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It's a balancing act though, no? Health Insurance is stupid expensive in the US. In Bolivia I used to pay $300/month for my entire family full coverage, no copa

It's a balancing act though, no? Health Insurance is stupid expensive in the US. In Bolivia I used to pay $300/month for my entire family full coverage, no copay. But they did screen for preexisting conditions when I signed up. So what's the answer? How can health insurance providers help people with pre-existing conditions, and also not gouge young healthy customers? Is the healthcare industry just charging too much money?

nradov 10y ago
Asking everyone to pay into a shared risk pool is not gouging. That's simply the nature of insurance. We're going to have to pay for people with pre-existing conditions one way or another, whether it's structured as a tax, penalty, or insurance premium. Certainly there is some waste, fraud, and abuse in the healthcare system which could be cut. But ultimately the only way to significantly cut costs would be to ration care. It's a hard issue and no one likes to talk about it.
- maxerickson 10y ago
  It's the nature of universal insurance with no lifetime limits. In terms of insurance, it's perfectly possible to write healthy young people a significantly cheaper policy that has limits and is no longer available as they age. It's probably pretty stupid for the young people to opt for that policy, but whatever.
  - cmdrfred 10y ago
    What is interesting is the really expensive portion of insuring individuals is already essentially single payer. When people age most of them end up on medicare and the majority of health expenses happen in the weeks and months prior to your death.
- sampo 10y ago
  > But ultimately the only way to significantly cut costs would be to ration care. As far as I know, Western European countries spend about half (per capita) on health care as what USA spends. I don't know if US health care is that much better. And if it's not, then in theory there is a way to get the same results cheaper.
  - nradov 10y ago
    Sure if we ration care intelligently based on maximizing QALYs per dollar or something then we can get roughly equivalent results (on a total population basis) for much less money. But that means we have to put a price on human life, and for emotional reasons most people don't like to do that.
  - jquery 10y ago
    My experience with the USA healthcare system has been utterly phenomenal. Almost no waits for procedures of any kind, top-tier care. My last hospital stay was 5 days with many lab tests and two ER visits and an ambulance ride preceding it. Out of pocket I paid $100, $50 of which was later refunded to me. Parts of the ACA are necessary but I can't help but feeling, based on the price increases, the Act itself is horribly inefficient. We didn't increase the supply, we just increased the demand for a product which is very inelastic, resulting in skyrocketing premiums. A reform must involve increasing the supply of care.
toomuchtodo 10y ago
> So what's the answer? How can health insurance providers help people with pre-existing conditions, and also not gouge young healthy customers? * Taxes go up, but they go up less than health insurance premiums would. Remove insurance companies as an industry. [1] * Price controls on providers (inelastic demand of healthcare means "the market" sets the price to "you pay whatever it costs so you don't die") [2] * Allow Medicare to negotiate with drug manufacturers, otherwise buy from other countries [3] That's about it. If Sam and YC want to see this fixed, start advocating for politicians who support single payer. Startups will not fix this problem. Blog posts will not fix this problem. Political activism will fix this problem. [1] https://www.youtube.com/watch?v=LtplKTHa4TA https://www.youtube.com/watch?v=LtplKTHa4TA [2] https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/Downloads/CMS1191262dl.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Res... [3] https://www.nytimes.com/2016/02/02/upshot/the-real-reason-medicare-is-a-lousy-drug-negotiator-it-cant-say-no.html?_r=0 https://www.nytimes.com/2016/02/02/upshot/the-real-reason-me...
- misnome 10y ago
  > Taxes go up, but they go up less than health insurance premiums would. Remove insurance companies as an industry. From the international perspective, I get the impression that Americans are against this because then you are "paying for other people" (as though insurance doesn't count, but through a private company is somehow 'better').
  - carry_bit 10y ago
    With actual insurance, you aren't paying for other people. Your premiums are based on the expected value of your future claims. The financial incentive helps preserve that property: If a company can identify the cheaper customers, then they can offer lower premiums than the companies that can't. The customers left behind are more expensive, forcing those premiums to rise in order to remain solvent.
cmdrfred 10y ago
>Is the healthcare industry just charging too much money? Yes. Twice as much as the rest of the world in fact. Mostly due to lack of competition (25 year monopolies for simply adding a antacid to an existing drug) and zero negotiation on pricing. The President Elect said as much yesterday. https://www.washingtonpost.com/amphtml/news/wonk/wp/2017/01/11/trump-on-drug-prices-pharma-companies-are-getting-away-with-murder/ https://www.washingtonpost.com/amphtml/news/wonk/wp/2017/01/...
- sergiotapia 10y ago
  Is there any truth to what Trump said that healthcare providers have monopolies on divided by geographical areas? One of his proposed solutions is to outlaw these monopolies and let the providers compete between themselves to lower costs.
  - maxerickson 10y ago
    It's vaguely true. Insurance policies are regulated at the state level (so to be sold to residents in a state a policy has to follow the regulations in that state). It's kind of hilarious that the conservative, small government party is proposing to federalize this regulation. The reality is that the policies that companies will be willing to sell across state lines are likely to be truly awfully shitty, by doing things like not having a coverage agreement with most hospitals (which will at least drive up out of pocket costs and complicate claims, if not enabling the companies to outright deny claims).
  - KirinDave 10y ago
    This is not a thing you can legislate away effectively. The key to understanding here is that negotiation for health care is hard due to the fractured nature of providers and care. Insurers are micro-monopolies because they tend to serve districts or business sectors more effectively (cheaply) than others and rise to the top, but without a huge base of citizens to negotiate for no significant pricing change can really occur.
  - alphabettsy 10y ago
    One of the largest and seemingly most unnoticed changes recently has been the consolidation of local hospitals into regional monopolies. It was already difficult to compare pricing in healthcare, now imagine when there are no other choices in your area.
binaryorganic 10y ago
I think it's less that they're charging "too much" money, and more that costs are too high (which can be true for plenty of reasons other than profit). I believe that single payer systems can bring prices lower with more efficiency, but there are plenty of things that can be done that are less controversial (combating waste, increasing administrative efficiencies, etc). One personal example from my life that put health care costs into perspective was surrounding the issue of Midwives vs. OB/GYNs when we were having our first child. We were approved by our insurance to have an OB/GYN deliver our child, which would cost the insurance company about $5,000 if everything went well (more if there were complications). But they wouldn't cover us at all if we delivered the child with a midwife, which cost about $1,500 and has been shown in study after study to reduce the likelihood of more costly intervention. In our case, we paid the midwife out of pocket, but there are so many people that don't have the economic freedom to make that choice and the result is that their insurance companies pay far more money for child births than they would have otherwise had to. Again, just one example, but I'm sure there are thousands more.
shitgoose 10y ago
just curious, what % is $300/average salary in Bolivia? PS health cost is US are not just stupid expensive, it is broad day light extortion. the victims for some reason prefer not to see it as robbery, but rather to argue about qualities of their robbers. charging $600 to empty the urine bag is possible only because the whole hospital system is rigged (i.e. excessively regulated and monopolized).
bzbarsky 10y ago
Helping people with preexisting conditions through an _insurance_ program is just daft conceptually. We do need to do this, but calling the result "insurance" just leads to confusion about how it should work, because it can't actually be "insurance" in the way the term is normally understood...

