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Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

• seibelj 10y ago
  Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?
  • njkanjsd 10y ago
    The healthcare system in countries like France, Canada, Germany is much more efficient and provides better healthcare to most of it's citizens than the US healthcare system pre and post obamacare. https://www.oecd.org/eco/growth/46508904.pdf https://www.oecd.org/eco/growth/46508904.pdf http://www.commonwealthfund.org/publications/press-releases/2014/jun/us-health-system-ranks-last http://www.commonwealthfund.org/publications/press-releases/...
    • bcohen5055 10y ago
      *citations needed
      • marxidad 10y ago
        http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/ http://healthaffairs.org/blog/2011/09/20/medicare-is-more-ef...
      • sp332 10y ago
        I was going to post this graph https://twitter.com/paulg/status/762920971078627328 https://twitter.com/paulg/status/762920971078627328 but in searching for a source I found the conversation underneath was more interesting. (For reference the source was https://ourworldindata.org/life-expectancy/ https://ourworldindata.org/life-expectancy/ and it's interactive.)
      • njkanjsd 10y ago
        http://www.commonwealthfund.org/publications/press-releases/2014/jun/us-health-system-ranks-last http://www.commonwealthfund.org/publications/press-releases/...
    • vidarh 10y ago
      Germany is mixed private/public insurance. EDIT: So does France.
      • danielweber 10y ago
        All those countries are very different. There's this cartoon understanding the health care system, where the US has system A, and every other country in the world has system B. You will find people on both sides of the aisle believing this. Even though Germany is closer to the US than it is to France.
        • vidarh 10y ago
          The big difference with respect to Germany, though, is that they are not afraid to regulate their health sector. The problem with the US model is not so much private vs. public, but a matter of lobbyists and ideology getting in the way of regulating it in the way that makes sense for people instead of for healthcare providers and insurers. (France also has a mix of private and public healthcare insurance)
    • deleted 10y ago
      [deleted]
    • X86BSD 10y ago
      Yeah I'm not buying this and never have. You're going to need to cite some kind of scientific statistics or stats or studies. When people get sick they come to the US for treatment if they can. You don't see world leaders and those with money going to Canada or Europe for treatment. Not when it's dire. The US is hella expensive for many reasons one is that we have the most bleeding edge medical technology.
      • danielweber 10y ago
        > You're going to need to cite some kind of scientific statistics or stats or studies. There are plenty of studies that support his position. But there are also lots of studies that oppose his position. And everyone will listen to the studies that support their prior viewpoint and say that the others are bunk. You could have a good debate about health care if everyone gave up their priors, was willing to listen to opposing evidence, and was willing to accept their preferred system has real honest-to-God not-said-sarcastically tradeoffs. Let us know when that happens.
      • njkanjsd 10y ago
        Here you go: http://www.commonwealthfund.org/publications/press-releases/2014/jun/us-health-system-ranks-last http://www.commonwealthfund.org/publications/press-releases/... You can find other articles and studies echoing the same conclusions. > When people get sick they come to the US for treatment if they can. No they don't. And many Americans go to other countries for treatment because they can't afford it in the US. > You don't see world leaders and those with money going to Canada or Europe for treatment. 'Those with money' is a tiny portion of the population, which is why I said 'most citizens' get better healthcare in other countries (developed ones). > The US is hella expensive for many reasons one is that we have the most bleeding edge medical technology. Not really, US has some bleeding edge medicine, not the best for every aspect of health, and the bleeding edge stuff is only available to a very tiny portion of the population.
        • X86BSD 10y ago
          reading those now.
  • skylan_q 10y ago
    different options with respect to coverage, for one
  • VonGuard 10y ago
    There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is very much in the pocket of the health care industry. As such, the markets were a compromise measure enacted by congress to make it easier for people to choose health care. Before Obamacare, it was sort of a black box where only HR people could figure out pricing structures and health care providers didn't really compete in any way with each other. Obamacare did do some good things that needed to be done, but essentially, everything about it was a bandaid intended to kick this shitty system down the road to the next person who had to deal with it. But hey, at least health care companies can't just turn you down because you have Diabetes or are too fat anymore.
    • eridius 10y ago
      There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.
      • dikaiosune 10y ago
        Of course, the constituencies which oppose single-payer seem often to be composed of the same people who will vote out anyone who messes with their Social Security, Medicare, or VA benefits.
        • Randgalt 10y ago
          That's an excellent point. Medicare and SSI are equally bad programs that should be phased out.
          • VonGuard 10y ago
            I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age.
  • danielweber 10y ago
    #1. This is going to generate useless flame wars, because most people on both sides don't know very basic facts. #2. Using a private insurance company means you get, in theory, to pick a provider that matches up with your desires on how to determine what is and isn't covered.
    • deleted 10y ago
      [deleted]
  • mhurron 10y ago
    > Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance For the citizen, none. For the insurance companies, they get forced signups. > Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste? The US spends the most of any nation on health care. The US is the only western nation with increasing infant and maternal mortality rates.
    • jasonlotito 10y ago
      > For the citizen, none. Actually, that's false. I can assure you that having lived in Canada and having moved to the US because of health care, having options beyond "deal with it" when not getting any sort of care or service is wonderful. Single-payer is great if you are actually getting the care you need. But when it fails, you are left with little to no alternative. What's worse is that because of the perception that single-payer is so great, people don't really push for real solutions to solve its many problems. People would rather stick their head in the sand and ignore the very real problems, pretending everything is ok. Until then, we happily live here in the US where we get more services for less than what it would have cost in Canada.
      • guelo 10y ago
        Somewhat off topic, it seems to be easier for Canadians to permanently move to the US then for Americans to move to Canada. In your experience is that true?
        • jasonlotito 10y ago
          Not sure. I'm American. My wife is Canadian. My children, by virtue of being my children, have dual citizenship. Edit: Just to be clear, I can't fairly compare. My wife has an easy time because of me and my children, and I had an easy time moving and working in Canada because of my skills.
      • serge2k 10y ago
  • lettergram 10y ago
    The main issue with healthcare in the u.s. actually has to do with Medicare, Medicaid, and social security. All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices. Private insurance options pay larger percentages: 12 - 50%. People without insurance usually will pay either 100% or 0%, with some people negotiating in between. Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates. Fyi I worked in a medical billing office for 5 years. We did payment processing for about 30% of all hospitals on the east coast and Midwest
    • snsr 10y ago
      > Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates. Bullshit. This isn't an easy problem, and you're casually dismissing systems that support millions of people.
      • username3 10y ago
        > All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices. True or false?
