8 ms·

yes, insurance companies are very corrupt. I would say they are inherently corrupt given their place and power in our system. I don't have a solution other tha

by socrates1998 9y ago

yes, insurance companies are very corrupt. I would say they are inherently corrupt given their place and power in our system. I don't have a solution other than don't get sick or have a car accident.

nostrademons 9y ago
I'll take advantage of us having the top commentthread to pose a question to the HN audience: Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to? Or would you rather live in a society where medicine can work miracles, even the most debilitating ailments can be cured, but only if you happen to be rich? The former is (to a first approximation) what you get with European-style single payer. The latter seems to be where American health care is headed. There's no situation where everybody can be saved, simply because we're all going to die in the end anyway, but the distribution of who dies and from what can be changed by different policies.
- chimeracoder 9y ago
  > The former is (to a first approximation) what you get with European-style single payer Aside from the fact that most European countries - even those with government-mandated healthcare - do not have single-payer insurance, this is a false dichotomy that ignores the global market dynamics. Just as Medicare in the US could not operate in its current form without the existence of the private market to implicitly subsidize the public system, European countries would have a very different healthcare story in the absence of the US market. Nobody likes to admit it, but there's a reason that the US is the source of over half of all direct biomedical and pharmaceutical research worldwide, including research conducted by European pharmaceutical companies. These companies use sales on the US market as the source of funds for the research that all countries benefit from, and in the absence of the US market, either those costs would be borne by Europe, or that research would simply not happen[0]. They also pull funding from the US market via other, less direct means. Yes, the US system has massive problems, and yes, it could and should be cheaper. But you can't analyze these as binary options in isolation, because they're not binary[1], and they're not operating in isolation either. [0] If you want to make the argument that Europe could come up with a system that pays for this research in the absence of the US market, fine, but then you have to explain both why that would not simply recreate the same expenses, and explain the fact that, so far, that system has not been created even by the European pharmaceutical and biomedical companies. [1] The UK has four main payers; the Netherlands doesn't even have single-payer at all, and so forth.
  - nostrademons 9y ago
    So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". The question still stands - would you rather live in the world where everyone has access to medical care but it isn't cutting-edge, or one where the very best in care and the very best in research techniques are available, but only for a price? I'm honestly curious about peoples' answers, because it is a dichotomy. Not necessarily a sharp one - you could imagine several intermediate systems in between - but there's a tradeoff between universal access vs. incentivizing further research and new techniques.
    - chimeracoder 9y ago
      > So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". Again, there is no "would you rather". You can't treat these as binary options, and you can't treat these as operating in isolation. They're an array of systems that mutually operate within a global context. There is no answer to that question, because the dichotomy assumes both a binary and isolation. There is indeed a tradeoff between quality and access, and there's a worthwhile and necessary conversation to be had around that. But that's not the same as the difference between the US and the multitudinous systems within Europe (most of which are not single-payer). And it's not the same as the question you opened with.
    - electricEmu 9y ago
      Why would there be a dichotomy? Both space travel and the internet come to mind as government funded projects moved the United States into lucrative markets with cutting edge technology. There is no dichotomy between universal coverage and cutting edge technology.
    - christophilus 9y ago
- tpush 9y ago
