I write about America’s health care system, and I got caught up in it • Hacker News Board

Re: I write about America’s health care system, and I got caught up in it

#71

Post by civilized » Sun, Jan 30, 2022, 3:18 PM UTC

lotsofpulp wrote: post #57

lil_dispaches wrote: post #54

Health Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise. The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't…

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

> you are protected from expenses above $17.4k per calendar year per family.

Given that this applies to in-network costs only, as you noted above, it seems very inaccurate to describe it as genuine protection. Any random provider in your current care situation can be out of network, it is very hard to know or have any control over especially in a crisis situation, and it is these providers that usually end up billing you through the nose.

It would be irresponsibly misleading to call your life insurance "protection" if the insurer just rolls a dice or consults the day of the month to determine if they'll pay your claim.

Re: I write about America’s health care system, and I got caught up in it

#72

Post by BobbyJo » Sun, Jan 30, 2022, 3:19 PM UTC

andi999 wrote: post #65

BobbyJo wrote: post #61

Earlier quoted context omitted.

> A system that rations care based on ability to pay... is immoral. You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing? Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing,…

The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand) If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give…

> The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand)

Changing housing situations is exactly as easy as changing hospitals and emergency rooms no? Since the latter are mostly decided by where you live. In fact, most mid to large cities feature many hospitals near any given residence, so it is actually easier. I would also point out that the demand curve for housing, energy and food are far more inelastic than for medicine.

> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.

Why couldn't the market find a price? Cancer actually seems like the worse example possible. The people I've known who've been diagnosed with cancer have shopped around for care from many different hospitals. It would seem that cancer would be the perfect candidate for market forces to lower prices since a diagnosis generally affords a bit of time to find and decide on treatment options. Even in the extreme case of 'you have months to live' people tend to spend a few weeks collecting different opinions.

Re: I write about America’s health care system, and I got caught up in it

#73

Post by cascom » Sun, Jan 30, 2022, 3:19 PM UTC

We (Americans) are in this situation simply because we have avoided making hard decisions in our healthcare system, and in many cases created actually done things that break the system further (limited to no healthcare rationing in Medicare, mandatory acceptance of pre existing conditions, attaching private insurance to one’s employer rather than the individual, etc.)

In short we haven’t come to a consensus as to derivation of the engineering axiom, you can have 1) broader access 2) quantity/quality 3) affordability —-pick two

Re: I write about America’s health care system, and I got caught up in it

#74

Post by tragictrash » Sun, Jan 30, 2022, 3:19 PM UTC

throwaway6734 wrote: post #64

tragictrash wrote: post #39

Earlier quoted context omitted.

What twisted fucked up naive world view does this come from. These people are poor, vulnerable and sick. You should be ashamed of yourself. Why don't I throw you in a cage, and then you can try voting for someone to advocate for your release. The point is the seniors need help now, not being told to go organize. The healthcare system is broken, and until you get sucked into it, you don't understand the extent of it.…

This is an overly paternalistic point of view that robs these people of their agency. They've spent their lives participating and interacting within the current political framework. Blaming all problems at the feet of "morally bankrupt leaders" is hyperbolic populist rhetoric to absolve personal responsibility.

Sounds like the morally bankrupt trying to defend themselves.

Re: I write about America’s health care system, and I got caught up in it

#75

Post by lil_dispaches » Sun, Jan 30, 2022, 3:20 PM UTC

lotsofpulp wrote: post #57

lil_dispaches wrote: post #54

Health Insurance is a political scam of epic proportions. There is no indemnity involved. It is not real insurance. You don't use insurance to pay a monthly bill, you have it for black swan events. Nor should insulin be 1000/mo, on paper or otherwise. The whole thing is performance politics to distract from the "insurance" companies running everything from medicine regulations to your kids playgrounds (so they don't…

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

You can't indemnify health, only property. Personal costs related to health have no bounds; for instance if you lose your job because of health, your "out of pocket" is your whole salary. Which real insurance would cover.

Your example is leagues of laws and regulation on top of a scam, a pyramid model that affords top care for those who can afford modest premiums and really do get expensive care for $5 copay, at the cost of everybody else who has to fight their employer via federal politics for the right to go bankrupt.

Indeed, I would say that using insurance to pay your insulin bill is coming out on top of the scam, because some books are getting cooked (+/- paper costs) at the expense of mutual indemnity (taxes, social security). An insulin user is a health insurance voter, but that is a weak expediency for actually fixing the price of insulin and ending the tyranny of insurance companies over healthcare, and it turns whole populations into do-or-die partisans.

Thanks, Obama!

Re: I write about America’s health care system, and I got caught up in it

#76

Post by mnhn1 » Sun, Jan 30, 2022, 3:21 PM UTC

BobbyJo wrote: post #61

syki wrote: post #56

Earlier quoted context omitted.