      • lbotos 10y ago
        I think the point was if everyone had to pay "full price" the full price would be lower, but right now the prices are inflated so 10% of the price is what they actually hoped to make.
      • lettergram 10y ago
        Supports millions of people in what way? I "casually" wrote off millions a dollars a day in the billing office for people who didn't have insurance. I "casually" wrote off 90% of people's bills who were state funded. The only people we actually were forced to try and collect on were private companies and people making over $X per year. I have no idea how much experience you have with this stuff, but the unfairness comes from the fact doctors/hospitals can effectively charge outrageous prices, knowing they will only make a percentage. On the state payments, they lose money and on the private insurance companies, wealthy and naive honest people they will make more. They have to charge that much to make up for the difference caused by the state options, and people who never pay. Just like any system with a (semi)guaranteed payment (college tuition, healthcare, government contracts, minimum wage, etc.) Prices will inflate capturing the free market rate + the guaranteed amount. If you want to fix that, you have to force deflation by forcing everyone to pay equally. You can do that by removing the guaranteed payment and create competition. Seriously, this is econ 101... Also, antibiotics, insulin, and many of the other standard drugs doctors prescribe could essentially be free for everyone for half the cost of Medicare. Insurance companies only pay like 10% on the dollar for that stuff. So I would much rather "support" everyone by providing the basics, and having the rest be a free market. It would solve probably 80% of the issues with the current healthcare system.
  • Mister_Snuggles 10y ago
    It's hard to tell if there are inefficiencies and waste or if health care is just simply really expensive. Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending. Is that due to waste or inefficiencies? I honestly have no idea. I just know that it's a big number. Another thing to keep in mind is that, at least in Canada, the government provides some base amount of health services, but there are still other things that aren't covered. In Alberta, someone might go to the ER for a severe asthma attack and that's covered, but the prescriptions to keep the asthma under control are paid for out of pocket or from a benefit plan (which could be an individual plan or through an employer). Similarly, dental is not covered, but may be covered under a benefit plan. [0] http://finance.alberta.ca/publications/budget/budget2016/fiscal-plan-expense.pdf http://finance.alberta.ca/publications/budget/budget2016/fis...
    • serge2k 10y ago
      There was talk of starting to cover dental. The prescription thing is a pain in the butt. My mom had to pay out of pocket for her medication for years, until she got a job with prescription coverage.
    • graeme 10y ago
      Why do you say inefficiencies? 40% is entirely out of context, because you haven't listed what other budgeting responsibilities Canadian provinces have. Canada spends far less per capita on health than the us, and gets better outcomes. It's certainly expensive, but it's hard to make the case that Canadian care is expensive relative to the US.
      • Mister_Snuggles 10y ago
        I was replying to this part of the parent comment when I used the words "inefficiencies" and "waste": > Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste? I also acknowledged that I have no idea if $20B is good or bad. And I did not make the case that it's more or less expensive relative to the US. Another commenter took the Alberta budget numbers and ran with it to get to a per-capita cost relative to the US.
  • api 10y ago
    There's no benefit I can see. Our present system combines everything that is bad about "socialized" medicine (loads of regulation, bureaucracy, inflexibility, etc.) with everything that is bad about private medicine (inequality, high cost, fragmentation).
    • Cursuviam 10y ago
      One of the few benefits is that the rich do well in this system.
      • Frondo 10y ago
        It's not just the rich who do well, it's the middlemen at every step of the process. Everyone skims a little extra off the top when medicine or medical equipment is so expensive. Bring costs in line with any other western nation and you're looking at a massive wealth transfer away from everyone with their finger in the health care pie--not just the rich.
  • Randgalt 10y ago
    The purpose of government is not to require the most efficient option. Government isn't capable of it anyway. Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will. For example, in Canada (until recently) people were prohibited from using private health care even if they want to. The health systems in Europe are not radically different from the US system. The efficiencies of each are difficult to quantify without context. For example, the US invents most of the drugs and medical technology used by the world. Would this still happen if there was more invasive regulation? We can't know. Besides all of this, think of every other area of the market where the government insinuates itself. Are public schools better than private schools? Almost never. Is the US postal system better than FedEx? Of course not. The government is not a commercial entity. The incentives and influences on it are not conducive to producing quality products at good prices.
    • loteck 10y ago
      For example, in Canada (until recently) Until recently. This means that all people can obtain health care regardless of their ability to pay, and that the system is flexible enough to continue to experiment with the ideal implementation. Are public schools better than private schools? Public schools are exactly 100% better than private schools for students who can't afford to attend private schools. Is the US postal system better than FedEx? They are if you want to get a letter delivered anywhere in the world cheaply. You have made a lot of good arguments for socializing care here.
      • Randgalt 10y ago
        1. Try getting an MRI in Canada. Canada rations care via wait lists. 2. Your argument implies that there wouldn't be low cost schools in the absence of public schools. The evidence is overwhelming that the opposite is true. 3. I live in Panama. When I need something mailed here I use FedEx or DHL. The USPS is unreliable and takes far too long. If there weren't laws against private first class mail in the US they'd be undercut in that market as well.
  • merb 10y ago
    > (government, aka "public option") that wouldn't happen. since it's monopolism. You would end up in a system like germany. And at the moment these "public" health insurance companies raising their fee's every year. Not better than having private ones, since their regulators just don't care. They praise their reduces with taxes but they don't care if everything else got higher we still end up in a loss.
  • tracker1 10y ago
    Personally, I would have split the difference... I would have created an NPO insurance corporation that was the default for all government paid access programs (employees, retired va, medicare/aid, state programs backed by federal funding)... this likely would have cost less than was already being paid out, in effect consolidating the management of several government programs as well as opening that corporation up to the states, businesses and individuals. Following would have been mandated coverage by employers, and from there would probably have been room to cover most of the rest or provide tax incentives to do so. As it is, when people are paying the entire premium cost directly, they're far more likely to use that resource more, effectively raising costs... the lockin is another negative issue. Creating a publicly sponsored baseline would establish more competition and as an NPO incentive to drive down pricing. The larger issue is IP surrounding medications and medical equipment. Much of which could be improved by front-loading patent application fees, reducing the approval rates for extension patents, and statutory licensing fees for medications more than 5 years old. In the end government should encourage competition, with innovation as a side effect instead of trying to encourage innovation by expanding upon misguided protectionist extremism. But that's my thought on a pragmatic solution that could have worked better with a libertarian mindset.
    • gnaritas 10y ago
      That's not how government works; it's not about pragmatic solutions or logical solutions; it's about what you can get enough people to agree on, which is what Obamacare is, the most enough people could agree on to get it passed. Whatever isn't in there, isn't there because it wouldn't have passed so all Monday morning quarterbacking about what it should have been entirely misses the point about how government works. Governing is about consensus among ideologically opposed members, not about correctness or efficiency.