  "Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to? Or would you rather live in a society where medicine can work miracles, even the most debilitating ailments can be cured, but only if you happen to be rich?" Is this honestly a question? There are way more non-rich people who need health insurance than there are people who may die because of "bureaucratic incompetence" or lack of incentive(what? do people really need money to not let someone die?). The way you phased it the former is obviously(to me at least) better than the latter one. It also sounds like you think medical research advances only in countries with the latter style of health insurance. Do you really think medical advances happen only in America?
  - nostrademons 9y ago
    I'd love to see you and chimeracoder (sibling comment) fight it out, because his comment was exactly that medical advances happen because of freeriding off the American system, and without the American system, those advances would not happen.
    - robbiep 9y ago
      The idea that the American system is pulling the rest of the world up by its bootstraps is in my belief absurd. Copied from earlier comments by me: let's go through a quick run-down of the 'major' pharmaceutical companies of the world, and where they are headquartered. Company Revenue (USD) Headquarters Novartis 53.6 Bn Switzerland Roche 47.8 Bn Switzerland Sanofi 36.9 Bn France GSK 34.9 Bn UK AstraZeneca 26 Bn UK/Sweden Bayer 43.4 bn Germany Baxter 15.3bn US Pfizer 49 Bn US Merck 42.23 Bn US BMS 18.8 bn US So, 4 of the top 10 pharmaceutical companies by revenue are headquartered in the US. By Revenue, those 4 account for 125.3 Bn out of a pie of 367.9 Bn; or 34%. It is not easy to get a list of the number of drugs under clinical trial, or the number of drugs that were recently brought to market by various manufacturers; and, as a side matter, a number of the more innovative drugs brought to market recently were all developed by small pharmaceutical companies (Boceprevir, Telaprevir, Imatinib, Ipilumimab) that were later acquired by the big boys. So a small pharma company did the innovating, usually funded by a university or the product of particuarly profound insights by PhD students; turned into successful drugs; run through to the stage 3 trial stage and then, once all the development costs are done and dusted, acquired for a discount price of the predicted future revenue stream So tell me, where are all the drugs being developed by america? I would say the rest of the world is more than pulling it's weight. In fact, given rough population parity between the European first world and the United states, it could in fact be argued that the United states is not pulling it's weight.
- ScottBurson 9y ago
  I support a single-payer approach, largely simply because the biggest risk pool spreads the risk most evenly, but I think we have to be very careful with the word "right". I agree that basic medical care can be considered a right, in the sense that a wealthy society, which we are, is morally obliged to provide it to its least fortunate. But there has to be a limit to what counts as "basic"; if we don't impose one, we're going to wind up with even worse cost inflation than we have now. The rich will have better health care even in a single-payer system, and I'm fine with that. The thing I really don't want is the pre-ACA system, where only people with good jobs can get access to health care. BTW I saw a great Yonatan Zunger blog post on this a while back... ah, here it is: https://healthcareinamerica.us/how-to-ask-good-questions-about-health-reform-725887002c03 https://healthcareinamerica.us/how-to-ask-good-questions-abo...
  - rbcgerard 9y ago
    You hit the nail on the head with what counts as "basic" - as long as politicians can win elections by giving a benefit to people that they don't have to pay for/or collectively can't afford, I'm not sure how you ever contain this problem...
- Mz 9y ago
  Neither. Why not dream bigger than that? We have unprecedented means to distribute information for "free" (or at least cheaply enough that even homeless people can access insane amounts of information, unlike in the past when a lot of stuff was only accessible to the elite) and diet and lifestyle are cited over and over and over as contributing to deadly conditions. There is lots of room here to do good things for everyone, quite cheaply. Though I am for the U.S. transitioning to universal basic health coverage for its citizens. The current situation is terribly broken.
- y4mi 9y ago
  I'm European so maybe I'm just proving your point , but I think you're severely overestimating modern medicine. Most ailments get 'treated' alright, but the actual help you get isnt statistically better than placebos would've been. Often, you get better despite of the treatment, not because of it. Even something as basic as a broken bone just boils down to 'force patient to keep still while nobody does anything for weeks'. .. heck, the biggest impact on healthcare continues to be personal hygiene. Most of the life expectancy improvements within the last 200 years can be attributed to that.