In all healthcare systems some form of rationing occurs since there aren’t enough resources to provide the best care to everyone. A system that rations care based on ability to pay or on wether or not your employer is generous is immoral. It is also immoral to profit off of denying someone care. Tough decisions have to be made and financially rewarding a company by denying care is despicable.

> A system that rations care based on ability to pay... is immoral. You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing? Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing,…

I don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc.

And indeed the US has many such services, though they are often overwhelmed, or performed through a complex set of nonprofits combining govt funds with donor money as best they can to provide good support. Sometimes they are overwhelmed specifically because of externalities related to the for-profit insurance healthcare system. The high and often unpredictable cost of any medical situation, means people with tight budgets become sicker before getting care, if they ever get it, leading to a higher percentage of bad outcomes, up to and including job loss and homelessness for the individual, and knock-on effects for the rest of their family. This puts extra pressure on the parts of the support system that do exist - those already mentioned, and, of course, the police, who end up getting called to many situations that could have been prevented by the people involved having better services to begin with, to meet their health, food, and housing needs.

Re: I write about America’s health care system, and I got caught up in it

#77

Post by lotsofpulp » Sun, Jan 30, 2022, 3:21 PM UTC

civilized wrote: post #71

lotsofpulp wrote: post #57

Earlier quoted context omitted.

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

> you are protected from expenses above $17.4k per calendar year per family. Given that this applies to in-network costs only, as you noted above, it seems very inaccurate to describe it as genuine protection. Any random provider in your current care situation can be out of network, it is very hard to know or have any control over especially in a crisis situation, and it is these providers that usually end up billing…

The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that:

https://www.cms.gov/nosurprises

https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule...

For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.

Re: I write about America’s health care system, and I got caught up in it

#78

Post by civilized » Sun, Jan 30, 2022, 3:21 PM UTC

lotsofpulp wrote: post #77

civilized wrote: post #71

Earlier quoted context omitted.

> you are protected from expenses above $17.4k per calendar year per family. Given that this applies to in-network costs only, as you noted above, it seems very inaccurate to describe it as genuine protection. Any random provider in your current care situation can be out of network, it is very hard to know or have any control over especially in a crisis situation, and it is these providers that usually end up billing…

The relatively new surprise billing and emergency care from out of network providers to be treated as in network providers legislation changes that: https://www.cms.gov/nosurprises https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule... For non emergency care, it should be easy to login to insurance company’s website and see if doctor or doctor group is in network or out of network.

Sort of. You get to initiate a fight with the insurer through an unaccountable arbiter.

Insurer websites have lied to us in the past, claiming X was in network (zero cost!) and then sending us a denial resulting in a giant out of network bill for that exact X. Same service, same provider.

Truly incompetent and evil system. Fills me with rage.

Re: I write about America’s health care system, and I got caught up in it

#79

Post by the-dude » Sun, Jan 30, 2022, 3:24 PM UTC

lotsofpulp wrote: post #69

the-dude wrote: post #67

Earlier quoted context omitted.

For reference, in NL I believe I have about €250 out of pocket maximum. Could be €500 now, not sure.

It is a spectrum of course, but a 500 Euro out of pocket maximum is probably better described as taxpayer funded healthcare. The US is pay $400 to $1,200 per person per month from age 0 to 64, and then pay up to $8,700 individual / $17,400 family per calendar year. At age 65, the government starts paying for your hospital care assuming you or your spouse paid Medicare taxes for at least 10 years, and you then have to…

Health insurance premiums are between €125 - €150 / month here.

Re: I write about America’s health care system, and I got caught up in it

#80

Post by lotsofpulp » Sun, Jan 30, 2022, 3:24 PM UTC

lil_dispaches wrote: post #75

lotsofpulp wrote: post #57

Earlier quoted context omitted.

Health insurance in the US has an in network out of pocket maximum of $8,700 for individual and $17,400 for families: https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... With the recent laws regarding mandatory coverage of emergencies while out of network, it seems to qualify for the definition of “insurance”, as you are protected from expenses above $17.4k per calendar year per family. The fact that most…

You can't indemnify health, only property. Personal costs related to health have no bounds; for instance if you lose your job because of health, your "out of pocket" is your whole salary. Which real insurance would cover. Your example is leagues of laws and regulation on top of a scam, a pyramid model that affords top care for those who can afford modest premiums and really do get expensive care for $5 copay, at the…

> Thanks, Obama.

Yes, thanks for getting the only legislation passed in the past 30+ years that expanded access to healthcare.

FYI, ACA is what made it possible for people to even purchase healthcare coverage without an employer. And also, taxpayer funded healthcare (“public option”) was preferred by the Obama administration, but had to be whittled down to meet the compromises needed since there was basically zero support from across the aisle.

The tax benefits of health coverage via employers is a separate matter, and while it should have been addressed, I am not surprised nor would I blame Obama for that, since it was already hard enough to get what we currently have passed.