      • tracker1 10y ago
        And the problem is that everyone in congress is trying to push for their own optimal interests, so the compromises are less ideal than a more pragmatic approach that would have the same effect as compromise from all parties. It's not either's ideal, but still better. If I had the financial independence to run for Congress, I absolutely would.. unfortunately I need to work for a living, and being able to sustain a living while even trying to run isn't something I'd be able to do. Beyond this, running as a Libertarian would be even more difficult. First, I'm in favor of voting for no incumbents for a few election cycles... from there, I'd love to see actual politicians working to sell pragmatic choices towards consensus instead of the give/take we get today, with the boatloads of pork that come with it.
  • ChuckMcM 10y ago
    In theory? As I understand it ... A market allows for innovators to find ways to deliver better service for less money and thus offer a more competitive product and gain market share. This competition forces all players to improve, or be forced from the market. A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service. In the US we have two examples of public insurance providers Medicare and the Veterans Administration (VA). What we haven't tried as far as I can tell is to apply regulatory pressure with marketing forces. So for example if we made it illegal for pharmaceutical companies from preventing generics to be sold or marketed. If we required by regulation that all facilities publish their costs, and to whom those costs were paid, for every procedure. If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database. Etc. It might help in making the market more efficient.
    • tracker1 10y ago
      IMHO if VA, Medicare and federal employee coverage were a gov't backed NPO insurance company, that could provide a baseline and competition. Of course, that would have to also cover the administration and congress. That would act as both a baseline and incentive to compete, with that corporation open to state, company and individual plans. As to pharmaceutical costs, there's two things that need to happen First is that extension patent approvals must be significantly reduced (requiring moving more of the patent fees up to the application stage to cover more review/appeal costs). The second would be statutory licensing for all patents on medication after say 5 years, allowing for generics at a fixed patent licensing fee after the patent is 5 years old. Those would be things to improve competition.
    • mschuster91 10y ago
      > If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database. Well, there's a couple of problems here: 1) People who fail to pay their bills cause financial losses, which have to be covered by the hospital. Therefore, given identical personnel/equipment/etc costs, a hospital in a "poorer" (= more unpaid bills) area will always be higher in cost than a hospital in a "richer" area, since losses have to be distributed among the fully paying customers. 2) You cannot just compare different hospitals on pricing alone. Factors that make this impossible include rent, personnel costs, and equipment costs (e.g. a hospital which uses an old MRT will operate at a cheaper rate than one which buys a new MRT every year). 3) Medical procedure costs can not be estimated at all, given just the diagnosis. Right now my cat is at the vet hospital, turns out the (relatively simple) laying of a pipe to the stomach (she doesn't eat/drink anymore due to liver inflammation, and syringe feeding a cat is cruel for both owner and cat) isn't so simple at all for this unique cat. (For the fellow cat owners, the only thing not healthy about this cat is the liver. The rest of her is in a pretty good condition, and the vets believe she'll make it and purr on for years).
  • deleted 10y ago
    [deleted]
  • danielweber 10y ago
    > rather than a single provider of health insurance (government, aka "public option") Those aren't the same thing at all. It's impossible to debate health care at all because everyone believes a bunch of fairy tales. HN is an extremely poor place to discuss this, because people here are smart enough to think that they aren't being influenced by politics.
  • organsnyder 10y ago
    A couple of arguments in favor of a marketplace: 1. In theory, a competitive marketplace should be able to cut costs and improve outcomes by incentivizing innovation and efficiency (of course, you also have to try to guard against incentivizing insurers to cut costs by reducing access to care). 2. Switching to a single-payer model would be incredibly disruptive to the economy. It would need to be done gradually to minimize the pain. I actually work for a health insurer, but I've also been a big proponent of healthcare reform for quite some time (I see the ACA as a step in the right direction). I'm definitely not opposed to single-payer, but I don't think it would be a silver bullet, either.
    • notadoc 10y ago
      > In theory, a competitive marketplace should be able to cut costs and improve outcomes Outside of theory, can you think of any example where this has actually happened in US health care? The only cost cutting I can think of are notably lower payments to doctors, the insurers fighting every claim, and higher deductibles and co-insurance for the patients. So I guess that cut costs for the health insurer, but the providers and patients costs have gone up directly and dramatically.
      • bluGill 10y ago
        The US health care market is not competitive in that way because of the incentives do not work that way. The US health care market is not consumer driving it is employer driven, and employers want all the things you bring up because it lowers their costs. What employers fear is that someone will offer a health insurance plan that is competitive to theirs, which makes it easier for my to change jobs. Employers like the fact that I pay $200/month for my health insurance, they pay $1000/month. If I want a health insurance plan that improves outcomes and which costs $1500/month I have to come up with the $1500/month, not just the $300 difference. (the above numbers are all made up, but they are realistic) I have long believed that we cannot solve the US health care problems without removing the incentives that force me to use my employers' policy like it or not. In short, you don't see those examples in the US because the system is not competitive on outcomes, only costs. Since cost is the only thing they compete one insurers offer lower payments to doctors, fight every claim, add higher deductibles (which is a hidden cost on me) and co-insurance for the patients. These are innovative, not all are innovations that I would want my insurance company to come up with, but since I'm not a customer they don't care what innovations I want.
  • madhadron 10y ago
    The only place I know that actually has a market is Switzerland. Insurers are required to offer "basic insurance." Everyone in the country is required to buy it. If you are below poverty line, it is paid for by the government. What is covered by basic insurance is set by the government, and so independent of insurer. Likewise, what insurers can ask to set rates is set by the government (age, income, sex, and smoking status basically). Insurers are required to sell basic insurance to anyone who wants to purchase. All insurance billing uses the same set of forms, so there's very little office overhead. This actually produces something that looks like a market. You can get on a website, put in a couple of values, and get a lot of quotes instantly, pick one, put in your credit card, and you're insured. Companies also sell further insurance beyond basic, and compete on quality of service for basic. Swiss healthcare is regarded as decent but far too expensive for what it is compared to the single payer systems in all its neighbors. Paying for healthcare isn't the place you worry about inefficiencies and waste. It's going to get paid for, and the possible efficiencies of pushing paper around are dwarfed by the cost of actually delivering medical care. So what you actually care about is delivery of health care. Italy does this really well. They have public hospitals and clinics and private ones, too. If you go to a public one, you're covered. If you go to a private one, the government pays the same to the clinic that it would pay to the public clinic. So the public system serves as a reference that the private system has to match in efficiency, performance, and price. There is no medical or macroeconomic justification for private insurance companies. It's historical accident perpetuated by monied interests.