  - robbiep 9y ago
    This is demonstrably false on a huge number of conditions: type 1 diabetes, arthritis (knee and hip replacements), childhood vaccinations, antibiotics- you are being disingenuous to the advances over even the last 50 years here.
    - y4mi 9y ago
      ah, I did not mean to imply that modern medicine is useless. I'm sorry if that sounded like that. there are absolutely examples of its success, as you've correctly pointed out! It's still not nearly as amazing as the grand-grandparent made it sound. and my previous statement still stands: personal hygiene continues to save more people than any other treatment. this includes vaccinations and antibiotics (they're both wonderful discoveries that help save a lot of people).
- DanBC 9y ago
  The US isn't heading toward "miracle treatments for the rich", it's heading towards "over testing, over diagnosis, and over treatment for the rich", all of which are linked to harm. And single payer systems mostly don't prevent private treatment - you don't need it because the single payer is good quality and the only benefit you get from private treatment is access to ineffective experimental very expensive treatments and nicer hospital rooms.
- robbiep 9y ago
  >'Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to?' That is delusional. As a doctor in a single payer country, I can categorically say that the quality of living of myself and my colleagues is excellent. In fact, for those not from privileged backgrounds (many, as we have relatively affordable tertiary education) not having a quarter to a half a million of debt" graduation actually means we are better off. So there's that, then there's the fact that I aggregate, the level of care in Australia, or the uk, or Japan, or Germany, is actually substantially better than that I the US. Inform yourself sir.
- dboreham 9y ago
  Put another way: "Oh no! I'm rich and so can pay for whatever infinite quality, resource wasting healthcare and so I'm scared I might have to endure poor people's healthcare". Rest easy - you can still buy your way to better care. Fwiw there is an "Intellectual Care Advantage" in that someone who is articulate and educated (aka well off) has a much better chance of getting good care, through their ability to navigate system, communicate with healthcare professionals, do their own research, be the squeaky wheel. But in my experience that advantage exists equally in both the US private system and in the European socialized system.
- neutronicus 9y ago
  I want everyone to have the same system, so that rich people are forced to expend their influence on trying to improve the system for everyone. Give them the option, and they'll just make the best walled garden they can and fuck everyone else.
roywiggins 9y ago
I do! End health insurance companies as we know them. Institute universal coverage, mandated by law. It doesn't have to be single payer or free at point of care, but it has to be universal coverage. It's not a trivial problem, but it's also largely a solved one. The US just hasn't implemented any of the models that work elsewhere.
- richmarr 9y ago
  That addresses healthcare, but health insurance is just one slice of the insurance market. I'm not aware of a general solution that covers all cases, but in auto insurance we found that the model of replacing underwriters with crowdfunded groups works.
  - raquo 9y ago
    Here in BC only the province is allowed to provide primary car insurance. Our current provincial government is incredibly corrupt and incompetent, including with regards to the provincial insurer specifically, but I'll still take it over private insurers I've had to deal with before.
backpropaganda 9y ago
The solution is AI. Self-driving cars and AI healthcare has the potential to make the insurance industries associated with both. I only recently learnt about the horrific healthcare in the US, and am doubling down on developing AI for healthcare. If I replace one doctor's job with an AI, I've probably saved 10s of lives.
- deleted 9y ago
  [deleted]
- jessaustin 9y ago
  How do you intend to ensure the fruits of your research will be used to benefit people rather than the large organizations who will (at least initially) control healthcare AI?
- dreamcompiler 9y ago
  Doctors per se are not the most critical problem in US healthcare. Premature optimization is the root of all evil. Find the real tentpoles and start there.

