Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

nejm.org

Post reply on HN
Print view View original

81–88 of 88 posts

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#81

Post by mikeash »

lend000 wrote: post #80
mikeash wrote: post #71

Earlier quoted context omitted.

The basic concept of health insurance works fine. Yes, your probability of dying approaches 1 as you age, but the costs you incur along the way can vary enormously. Somebody who's wonderfully healthy until they instantly die in bed of a heart attack will cost the insurer basically nothing, while somebody with a chronic condition can easily cost millions of dollars over decades. Costs can vary enormously depending on…

> If you think the advantages of going full free market in health care outweigh having poor people die of easily treatable diseases, then that's a valid opinion, but you should acknowledge the negative consequences. How does one lead to the other? Social safety nets are not mutually exclusive with removing a lot of other market barriers. See my prior comment on this thread -- our healthcare market is the most distort…

"But if you are responsible and get insurance BEFORE you get sick (by the way, not much sympathy for those who do not and demand that insurers take them, since that's the whole point of insurance)"

So, screw people who are born with a chronic condition, or people who lose coverage due to poverty and then want to get back on later?

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#82

Post by lend000 »

mikeash wrote: post #81
lend000 wrote: post #80

Earlier quoted context omitted.

> If you think the advantages of going full free market in health care outweigh having poor people die of easily treatable diseases, then that's a valid opinion, but you should acknowledge the negative consequences. How does one lead to the other? Social safety nets are not mutually exclusive with removing a lot of other market barriers. See my prior comment on this thread -- our healthcare market is the most distort…

"But if you are responsible and get insurance BEFORE you get sick (by the way, not much sympathy for those who do not and demand that insurers take them, since that's the whole point of insurance)" So, screw people who are born with a chronic condition, or people who lose coverage due to poverty and then want to get back on later?

> So, screw people who are born with a chronic condition, or people who lose coverage due to poverty and then want to get back on later?

I don't think insurance is necessary in the system I propose, but to the first point, nature already screwed you, life isn't fair, etc. To the second, I actually addressed that in my comment as something that could be eligible for protection for some period.

But let me know if you take issue with the main points -- not trying to get into a battle of details.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#83

Post by mikeash »

lend000 wrote: post #82
mikeash wrote: post #81

Earlier quoted context omitted.

"But if you are responsible and get insurance BEFORE you get sick (by the way, not much sympathy for those who do not and demand that insurers take them, since that's the whole point of insurance)" So, screw people who are born with a chronic condition, or people who lose coverage due to poverty and then want to get back on later?

> So, screw people who are born with a chronic condition, or people who lose coverage due to poverty and then want to get back on later? I don't think insurance is necessary in the system I propose, but to the first point, nature already screwed you, life isn't fair, etc. To the second, I actually addressed that in my comment as something that could be eligible for protection for some period. But let me know if you t…

How long is that period of protection? Anything less than infinity seems deeply problematic.

I consider these questions to be among the main points. If you don't, that would explain our difference of opinion. I really can't understand shrugging off screwing over people born with chronic conditions on the basis that life is unfair anyway. I mean, you can use that argument to justify nearly anything. Why outlaw murder? Sure, it sucks to get murdered, but life is unfair.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#84

Post by lend000 »

mikeash wrote: post #83
lend000 wrote: post #82

Earlier quoted context omitted.

> So, screw people who are born with a chronic condition, or people who lose coverage due to poverty and then want to get back on later? I don't think insurance is necessary in the system I propose, but to the first point, nature already screwed you, life isn't fair, etc. To the second, I actually addressed that in my comment as something that could be eligible for protection for some period. But let me know if you t…

How long is that period of protection? Anything less than infinity seems deeply problematic. I consider these questions to be among the main points. If you don't, that would explain our difference of opinion. I really can't understand shrugging off screwing over people born with chronic conditions on the basis that life is unfair anyway. I mean, you can use that argument to justify nearly anything. Why outlaw murder?…

> How long is that period of protection? Anything less than infinity seems deeply problematic.

Our current system of infinity is clearly problematic. But I really don't want to get into an argument of defending any implementation of health insurance (even one which I think would be better than the current) because I don't think there's a good way to do it period, as per my first comment.

> Why outlaw murder? Sure, it sucks to get murdered, but life is unfair.

Two completely separate things, not even on the same spectrum. Outlawing murder is preventing a violation of a person's rights, i.e. aggression. You maximize society's net freedom by outlawing it. Forcing society to try to make life "equal" for someone who was born with some terrible condition inherently violates freedoms through mandates, taxes, etc. And of course there's the whole thing about it not being practical. Everyone dies, and almost everyone would benefit from an extremely expensive heart transplant/frequent blood transfusions late in their life. But unfortunately, we can't give it to them (yet). However, there will always be some new and great medicine that is too scarce for everyone to have. Fortunately, private individuals are very charitable without the government and create institutions to treat and study chronic diseases.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#85

Post by dllthomas »

lend000 wrote: post #58
nyxtom wrote: post #31

Earlier quoted context omitted.