nradov 10y ago

Asking everyone to pay into a shared risk pool is not gouging. That's simply the nature of insurance. We're going to have to pay for people with pre-existing conditions one way or another, whether it's structured as a tax, penalty, or insurance premium. Certainly there is some waste, fraud, and abuse in the healthcare system which could be cut. But ultimately the only way to significantly cut costs would be to ration care. It's a hard issue and no one likes to talk about it.

maxerickson 10y ago
It's the nature of universal insurance with no lifetime limits. In terms of insurance, it's perfectly possible to write healthy young people a significantly cheaper policy that has limits and is no longer available as they age. It's probably pretty stupid for the young people to opt for that policy, but whatever.
- cmdrfred 10y ago
  What is interesting is the really expensive portion of insuring individuals is already essentially single payer. When people age most of them end up on medicare and the majority of health expenses happen in the weeks and months prior to your death.
sampo 10y ago
> But ultimately the only way to significantly cut costs would be to ration care. As far as I know, Western European countries spend about half (per capita) on health care as what USA spends. I don't know if US health care is that much better. And if it's not, then in theory there is a way to get the same results cheaper.
- nradov 10y ago
  Sure if we ration care intelligently based on maximizing QALYs per dollar or something then we can get roughly equivalent results (on a total population basis) for much less money. But that means we have to put a price on human life, and for emotional reasons most people don't like to do that.
- jquery 10y ago
  My experience with the USA healthcare system has been utterly phenomenal. Almost no waits for procedures of any kind, top-tier care. My last hospital stay was 5 days with many lab tests and two ER visits and an ambulance ride preceding it. Out of pocket I paid $100, $50 of which was later refunded to me. Parts of the ACA are necessary but I can't help but feeling, based on the price increases, the Act itself is horribly inefficient. We didn't increase the supply, we just increased the demand for a product which is very inelastic, resulting in skyrocketing premiums. A reform must involve increasing the supply of care.