yes, insurance companies are very corrupt. I would say they are inherently corrupt given their place and power in our system. I don't have a solution other than don't get sick or have a car accident.

nostrademons 9y ago

I'll take advantage of us having the top commentthread to pose a question to the HN audience: Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to? Or would you rather live in a society where medicine can work miracles, even the most debilitating ailments can be cured, but only if you happen to be rich? The former is (to a first approximation) what you get with European-style single payer. The latter seems to be where American health care is headed. There's no situation where everybody can be saved, simply because we're all going to die in the end anyway, but the distribution of who dies and from what can be changed by different policies.

chimeracoder 9y ago
> The former is (to a first approximation) what you get with European-style single payer Aside from the fact that most European countries - even those with government-mandated healthcare - do not have single-payer insurance, this is a false dichotomy that ignores the global market dynamics. Just as Medicare in the US could not operate in its current form without the existence of the private market to implicitly subsidize the public system, European countries would have a very different healthcare story in the absence of the US market. Nobody likes to admit it, but there's a reason that the US is the source of over half of all direct biomedical and pharmaceutical research worldwide, including research conducted by European pharmaceutical companies. These companies use sales on the US market as the source of funds for the research that all countries benefit from, and in the absence of the US market, either those costs would be borne by Europe, or that research would simply not happen[0]. They also pull funding from the US market via other, less direct means. Yes, the US system has massive problems, and yes, it could and should be cheaper. But you can't analyze these as binary options in isolation, because they're not binary[1], and they're not operating in isolation either. [0] If you want to make the argument that Europe could come up with a system that pays for this research in the absence of the US market, fine, but then you have to explain both why that would not simply recreate the same expenses, and explain the fact that, so far, that system has not been created even by the European pharmaceutical and biomedical companies. [1] The UK has four main payers; the Netherlands doesn't even have single-payer at all, and so forth.
- nostrademons 9y ago
  So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". The question still stands - would you rather live in the world where everyone has access to medical care but it isn't cutting-edge, or one where the very best in care and the very best in research techniques are available, but only for a price? I'm honestly curious about peoples' answers, because it is a dichotomy. Not necessarily a sharp one - you could imagine several intermediate systems in between - but there's a tradeoff between universal access vs. incentivizing further research and new techniques.
  - chimeracoder 9y ago
    > So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". Again, there is no "would you rather". You can't treat these as binary options, and you can't treat these as operating in isolation. They're an array of systems that mutually operate within a global context. There is no answer to that question, because the dichotomy assumes both a binary and isolation. There is indeed a tradeoff between quality and access, and there's a worthwhile and necessary conversation to be had around that. But that's not the same as the difference between the US and the multitudinous systems within Europe (most of which are not single-payer). And it's not the same as the question you opened with.
  - electricEmu 9y ago
    Why would there be a dichotomy? Both space travel and the internet come to mind as government funded projects moved the United States into lucrative markets with cutting edge technology. There is no dichotomy between universal coverage and cutting edge technology.
  - christophilus 9y ago
tpush 9y ago
"Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to? Or would you rather live in a society where medicine can work miracles, even the most debilitating ailments can be cured, but only if you happen to be rich?" Is this honestly a question? There are way more non-rich people who need health insurance than there are people who may die because of "bureaucratic incompetence" or lack of incentive(what? do people really need money to not let someone die?). The way you phased it the former is obviously(to me at least) better than the latter one. It also sounds like you think medical research advances only in countries with the latter style of health insurance. Do you really think medical advances happen only in America?
- nostrademons 9y ago
  I'd love to see you and chimeracoder (sibling comment) fight it out, because his comment was exactly that medical advances happen because of freeriding off the American system, and without the American system, those advances would not happen.
  - robbiep 9y ago
    The idea that the American system is pulling the rest of the world up by its bootstraps is in my belief absurd. Copied from earlier comments by me: let's go through a quick run-down of the 'major' pharmaceutical companies of the world, and where they are headquartered. Company Revenue (USD) Headquarters Novartis 53.6 Bn Switzerland Roche 47.8 Bn Switzerland Sanofi 36.9 Bn France GSK 34.9 Bn UK AstraZeneca 26 Bn UK/Sweden Bayer 43.4 bn Germany Baxter 15.3bn US Pfizer 49 Bn US Merck 42.23 Bn US BMS 18.8 bn US So, 4 of the top 10 pharmaceutical companies by revenue are headquartered in the US. By Revenue, those 4 account for 125.3 Bn out of a pie of 367.9 Bn; or 34%. It is not easy to get a list of the number of drugs under clinical trial, or the number of drugs that were recently brought to market by various manufacturers; and, as a side matter, a number of the more innovative drugs brought to market recently were all developed by small pharmaceutical companies (Boceprevir, Telaprevir, Imatinib, Ipilumimab) that were later acquired by the big boys. So a small pharma company did the innovating, usually funded by a university or the product of particuarly profound insights by PhD students; turned into successful drugs; run through to the stage 3 trial stage and then, once all the development costs are done and dusted, acquired for a discount price of the predicted future revenue stream So tell me, where are all the drugs being developed by america? I would say the rest of the world is more than pulling it's weight. In fact, given rough population parity between the European first world and the United states, it could in fact be argued that the United states is not pulling it's weight.