    • MrQuincle 10y ago
      The Netherlands has also a private market like this: https://www.government.nl/topics/health-insurance https://www.government.nl/topics/health-insurance. I always go for a high deductible (and lower monthly fee) for example. Edit: (1) Costs for individual: It does cost me around 80 euros, my deductible is 800 euros (maximum allowed) and I'm 100% covered for medical costs at the physician and at the hospital. (2) Costs for government: 11.9% of GDP.
  • brightball 10y ago
    The benefit vs how they happened are very different things. Initially, the benefit was that people paid all medical expenses out of pocket and could purchase insurance in case of extreme medical issues. Businesses started offering health insurance as a perk to attract employees and would negotiate a group rate. This benefits the business by both helping to attract / retain employees as well as helping to keep those employees healthy. Labor unions campaigned to have employer sponsored health insurance which lead to insurance lock-in to a business, usually on 3-5 year agreements, without the employee having any say in where they were getting their insurance from or how much it cost. In effect, this removed health insurance from the consumer market. Compounding the problem, businesses could tax deduct the cost of insurance while employees could not. So both the cost and quality of insurance was removed from the consumer market. Insurance removes the cost of medical care from the consumer market. Federal tax deductions only for businesses incentivize this arrangement. The problem here is not caused by capitalism. This is also before we take into account sheer supply/demand factors around doctors and the regulatory bodies involved in the supply side.
    • ruste 10y ago
      This is the best explanation I've seen so far.
    • xenadu02 10y ago
      We used to have much less medical care available; the best treatment for most diseases was "do nothing". That is no longer the case. We buy car insurance and fire insurance expecting to never or rarely make a claim. We buy health insurance knowing we definitely will be making claims. Supply and demand only works when you can establish a price equilibrium which absolutely requires that some people are priced out of the market. In healthcare that means massive disability and/or death. I don't think a fully free market in healthcare is in any way ethical. Like infrastructure or universal mail/electricity/water, healthcare is one of those things where at least some elements cannot be efficiently delivered by a free market.
      • dredmorbius 10y ago
        And yet, the most dramtic improvements in healthcare outcomes (life expectency, mortality), came in the period before intensive medicine. Robert Gordon's The Rise and Fall of American Growth (2016) describes this in detail. Progress since 1970 has been particularly abysmal and almost totally due to increased access for the most under-served populations. It turns out that there are very sharply diminishing returns to intensive medical care. And that getting the basics right -- pre-natal care, effective childbirth, well-mother-and-baby care, vaccinations, good nutrition, an environment clear of pollution and contamination (especially lead, mercury, asbestos, smoke, and miscellaneous hazards) has a tremendous effect on improving infant survival and adult capabilities in both physical and mental health. The same precise services which lack of healthcare limit. There are also specific interventions which can be hugely impressively. One doctor I know entered the profession after witnessing what a single dose of narcan could do to an ODing heroin junkie. (Mind, you've still got an addict to deal with after ripping them out of Death's Cold Hands, but you've got a live addict, not a dead one.) Wound care, reconstructive surgery, bonesetting, and treatments for at least some diseases and conditions are pretty amazing. But people still eventually die, and putting of the inevitable is extremely expensive. The share of Medicare (and total) healthcare expenditures invoked in the last 12 months of life are quite high, though I've not the specific figures. And the US healthcare industry, in cost for outcomes achieved, is horrendously inefficient. It remains unavailable for far, far too many people.
  • rayiner 10y ago
    From the point of view of people opposed to single-payer, you're not even asking the right question. It's not about which is more beneficial on the balance. It's about whether the private sector solution is so broken as to overcome the presumption against a government-run solution.
  • toddmorey 10y ago
    There's pretty enlightening chart on this article: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective http://www.commonwealthfund.org/publications/issue-briefs/20... The general consensus is that the U.S. spends more on health care than other high-income countries but has worse outcomes. "Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%)." If there are benefits to a private system, we aren't seeing them. (That may be because we don't have a private system OR a public system. We have a frankenstein hybrid that's the worst of both and works for no one.) The biggest problem is all the attention has been focused on who pays, rather than how much. The cost system for US Healthcare is so opaque, so disjointed that no one--not the providers, not the customers, not the insurers--have the required understanding or motivations to control costs.
    • maxerickson 10y ago
      I absolutely think that a national policy should focus on maximizing outcomes across society, but it is easy to imagine that some people don't care about the outcomes that other people receive.
  • riboflava 10y ago
    The best is probably a mix, like Singapore. The citizens win in the case the government provider is efficient or inefficient, because in either scenario the government sets a floor of efficiency that private companies can't go under and survive. In a purely private market there's the potential for collusion, or in a heavily regulated market there's the potential for forced inefficiencies. When you just have the single government provider, you cut off the possibility of doing much better, and you create a big incentive for everyone in the industry to inflate their costs because the government always pays.
  • Spooky23 10y ago
    Benefit: It got the republican votes necessary to pass the law. Benefit: It prevented a mass disruption of jobs. Health insurers have lots and lots of workers.
  • millstone 10y ago
    I'm surprised at how many people think the answer is "no benefit" or political expediency. The hope is that insurers will compete with each other and find ways to reduce costs. Obamacare has regulations designed to prevent the most egregious cost-saving measures (denying claims, rescission, etc), so insurers will have to find ways to reduce costs other than simply not paying. Because many insurers are small, they can try experiments that would be prohibitive in a larger insurer. We'll get a lot of data about what works and what doesn't, which will filter up to larger insurers (like Medicare!). One example of a way that an insurer could save money is pay-for-performance, that pays health care providers based on the health improvements of their patients instead of volume of services. Aetna is trying this. That's the case for a market. (There's definitely a case against it too.) One thing missing from this discussion is the fact that the health care exchanges are small relative to the rest of the market: around 10 million enrollees on the exchanges, compared to ~150 million in employer sponsored plans. This is because Medicaid expansion covered more people, and fewer employers dropped their employee-sponsored health insurance, compared to predictions. So the exchanges aren't really a big player.
  • 3princip 10y ago
    Everything the government provides causes lots of inefficiencies and waste, and unintended consequences to boot. That said, some things may be worth the sacrifice, healthcare may be one of those things. One question to ask, will the quality of care improve (whatever the cost) if the government takes over? Since the US is made up of states, what is stopping one state from providing single-payer and proving the model works?
    • lutorm 10y ago
      At least one has: https://en.wikipedia.org/wiki/Vermont_health_care_reform https://en.wikipedia.org/wiki/Vermont_health_care_reform It apparently didn't work well, though.