toomuchtodo 10y ago

> So what's the answer? How can health insurance providers help people with pre-existing conditions, and also not gouge young healthy customers? * Taxes go up, but they go up less than health insurance premiums would. Remove insurance companies as an industry. [1] * Price controls on providers (inelastic demand of healthcare means "the market" sets the price to "you pay whatever it costs so you don't die") [2] * Allow Medicare to negotiate with drug manufacturers, otherwise buy from other countries [3] That's about it. If Sam and YC want to see this fixed, start advocating for politicians who support single payer. Startups will not fix this problem. Blog posts will not fix this problem. Political activism will fix this problem. [1] https://www.youtube.com/watch?v=LtplKTHa4TA https://www.youtube.com/watch?v=LtplKTHa4TA [2] https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/Downloads/CMS1191262dl.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Res... [3] https://www.nytimes.com/2016/02/02/upshot/the-real-reason-medicare-is-a-lousy-drug-negotiator-it-cant-say-no.html?_r=0 https://www.nytimes.com/2016/02/02/upshot/the-real-reason-me...

misnome 10y ago
> Taxes go up, but they go up less than health insurance premiums would. Remove insurance companies as an industry. From the international perspective, I get the impression that Americans are against this because then you are "paying for other people" (as though insurance doesn't count, but through a private company is somehow 'better').
- carry_bit 10y ago
  With actual insurance, you aren't paying for other people. Your premiums are based on the expected value of your future claims. The financial incentive helps preserve that property: If a company can identify the cheaper customers, then they can offer lower premiums than the companies that can't. The customers left behind are more expensive, forcing those premiums to rise in order to remain solvent.

cmdrfred 10y ago

>Is the healthcare industry just charging too much money? Yes. Twice as much as the rest of the world in fact. Mostly due to lack of competition (25 year monopolies for simply adding a antacid to an existing drug) and zero negotiation on pricing. The President Elect said as much yesterday. https://www.washingtonpost.com/amphtml/news/wonk/wp/2017/01/11/trump-on-drug-prices-pharma-companies-are-getting-away-with-murder/ https://www.washingtonpost.com/amphtml/news/wonk/wp/2017/01/...

sergiotapia 10y ago
Is there any truth to what Trump said that healthcare providers have monopolies on divided by geographical areas? One of his proposed solutions is to outlaw these monopolies and let the providers compete between themselves to lower costs.
- maxerickson 10y ago
  It's vaguely true. Insurance policies are regulated at the state level (so to be sold to residents in a state a policy has to follow the regulations in that state). It's kind of hilarious that the conservative, small government party is proposing to federalize this regulation. The reality is that the policies that companies will be willing to sell across state lines are likely to be truly awfully shitty, by doing things like not having a coverage agreement with most hospitals (which will at least drive up out of pocket costs and complicate claims, if not enabling the companies to outright deny claims).
- KirinDave 10y ago
  This is not a thing you can legislate away effectively. The key to understanding here is that negotiation for health care is hard due to the fractured nature of providers and care. Insurers are micro-monopolies because they tend to serve districts or business sectors more effectively (cheaply) than others and rise to the top, but without a huge base of citizens to negotiate for no significant pricing change can really occur.
- alphabettsy 10y ago
  One of the largest and seemingly most unnoticed changes recently has been the consolidation of local hospitals into regional monopolies. It was already difficult to compare pricing in healthcare, now imagine when there are no other choices in your area.

binaryorganic 10y ago

I think it's less that they're charging "too much" money, and more that costs are too high (which can be true for plenty of reasons other than profit). I believe that single payer systems can bring prices lower with more efficiency, but there are plenty of things that can be done that are less controversial (combating waste, increasing administrative efficiencies, etc). One personal example from my life that put health care costs into perspective was surrounding the issue of Midwives vs. OB/GYNs when we were having our first child. We were approved by our insurance to have an OB/GYN deliver our child, which would cost the insurance company about $5,000 if everything went well (more if there were complications). But they wouldn't cover us at all if we delivered the child with a midwife, which cost about $1,500 and has been shown in study after study to reduce the likelihood of more costly intervention. In our case, we paid the midwife out of pocket, but there are so many people that don't have the economic freedom to make that choice and the result is that their insurance companies pay far more money for child births than they would have otherwise had to. Again, just one example, but I'm sure there are thousands more.

shitgoose 10y ago

just curious, what % is $300/average salary in Bolivia? PS health cost is US are not just stupid expensive, it is broad day light extortion. the victims for some reason prefer not to see it as robbery, but rather to argue about qualities of their robbers. charging $600 to empty the urine bag is possible only because the whole hospital system is rigged (i.e. excessively regulated and monopolized).

bzbarsky 10y ago

Helping people with preexisting conditions through an _insurance_ program is just daft conceptually. We do need to do this, but calling the result "insurance" just leads to confusion about how it should work, because it can't actually be "insurance" in the way the term is normally understood...