inadequate). That does not imply that the private service is uncompetitive. There can be no competition when one service must find willing customers while the other takes its funding by force.

This is the same issue with toll roads vs. public roads. Imagine there are two similar roads leading from A to B, one a toll road and the other public. The toll road charges drivers $1 per 100 miles. The public road is free to use but costs every driver $5 per 100 miles in taxes. Which one do you think drivers will take? The more expensive public road, of course—because they're already paying for it, whereas the toll road would be an additional expense.

Re: What I learned from reading a thousand emergency room bills

#552

Post by randyrand » Thu, Dec 20, 2018, 9:21 PM UTC

panic wrote: post #387

randyrand wrote: post #375

Earlier quoted context omitted.

Doesnt UHC not solve any underlying problems and just pass the bill onto taxpayers?

These procedures don't actually cost as much as they're billing. The amount becomes much lower when you can collectively negotiate.

Collective negotiation is nice. It has the ability to affect markup (which is important) but it can't solve underlying costs.

In other words, UHC is a step to lower costs, but it will still be more expensive than a good free/mixed market solution.

Re: What I learned from reading a thousand emergency room bills

#553

Post by krupan » Thu, Dec 20, 2018, 9:37 PM UTC

vec wrote: post #526

krupan wrote: post #513

Earlier quoted context omitted.

A) we do not have universal single payer food. Some welfare for the poor yes. B) that's because food is a free market

A) Right. We have universal single payer food insurance , also known as taxpayer funded welfare for the poor. We're in essence covered by, and paying premiums to, a mandatory State-run insurance policy such that if we ever can't afford the minimum necessary food to survive the State will (at least in theory) step in and buy it for us from the open market. B) Let me rephrase. I'm not going to wake up one day to find t…

A) and it works like insurance in that most of us don't ever need it, but it's there just in case. Also, it does not regulate prices, providers, etc.

B) Again, yes, we need health insurance for rare surprises just like we get fire insurance, auto collision insurance, etc. in case of those rare occurrences. We do not need insurance for medical treatments that everyone gets. We just need to plan ahead financially for those, just like we do for food, clothing, housing, etc. Preparing ahead of time for known expenses is not insurance. If everyone's house burned down a few times each year fire insurance would not work, you would instead just factor that in to the cost of living.

Re: What I learned from reading a thousand emergency room bills

#554

Post by vec » Thu, Dec 20, 2018, 9:48 PM UTC

nybble41 wrote: post #551

vec wrote: post #138

Earlier quoted context omitted.

> If the private system provides value, it will likely survive. And if it doesn't survive, good ! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.

You haven't rendered private health care "obsolete", you've just forced people to join your public system. Obviously people aren't going to pay for two health providers (unless the public system is completely inadequate). That does not imply that the private service is uncompetitive. There can be no competition when one service must find willing customers while the other takes its funding by force. This is the same i…

True, but that's subtly different than the point I'm trying to make.

Imagine your hypothetical were reversed. Imagine we already had a network toll roads priced at an average of $5/100 miles, and that we had a plan to build and maintain public roads at an expected cost of $1/100 miles. There might be plenty of good reasons not to prefer the more efficient public plan, but the fact that it would put toll road vendors out of business isn't one of them.

Capitalists don't mindlessly prefer private things just because they're private. We like them because they tend to self-optimize for efficiency more effectively than a centrally managed system can. Usually. There are a whole thread's worth of reasons to believe health care is one of the exceptions, both in theory and in practice. If that's the case, then refusing to implement a superior public system solely because it would decimate the inferior private one is just another flavor of the same anticompetitive protectionist bullshit that makes tarrifs and professional licensing and restrictive zoning and a dozen other types of cronyism distasteful.

Re: What I learned from reading a thousand emergency room bills

#555

Post by dv_dt » Thu, Dec 20, 2018, 9:57 PM UTC

Domenic_S wrote: post #309

dv_dt wrote: post #178

Earlier quoted context omitted.

With our level of inequality, this is coming back. In the last Southern California wildfire, there were reports again of private firefighting groups operating in the Malibu area.

This is a wildly different situation than what the GP was talking about. If you have the means, why wouldn't you hire a private crew? The public crews are there to get the best outcome at a macro level, not to protect your house in particular.

It's not clear to me it is different. You still have a divergence of motivational coordination between public fire teams and private ones. For one a private fire team can force public ones to stay committed to areas by not heeding evacuation orders...

Re: What I learned from reading a thousand emergency room bills

#556

Post by ThomPete » Thu, Dec 20, 2018, 10:13 PM UTC

wastedhours wrote: post #464

ThomPete wrote: post #450

Earlier quoted context omitted.

Its pretty obvious to anyone who is not looking to get triggered that there is nothing racist nor fingerpointing in what i say. The illegal immigration is used to illustrate one of the things that make the us system wastely different especially from the scandinavian system even though they are always used as an example. Almost every person there is has lived their whole life there. And given i dont actually give you…

Your comment was making an implied link between the difficulties in the US healthcare system and the 11 million illegal immigrants - whether you intended or not (if you didn't, there'd be next to no reason to bring up illegal immigration at all). Why would illegal immigration have any impact on healthcare, unless you were implying that they were a drain on the system (which is an assertion needing to be backed up by…

My comment was making an implied link between many different things, illegal immigration being one of them. As it has an impact on the complexity os the US healthcare system and is one of the reasons why you can't just have a Scandinavian model.