  • Spooky23 10y ago
    Remember that the existence of private players doesn't mean that you have a free market, which tends to drive efficiencies. In the US, it's more of a planned/command economy. A retail consumer gets the worst price. (Think the "rack rate that you never pay that's in the back of a hotel door) The government through Medicare/Medicaid/Tricare gets the best price. Everyone else is in the middle, on a spectrum of discount based mostly on size or some other market power. In a single payer system, you end up controlling costs by compelling the providers to work for the system (similar to an HMO like Kaiser), prioritizing certain services and using regulation to discourage bad vendor behavior, like drug profiteering.
    • 20yrs_no_equity 10y ago
      > you end up controlling costs by compelling the providers This is the basic premise of socialism. But it never works out. What you end up getting is either very low quality at high prices or very low availability. Obamacare attempts to do exactly that, and as a result the providers are simply leaving the "market". Meanwhile, price has skyrocketed, and quality of coverage has dropped dramatically. My marketplace plan would likely bankrupt me if I got a serious condition, however the coverage I had before Obamacare was very good and very cheap. I'm not that much older!
      • philjohn 10y ago
        Except that's not the case in other single payer systems ... The NHS has its flaws (having to wait for non-urgent or non life-threatening issues to be treated, but they are in fact treated, just at a lower priority) but if you present at the hospital with chest pains you'll be sorted out straight away, without having to pay up front - free at the source of treatment, one of the founding tenets of the service. It also doesn't preclude a private system that works alongside it, which many companies offer to their employees. This allows you to get seen quicker for the non-urgent stuff - if it's life threatening you'll be taken straight to an NHS hospital, but have your follow up care privately. We pay less of our GDP on healthcare, yet have comparable, if not better, outcomes. With the current "privatisation" that's occurring, vendors are invited to bid for the work, no compelling, it's there if they want it. If nobody comes forward to provide it, the NHS will do it instead.
  • tbihl 10y ago
    First of all, it makes no sense if you've mandated the specifications of the product being sold via legislation. Having said that, a huge benefit would be the ability to buy insurance: actual insurance, in which you're paying a subscription fee for the service of protecting you from the risk of a huge surgery bill, rather than a payment plan that covers everything inside the walls of a hospital. As a young adult, I would be happy to pay for a service that would insulate me from risk I can't handle, because it would make me financially stable. But if the plan also covers predictable things like obese people needing diabetes meds, children being delivered, and obscenely expensive cancer treatment that only slightly extends a low-quality end of life, that's a different question. Suddenly (probability of medical emergency) X (expected cost) << (cost of insurance premium), even if you add a $500 penalty to the left side of the equation. Bankruptcy seems like the smart insurance if I'm not amassing significant savings, in that case. Everything outside of those complicated, expensive procedures would suddenly be susceptible to price sensitivity, since the users would also be the people paying. Faced with that pressure, routine procedures would fall to prices that don't look like typos. Having said that, what I've read about the British system seems like it could be effective, if it were politically feasible: procedures have to stay below the cost per unit of increase in life expectancy or quality of life, or else you have to fund it yourself. When the current American system was being battled into law, it seems like that number was about 30kpounds per year of life.
  • gozur88 10y ago
    If the government is going to be making all the decisions there's no benefit. But I doubt we would have had Obamacare at all if he'd proposed a single-payer plan. Insurance companies, which have a lot of clout in Washington, helped push it through because they expected to make more money. Which, quite frankly, was stupid. It was pretty clear from the outset the ACA would break the US health care system so badly single-payer is the only option going forward.
    • jessaustin 10y ago
      Do you think that was as clear to the sponsors of the ACA as it was to you?
      • gozur88 10y ago
        If by "sponsors" you mean the political leaders, then yes. They knew they were fudging the books. They explicitly abused the GAO ten year window to make it look like there would be enough money even though the wheels were due to start coming off after seven years. They also had enough political experience to know getting the (delayed) more unpopular parts (like cuts in payments to doctors accepting Medicare, increases to penalties for people who don't buy insurance, and extra taxes for "Cadillac plans") might be too difficult to get through when the time came. That's why they were delayed. I suppose I can give them enough benefit of the doubt to say many of them may have believed once the system was in place they could solve the problems by closing the gap with something something.
        • jessaustin 10y ago
          "Sponsor" is a standard term with a widely accepted meaning when discussing Congress. https://en.wikipedia.org/wiki/Sponsor_(legislative) https://en.wikipedia.org/wiki/Sponsor_(legislative)
          • gozur88 10y ago
            Yes, and it's a word with other meanings as well. That's the one I thought you meant, but I wasn't sure.
  • zeveb 10y ago
    > Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Government provision of health insurance means that every procedure covered is a political issue (e.g. abortion for the left, sexual-orientation counselling for the right). This means that there will be nationwide winners and losers, and no-one but the rich will be able to simply change providers, as with a private market. As an example, look at how public schools are run: only the rich are able to opt out of government schooling. American governments are not capable of running efficient programmes, because to a first approximation American government employment is a make-work program for people who can't get hired at anywhere that cares about competence. That means that a government insurance provider will be incompetent and inefficient. To make things worse, the employees of said provider will be unionised, and that union will do its best to make it even more inefficient (e.g. take a look at the prison guards' unions).
    • random28345 10y ago
      > American governments are not capable of running efficient programmes, because to a first approximation American government employment is a make-work program for people who can't get hired at anywhere that cares about competence. American governments are not capable of running efficient programs because to a zeroth approximation Americans keep electing politicians that not only promise that government can't do anything right, but also work to ensure it.
    • SteveLAnderson 10y ago
      "American governments are not capable of running efficient programs" - that's simply false, and your statement about government employees is insulting.
      • phil21 10y ago
        Insulting to whom? While it's a generalization, it's pretty much accurate in the entirety of my personal and professional experience. Some good competent folks work for the government, but they are drowned out to the point of absurdity by the masses of folks doing enough to not get fired. Which generally means showing up on time and not doing something the other bored employees in the office can complain to your manager about. I have pretty extensive experience with it at both local and state levels, with some experience on the Federal side. There are certain agencies and careers that seem to still attract decent folks, but they seem exceedingly rare.
  • davidf18 10y ago
    Switzerland, Germany and other countries lack single player plans. Israel has 4 different integrated health providers that compete to provide care. I am sure there are many other examples of health care systems that choose not to use a single payer.
  • mathattack 10y ago
    I'm not well enough informed to give a complete opinion on what's better, because it's a complicated solution. I do know some reasons why a public option might not be good. (This doesn't mean it's the wrong option - just considerations) 1 - When you eliminate competition, you lose innovation and smart cost control. Look at most monopolies for evidence of this. 2 - You wind up forcing a "one size fits all" on everyone. What if some people prefer a bare bones service, and others prefer an advanced one? 3 - How many things does the government really run well?