That's not a sustainable choice for our economy, it leads to too many people living like nothing could possibly go wrong until they need a doctor. The point of insurance is to distribute risk, not participating in that effectively negates the effectiveness of the industry.

The whole idea of health insurance is backwards and inconsistent with a free market in my opinion (fraudulent). The problem is that the government has enshrined it as the gateway to healthcare. Insurance is a useful product for mitigating risk, so accident insurance could be a very constructive concept (protecting against accidental injuries, broken arms, falls, car crashes, etc.). However, health problems are not a…

I agree that we far too often conflate "health insurance" and "health care".

That said, while in some sense "health problems" are guaranteed, the range of costs involved is huge.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#86

Post by mikeash »

lend000 wrote: post #84
mikeash wrote: post #83

Earlier quoted context omitted.

How long is that period of protection? Anything less than infinity seems deeply problematic. I consider these questions to be among the main points. If you don't, that would explain our difference of opinion. I really can't understand shrugging off screwing over people born with chronic conditions on the basis that life is unfair anyway. I mean, you can use that argument to justify nearly anything. Why outlaw murder?…

> How long is that period of protection? Anything less than infinity seems deeply problematic. Our current system of infinity is clearly problematic. But I really don't want to get into an argument of defending any implementation of health insurance (even one which I think would be better than the current) because I don't think there's a good way to do it period, as per my first comment. > Why outlaw murder? Sure, it…

A lot of people consider health care to be a basic human right. Taxing people to provide health care is, from that perspective, not fundamentally different from taxing people to prosecute murder.

I get that you probably don't think health care is a human right, but "not even on the same spectrum" is not a simple statement of fact.

If your preferred outcome involves screwing these people and various others because you think overall it's a worthwhile tradeoff, then so be it, but I want to make sure we're clear on that consequence.

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#87

Post by lend000 »

mikeash wrote: post #86
lend000 wrote: post #84

Earlier quoted context omitted.

> How long is that period of protection? Anything less than infinity seems deeply problematic. Our current system of infinity is clearly problematic. But I really don't want to get into an argument of defending any implementation of health insurance (even one which I think would be better than the current) because I don't think there's a good way to do it period, as per my first comment. > Why outlaw murder? Sure, it…

A lot of people consider health care to be a basic human right. Taxing people to provide health care is, from that perspective, not fundamentally different from taxing people to prosecute murder. I get that you probably don't think health care is a human right, but "not even on the same spectrum" is not a simple statement of fact. If your preferred outcome involves screwing these people and various others because you…

> I get that you probably don't think health care is a human right

Correct, I consider human rights to be more fundamental than a new product/service -- health care didn't even exist a century ago. It is expensive, scarce, and difficult to define, as it is constantly changing. The only thing that is guaranteed is that there will be a point where a patient cannot be given any more healthcare, because of the diminishing returns (measured in hours of added lifespan per dollar).

> If your preferred outcome involves screwing these people and various others because you think overall it's a worthwhile tradeoff, then so be it, but I want to make sure we're clear on that consequence.

Yes you've mentioned that point before and I addressed it. To recapitulate: there is definitely an interesting argument to be made for the tradeoffs involved, and I think it would be worthwhile if measured in terms of average lifespan. However, as I said, I am not as convinced as you are that people with pre-existing conditions are going to be "screwed" in a more free-market, insurance-free system. Their costs of treatment goes down, and by the nature of insurance, they would typically be paying more than the cost of their treatment anyway (over time) to the insurance company, so....

Re: Barack Obama Publishes Defense of the ACA in the New England Journal of Medicine

#88

Post by mikeash »

lend000 wrote: post #87
mikeash wrote: post #86

Earlier quoted context omitted.

A lot of people consider health care to be a basic human right. Taxing people to provide health care is, from that perspective, not fundamentally different from taxing people to prosecute murder. I get that you probably don't think health care is a human right, but "not even on the same spectrum" is not a simple statement of fact. If your preferred outcome involves screwing these people and various others because you…

> I get that you probably don't think health care is a human right Correct, I consider human rights to be more fundamental than a new product/service -- health care didn't even exist a century ago. It is expensive, scarce, and difficult to define, as it is constantly changing. The only thing that is guaranteed is that there will be a point where a patient cannot be given any more healthcare, because of the diminishin…

Costs might come down in a free market system, but many chronic conditions will remain unaffordable to treat even after, say, an order of magnitude reduction in costs.

As for paying more in insurance premiums than you'd pay for treatment, that's only if insurance companies are allowed to account for your chronic condition when determining premiums. If you forbid insurance companies from charging more for existing conditions (as the ACA does) then that doesn't apply, and healthy people subsidize the costs.

Post reply on HN