There is a world of difference between a small homogenous group of countries where everyone pays more or less the same taxes their whole life and where immigration is fairly limited and then a country like the US where people arrive often later in life after they grew up other places and before they start paying taxes to the system.

Healthcare budgets are built up over decades not just year over year. It's based on people when they are young and don't cost too much for the system pays to the system so that when they grow older they are offset by younger generations again.

11 million people who live partly outside the system even when they pay taxes is a big number and since they live concentrated in around 20 metropolitan areas almost half of them in 3 states that make them an actual issue on top of the other things as they are not just distributed across the entire country.

In what universe it's racist to point out that illegal immigrants adds to the complexity of why the US can't have the scandinavian model is beyond me. You are the only one making illegal immigration a matter of race for some absurd reason.

Re: What I learned from reading a thousand emergency room bills

#557

Post by ThomPete » Thu, Dec 20, 2018, 10:17 PM UTC

Broken_Hippo wrote: post #475

ThomPete wrote: post #165

Earlier quoted context omitted.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. I really don't understand why it being a big country would make things difficult. Any sane person would adjust the needs dependent on state and smaller. Norway's population is about the same as Indiana's, but is more sparsely populated - so some of the same problems as the…

That's because you haven't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations.

Healthcare systems like the scandinavian are established over decades as the young needs to pay for the old until they get old themselves and have to get covered by the young.

This kind of system is more or less impossible in the US and it would be extremely expensive.

That doesn't mean the current system in the US is any good, it's horrible to say the least. But the scandinavian dream isn't possible in the US and I have yet to see anyone showing any actual proposal that would work given the setup with federal and state and what they can decide.

Re: What I learned from reading a thousand emergency room bills

#558

Post by vec » Thu, Dec 20, 2018, 10:22 PM UTC

krupan wrote: post #553

vec wrote: post #526

Earlier quoted context omitted.

A) Right. We have universal single payer food insurance , also known as taxpayer funded welfare for the poor. We're in essence covered by, and paying premiums to, a mandatory State-run insurance policy such that if we ever can't afford the minimum necessary food to survive the State will (at least in theory) step in and buy it for us from the open market. B) Let me rephrase. I'm not going to wake up one day to find t…

A) and it works like insurance in that most of us don't ever need it, but it's there just in case. Also, it does not regulate prices, providers, etc. B) Again, yes, we need health insurance for rare surprises just like we get fire insurance, auto collision insurance, etc. in case of those rare occurrences. We do not need insurance for medical treatments that everyone gets. We just need to plan ahead financially for t…

As I understand it, we have a relatively small number of people with serious or chronic illnesses whose normal, predictable healthcare expenses will drastically and permanently outstrip their realistic ability to pay. The only way they will ever be able to receive treatment is on someone else's dime, one way or another. And because everyone involved knows they're going to cost more to treat than they can pay then no sane insurer will willingly cover them if they have a choice in the matter.

As far as I can tell the main difference between the socialized food insurance we already have and the socialized medical insurance I'd like us to have is that subsistence level food costs are uniformly low for everyone whereas subsistence level medical costs vary wildly from person to person.

Re: What I learned from reading a thousand emergency room bills

#559

Post by WalterBright » Thu, Dec 20, 2018, 10:23 PM UTC

nybble41 wrote: post #550

WalterBright wrote: post #371

Earlier quoted context omitted.

A free market police system cannot work, because the police use force against people, which is not allowed by the free market. Worse, the police aren't going to arrest people who pay them.

> A free market police system cannot work, because the police use force against people, which is not allowed by the free market. The "free market" (in a libertarian sense) does not permit the initiation of force against people who have not resorted to force themselves. If that is a significant restriction on your police department's activities then there is something seriously wrong with your police department. > Wor…

Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet.

There are private police forces, we call them the "mafia", and people pay them for "protection". Sure, they're corrupt, but with no government funded police, whatcha going to do about it?

Re: What I learned from reading a thousand emergency room bills

#560

Post by vec » Thu, Dec 20, 2018, 11:04 PM UTC

ThomPete wrote: post #557

Broken_Hippo wrote: post #475

Earlier quoted context omitted.

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. I really don't understand why it being a big country would make things difficult. Any sane person would adjust the needs dependent on state and smaller. Norway's population is about the same as Indiana's, but is more sparsely populated - so some of the same problems as the…

That's because you haven't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations. Healthcare systems like the scandinavian are established over decades as the young needs to pay for the old until they get old themselves and have to get covered by the young. This kind of system is more or le…

> This kind of system is more or less impossible in the US and it would be extremely expensive.

That's literally how Social Security works, and the fact that more guest workers pay payroll taxes into the system than are eligible to collect benefits from it actually makes it slightly cheaper than it would otherwise be.