    • st3v3r 10y ago
      1 is disproven when you look at other countries with single payer, and they have a much better handle on their healthcare costs than we do. 3 - about the same amount as the private sector.
      • mathattack 10y ago
        On #1 there is a lot of data that suggests single payer can be cheaper. On innovation, other countries lag. I disagree on #3, at least in the US. Would we rather have Health Care run like UPS or the Postal Service?
  • karzeem 10y ago
    There's a book called "Catastrophic Care" that directly addresses this question. It's an expansion of an article the same author wrote for The Atlantic (http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ http://www.theatlantic.com/magazine/archive/2009/09/how-amer...). And for a summary of the book in video form, here's a long interview the author did with Malcolm Gladwell: https://www.youtube.com/watch?v=eP--XMgEv4c https://www.youtube.com/watch?v=eP--XMgEv4c To answer your question, the way we think of health insurance isn't compatible with a free market system. Insurance pools risk and money to cap your losses in rare, ruinous events. But that's not how we use health insurance. We use health insurance to pay for low-cost, common, certain-to-happen events (blood work, checkups, X-rays, sprained joints, etc.). To borrow an example from the book, imagine we had grocery insurance. Every month, you paid $500 to the grocery insurance company, and you could go to the store to pick out any covered groceries. The market for food would quickly take on all the negative features we find in the market for healthcare. Prices that are crazy and only get higher, minimal competitive forces against low-quality providers, no transparency for consumers, etc. Market forces are great at lowering prices while increasing quality, but they only work if people personally decide how and where to spend their money. If you give your money to a third party who then makes all the spending decisions, it smothers all the price/demand/competition signals that providers should naturally get. (And which, in a healthy market, automatically put providers out of business when their prices get to high or their results dip too low.) To borrow from the book again: it seems crazy to expect people to pay for healthcare out of pocket. But add up your premiums. You're probably paying $6-10k per year right now. That's many times more than enough to cover typical healthcare in most years. With plenty left over to buy catastrophic coverage for high-cost low-probability stuff. And in a market where people are making their own decisions with their own money, prices would quickly drop, which would stretch your out-of-pocket dollars much further than they go today. Every $2500 MRI would go out of business, replaced by $500 ones. (We already see this kind of price deflation in the corners of medicine where people do pay out of pocket, namely laser vision correction, plastic surgery, and to some extent walk-in checkup clinics.)
  • 20yrs_no_equity 10y ago
    > Can a capitalist case be made for their existence? Yes, and rather than do it myself, I'll let Nobel Prize winning economist Milton Friedman do it: http://www.hoover.org/research/how-cure-health-care-0 http://www.hoover.org/research/how-cure-health-care-0 Note the date. He did studies in the 1970s and updated them in the 1990s with consistent results. This was all well known and the case was made repeatedly before Obamacare was passed.
  • tn13 10y ago
    Competition is very important. Government provides free education. Is there a case for private educational institutes ? Surely yes there is. Catholic schools, schools focused on gifted children, schools focused on differently-able children etc. that diversity is important in all spheres of life. Also, please note that when you use words like "government provided insurance" the word insurance can mean something totally different under government just the way we have learned that government's definitions of "traitor", "whistleblower", "sex offender" are different from what common sense might tell us. If only government provides insurance government also ends up deciding what health services we can use or not use. For example Liberals might say "sex change surgery" is essential procedure and force tax-payers pay for it. Conservatives on other hand might say any health issues occurring because of anal sex will not be covered. I think one big problem is that American's who support single payer system fail to see that "healthcare" is a lose term and under the "single payer" that definition might change to suite the payer instead of consumers. I really like this news item : https://www.youtube.com/watch?v=K0e3-EvpDwM https://www.youtube.com/watch?v=K0e3-EvpDwM
  • ende 10y ago
    Independent of the presence or absence of a public option, the benefits of a private market largely depend on whether an actual competetive market with consumer choice and pricing comparison can exist. In the US it cannot due to regulatory capture and occupational licensing plaguing the industry and creating massive market distortions. Consumers are completely disconnected from pricing. Single payer and private markets can be complimentary, with private insurance funding more personalized care and a recourse from the dreaded death panels. Single payer with private markets seems to be the model many countries are converging on.
  • intopieces 10y ago
    I was under the impression that the purpose of the private healthcare marketplace was to satisfy the right-leaning Democrats who were on the fence about passing Obamacare and as a pacifier against a full-scale filibuster by Republicans. I think the architects have known it's going to fail, and want to use this failure as leverage for the creation of the public option.
  • nikcheerla 10y ago
    Anecdotally, while Britain's medical system has less wait times, doctors working for the NHS are chronically overworked and underpaid. Many move to Australia or go into private practice after completing their residencies.
• MrZongle2 10y ago
  And if the merger isn't blocked, what guarantee does Aetna make that they won't drop out of the exchanges anyway?
  • mikestew 10y ago
    It does have the distinct smell of the broadband subsidies: "Give us money if you want us to roll out high-speed broadband." "Thanks for the check. Oh, BTW, we decided high-speed broadband wasn't really working for us, so we nixed it." Aetna deal goes through: "Shockingly, we're still losing money on exchanges, so we're not going to do that anymore. Thanks for letting that merger go through, though."
  • addicted 10y ago
    Anecdotally, any course of action depending on "synergies" being realized will not happen.
• nfriedly 10y ago
  Good riddance. Heath insurance in the US seems to benefit the insurance companies more than anyone else.
  • rch 10y ago
    How about pharmaceutical companies? It seems to me that 'insurance' has become more like a group pre-paid debit card for predictable medical expenses than a lower cost hedge against statistically rare events.
  • harryh 10y ago
    That's silly. Insurance is a great method of hedging risk. If my apartment burns down it would cost me A LOT of money to replace my stuff. But the chances of it burning down are really small. So I can purchase renters insurance for just a couple hundred bucks a year, an expense I can easily afford. That benefits me a great deal! Maybe when you said insurance you meant to say "health insurance" but the same principle applies. If I have a heart attack then treating it will be hideously expensive, but that's also unlikely to happen.
    • nfriedly 10y ago
      I was referring to health insurance specifically. I edited that in just now to clarify. Health insurance should work exactly as you describe, but far to often I've seen it cover the little things like colds, and then fail to adequately cover big things like a heart attack.
    • zedzedb5 10y ago
      RISK seems to be the least mentioned word in this entire thread. "Insurance is a great method of hedging risk." Spot on. I wish we had education in RISK Management rather than what we have now.
    • philjohn 10y ago
      Except a building isn't almost certain to burn down during its lifespan. Humans, metaphorically, burn down at a much higher rate. Cancer, heart disease, systemic infection ... "Spreading the risk" doesn't work when the likelihood of something bad happening approaches a percentage in the high double digits, especially with an ageing population and falling birth rates to keep paying into the ponzi scheme.
• saosebastiao 10y ago
  Good. Block their deal, let them drop out of obamacare, and then give us the Single Payer that we've always deserved and watch those fuckers go bankrupt like they've always deserved.
  • skylan_q 10y ago
    i couldn't in any good conscience support single-payer or socialized medicine it's the same economic model that created breadlines
    • vectorpush 10y ago
      Can you elaborate on this reasoning?
      • skylan_q 10y ago
        free market systems are dynamic and adjustable to real-world inputs in a way that no planned system can match in terms of providing the most service/product to the most people. what people really want when they push for socialized medicine is equality over improvement. envy holds us back so much.
        • vidarh 10y ago
          That's great for the people with lots of money. Not great for the people who die or go bankrupt in the name of "improvement".
          • skylan_q 10y ago
            Liberalize healthcare to allow anyone to provide it. Did you know that before the AMA was created that doctors had to do house calls or face living in abject poverty as a result of the market being flooded with healthcare professionals?
            • 10y ago
• snsr 10y ago
  Kind of ironic given that Aetna is largely responsible for the elimination of the public option from the Affordable Care Act. Thanks again Joe Lieberman https://en.wikipedia.org/wiki/Aetna#Lobbying_and_campaign_contributions https://en.wikipedia.org/wiki/Aetna#Lobbying_and_campaign_co...
  • harryh 10y ago
    If you think a ~$100,000 a year to a politician (plus another couple million to some other politicians) is largely responsible for the rules that govern how 20% of our economy functions you are quite mistaken. There are huge economic and political forces at work that render Aetna's tiny expenditure irrelevant in the grand scheme of things.
    • georgemcbay 10y ago
      I'm no expert in this at all, but I do know a number of people who work in government and across the board they are all of the opinion that most people would be shocked if they knew just how cheap it was to buy major influence, even at the national level.
      • harryh 10y ago
        There are people that are experts and they generally agree that the effects of political contributions are much smaller than is generally believed by the public.
        • georgemcbay 10y ago
          Unless you cite some credible sources, this is just a case of dueling anecdotes.
    • random28345 10y ago
      > If you think a ~$100,000 a year to a politician (plus another couple million to some other politicians) is largely responsible for the rules that govern how 20% of our economy functions you are quite mistaken. cough https://en.wikipedia.org/wiki/Copyright_Term_Extension_Act https://en.wikipedia.org/wiki/Copyright_Term_Extension_Act cough That was purchased pretty cheaply, and industries affected by copyright(books, movies, music, software, software) are a decent chunk of the economy.
• rrggrr 10y ago
  You can either have a system where everyone is covered at great relative expense to the healthy, or one where everyone is covered at great expenses to taxpayers. Either way, quality of care, breadth of services and speed of access are going to suffer. Demographic reality is inescapable.
  • zaroth 10y ago
    Only 5-10% pay the majority of taxes, but almost everyone is, eventually, not healthy. Another way to put it is that average lifetime healthcare cost is about $250k for men, $350k for women. So yes, definitely people should be paying for health insurance while they are healthy, so that they can also have it when they are sick. In a sense, health insurance should be priced just like a $250k/$350k term-life policy that you take out at birth.
    • antisthenes 10y ago
      > Another way to put it is that average lifetime healthcare cost is about $250k for men, $350k for women. Do you have a source for these numbers?
      • zaroth 10y ago
        The Lifetime Distribution of Health Care Costs http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/
• fredgrott 10y ago
  There is a solution to this.. If there was say a more market based price tier and that tier to Obamacare was made up of both US Federal workers plans and State workers plans than there would be a huge amount of healthy people in the whole group and private ins co's would be striving to be part of ObamaCare as their costs than would not exceed their revenues.
• dieselz 10y ago
  Before the pitchforks come out, keep this in mind: before Obamacare increased access to affordable individual plans, employers were the typical purchasers of health care plans. When you have a 100+ person company, the company pays a rate that averages out their employee pool's healthcare needs. Now we have a situation where more people can more efficiently participate in the healthcare market. Individuals who are young and healthy will opt for a lower cost plan, and those who already have illnesses or higher risk for illness will spend more for their healthcare. This efficiency on the consumer side is destroying revenue for the healthcare companies. I am not saying that anything was even close to perfect before, but we're seeing the private sector responding to Obamacare - it's not profitable enough or even sustainable in some cases. Now the government wants to block companies from trying to salvage their profits? Yes, consumers are benefitting now, but what happens when there are 2 options left for healthcare in each state? I think in this case, it's clear that the hybrid Capitalist / Socialist approach is not the way to go. Either the government needs to let health care companies operate the way the market allows them to, or move to a single payer system.
  • blocktuw 10y ago
    I fail to see how I as a consumer am personally benefitting. I have more expensive healthcare that covers less and it gets more expensive and covers less every year. I'm sure there are a few very sick people out there who are benefitting. I'm glad that we as a society are able to help them out. But it's clear that I do not have choice in needing healthcare, whereas these providers do have a choice in providing healthcare. I agree with you that the hybrid approach is not working.
  • oh_sigh 10y ago
    > Individuals who are young and healthy will opt for a lower cost plan, This doesn't jive with the Obamacare marketing: They specificially needed to get a lot of young healthy people to sign up, because their fees would pay for the older generations who have higher health care costs.
• loteck 10y ago
  If we are unwilling to confront the bloody, economy-crashing hellscape that is the foreseeable result of a system that only provides non-emergency care to people who can pay, then it seems like socializing the costs of care is the only method that could be made to be sustainable.
• ksnieck 10y ago
  I don't really understand how this is a threat without understanding whether Humana is on the same exchanges and what other providers are on those exchanges. Journalists seem to get really excited when they get some inside scoop.
• uptown 10y ago
  The public is starting to get a peek at the 2017 rates. To put it lightly, they're not pretty. This post shows the proposed premium increases, averaging around 24%. It's likely these may land somewhere below those numbers, but the cost of simply being insured before any co-pays or paying any deductibles has rapidly become unsustainable for a huge percentage of the population, especially the middle-class who earn too much for subsidies but not enough to cover the costs of proper insurance and care. http://www.zerohedge.com/news/2016-08-15/obamacare-sticker-shock-average-2017-premium-surges-24 http://www.zerohedge.com/news/2016-08-15/obamacare-sticker-s...
  • addicted 10y ago
    The "leaked" numbers have always been higher than what actually happens. The insurance companies always propose higher increases in order to have a stronger bargaining position, and those numbers have historically been bargained down to something decent.
    • uptown 10y ago
      Absolutely. But I'd wager the vast majority of the increases land well above the rate of inflation. And since open-enrollment begins a few days before the Presidential election, it'll be interesting to see how those numbers are managed given that Hillary has hitched her campaign to the Affordable Care Act as an extension of her original campaign for universal health insurance when she was First Lady.
      • coredog64 10y ago
        As it's unlikely to be a competitive race by then, I would expect that certain people will be reminded of certain aspects of the power of the executive branch and that will be that.
• dang 10y ago
  Url changed from http://www.npr.org/sections/health-shots/2016/08/17/490202346/aetna-ceo-to-justice-department-block-our-deal-and-well-drop-out-of-exchanges http://www.npr.org/sections/health-shots/2016/08/17/49020234..., which points to this. Strange world when HuffPo has the more original source and the more substantive piece than NPR...
• warfighting 10y ago
  How long would a government run tech company survive in the valley? Now tell me again why you want them centrally planning your healthcare?
  • csallen 10y ago
    I never understood this mindset. It assumes that the govn't is incompetent (which it often is in many areas, fair point), but then ignores the most obvious response, which is to diagnose and fix the problems at hand. Simply abandoning the government solution is not the only option. In fact, one of the government's biggest problems is that so many people are obsessed with neglecting/sabotaging it just to prove some point that it's bad.
    • zeveb 10y ago
      > It assumes that the govn't is incompetent (which it often is in many areas, fair point), but then ignores the most obvious response, which is to diagnose and fix the problems at hand. It's utterly impossible to fix the problems of government competence because Americans don't want their government to be competent. They want it to be supportive, and diverse, and all sorts of things, but competence is not one of them. If American government were competent, it would hire precisely the people whose unions donate so much to American politicians.
  • gnaritas 10y ago
    Government isn't a company, isn't competing with them, and shouldn't be measured in the way companies are measured; that you're even making this comparison speaks to the fact that you don't understand the purpose of government. Why do I want centrally planning in my healthcare, because it can accomplish something companies can't: full coverage for all citizens rich and poor alike. No market solution can or will ever provide that, government CAN.
• CodeSheikh 10y ago
  We need a serious disruption of insurance industry. A paradigm change.
  • deleted 10y ago
    [deleted]
• Apocryphon 10y ago
  So how can consumers respond to this corporate chicanery? In a capitalist system, the natural recourse is for citizens to turn to the private market for alternatives. Could this provide an incentive for Aetna's competitors to make it easier for Aetna's customers to switch to them? One would assume that libertarians and free marketeers would cheer the concept of boycotts, as it is one of the mechanisms that citizens are empowered with in a laissez-faire society.
  • rayiner 10y ago
    What corporate chicanery? They took a loss on exchange plans last year. They have every right to pull out of the exchanges until the government makes them stay. I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-subsidization, propping up money-losing individual plans with profits from group plans. And then they berate companies for pulling out of money-losing enterprises, as if providing healthcare for people who can't afford it is the job of private companies rather than the government.
    • Apocryphon 10y ago
      It's more about opposing their attempts to thwart antitrust law. After AT&T's merger failed, T-Mobile used the money and the public fallout as an opportunity to reinvent themselves as a company that caters to the public. I'm wondering if this could be a similar opportunity for Aetna's competitors. If the government is unable to prevent monopolies, then consumers should step in by punishing companies that seek to monopolize. Edit: Again, that's one of the concepts behind libertarianism, isn't? The idea that instead of relying upon government regulation, there's almost some economic reputation system in place which would cause consumers to reject doing business with bad actors. So in theory, the recourse here would be for the individual consumer to reject Aetna directly in response for their monopolistic practices.
      • onewaystreet 10y ago
• ihsw 10y ago
  This is a worst case scenario for Obamacare -- the leverage that empowered the insurers to dictate the terms of the ACA never went away, and it won't anytime soon. Anything less than the Federal government threatening to nationalize Aetna would be insufficient, lest the Obama administration wants to appear weak and invite further dissent. Just another reason why single-payer is the best option.
• pseingatl 10y ago
  This is precisely why single payer is desperately needed. And proof that Obamacare is a Rube Goldberg machine. I remember listening to a Kentucky senator who said they were gobsmacked that no insurance company signed up in his state. The program is based on wishes, not good practices. Having Justice tinker with antitrust to keep it alive will never work. Insurance companies could give a F about their policy holders, their shareholders and profits are the only ones who count.
  • jlmorton 10y ago
    This is not proof at all that "Obamacare is a Rube Goldberg machine." This is a major insurer pulling out the markets, but over trivial amounts of losses. I don't know what you mean about Kentucky. There are plenty of health insurance companies with offering on the Kentucky exchanges (Anthem BCBS, CareSource Kentucky, Humana, Aetna, and Bluegrass Family Health). And in any event, even if there truly were no insurance companies with offerings on the Kentucky exchanges, I find it very implausible that either Mitch McConnell, or Rand Paul would have claimed to be "gobsmacked." They were leaders in the fight against ACA, and they certainly claimed before passage that the law would destroy the health care industry.
    • harryh 10y ago
      I don't think it's fair to categorize Aetna's annual loss of ~300M as trivial. That represents about 12.5% of their profits. If someone cut your salary by 12.5% I don't think you would think that was trivial.
      • Steko 10y ago
        Salary is analogous to revenue not profits.
        • harryh 10y ago
          Salary is the money I get from my employer to buy stuff with. If I'm a shareholder of a company, then my cut of their profits (not revenue) is money I get to buy stuff with.
• swalsh 10y ago
  Only tangently related, but I strongly encourage anyone who has interest in learning more about the state of the industry and how technology relates to it read this book: https://www.amazon.com/Digital-Doctor-Hope-Medicines-Computer/dp/0071849467 https://www.amazon.com/Digital-Doctor-Hope-Medicines-Compute...
• british_india 10y ago
  Single Payer.
• twblalock 10y ago
  I don't understand why so many private insurers participated in the exchanges in the first place. It seems pretty obvious that the people who need to purchase from the exchanges are less likely to be healthy than the general population, because they probably haven't had much preventative care in the past, due to their prior lack of insurance, and also because poverty and poor health are highly correlated. Imagine that you ran a car insurance company, and the government set up an exchange where the least-skilled drivers could purchase insurance. Would you participate?