ScottBurson 9y ago
I support a single-payer approach, largely simply because the biggest risk pool spreads the risk most evenly, but I think we have to be very careful with the word "right". I agree that basic medical care can be considered a right, in the sense that a wealthy society, which we are, is morally obliged to provide it to its least fortunate. But there has to be a limit to what counts as "basic"; if we don't impose one, we're going to wind up with even worse cost inflation than we have now. The rich will have better health care even in a single-payer system, and I'm fine with that. The thing I really don't want is the pre-ACA system, where only people with good jobs can get access to health care. BTW I saw a great Yonatan Zunger blog post on this a while back... ah, here it is: https://healthcareinamerica.us/how-to-ask-good-questions-about-health-reform-725887002c03 https://healthcareinamerica.us/how-to-ask-good-questions-abo...
- rbcgerard 9y ago
  You hit the nail on the head with what counts as "basic" - as long as politicians can win elections by giving a benefit to people that they don't have to pay for/or collectively can't afford, I'm not sure how you ever contain this problem...
Mz 9y ago
Neither. Why not dream bigger than that? We have unprecedented means to distribute information for "free" (or at least cheaply enough that even homeless people can access insane amounts of information, unlike in the past when a lot of stuff was only accessible to the elite) and diet and lifestyle are cited over and over and over as contributing to deadly conditions. There is lots of room here to do good things for everyone, quite cheaply. Though I am for the U.S. transitioning to universal basic health coverage for its citizens. The current situation is terribly broken.
y4mi 9y ago
I'm European so maybe I'm just proving your point , but I think you're severely overestimating modern medicine. Most ailments get 'treated' alright, but the actual help you get isnt statistically better than placebos would've been. Often, you get better despite of the treatment, not because of it. Even something as basic as a broken bone just boils down to 'force patient to keep still while nobody does anything for weeks'. .. heck, the biggest impact on healthcare continues to be personal hygiene. Most of the life expectancy improvements within the last 200 years can be attributed to that.
- robbiep 9y ago
  This is demonstrably false on a huge number of conditions: type 1 diabetes, arthritis (knee and hip replacements), childhood vaccinations, antibiotics- you are being disingenuous to the advances over even the last 50 years here.
  - y4mi 9y ago
    ah, I did not mean to imply that modern medicine is useless. I'm sorry if that sounded like that. there are absolutely examples of its success, as you've correctly pointed out! It's still not nearly as amazing as the grand-grandparent made it sound. and my previous statement still stands: personal hygiene continues to save more people than any other treatment. this includes vaccinations and antibiotics (they're both wonderful discoveries that help save a lot of people).
DanBC 9y ago
The US isn't heading toward "miracle treatments for the rich", it's heading towards "over testing, over diagnosis, and over treatment for the rich", all of which are linked to harm. And single payer systems mostly don't prevent private treatment - you don't need it because the single payer is good quality and the only benefit you get from private treatment is access to ineffective experimental very expensive treatments and nicer hospital rooms.
robbiep 9y ago
>'Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to?' That is delusional. As a doctor in a single payer country, I can categorically say that the quality of living of myself and my colleagues is excellent. In fact, for those not from privileged backgrounds (many, as we have relatively affordable tertiary education) not having a quarter to a half a million of debt" graduation actually means we are better off. So there's that, then there's the fact that I aggregate, the level of care in Australia, or the uk, or Japan, or Germany, is actually substantially better than that I the US. Inform yourself sir.
dboreham 9y ago
Put another way: "Oh no! I'm rich and so can pay for whatever infinite quality, resource wasting healthcare and so I'm scared I might have to endure poor people's healthcare". Rest easy - you can still buy your way to better care. Fwiw there is an "Intellectual Care Advantage" in that someone who is articulate and educated (aka well off) has a much better chance of getting good care, through their ability to navigate system, communicate with healthcare professionals, do their own research, be the squeaky wheel. But in my experience that advantage exists equally in both the US private system and in the European socialized system.
neutronicus 9y ago
I want everyone to have the same system, so that rich people are forced to expend their influence on trying to improve the system for everyone. Give them the option, and they'll just make the best walled garden they can and fuck everyone else.

roywiggins 9y ago

I do! End health insurance companies as we know them. Institute universal coverage, mandated by law. It doesn't have to be single payer or free at point of care, but it has to be universal coverage. It's not a trivial problem, but it's also largely a solved one. The US just hasn't implemented any of the models that work elsewhere.

richmarr 9y ago
That addresses healthcare, but health insurance is just one slice of the insurance market. I'm not aware of a general solution that covers all cases, but in auto insurance we found that the model of replacing underwriters with crowdfunded groups works.
- raquo 9y ago
  Here in BC only the province is allowed to provide primary car insurance. Our current provincial government is incredibly corrupt and incompetent, including with regards to the provincial insurer specifically, but I'll still take it over private insurers I've had to deal with before.

backpropaganda 9y ago

The solution is AI. Self-driving cars and AI healthcare has the potential to make the insurance industries associated with both. I only recently learnt about the horrific healthcare in the US, and am doubling down on developing AI for healthcare. If I replace one doctor's job with an AI, I've probably saved 10s of lives.

deleted 9y ago
[deleted]
jessaustin 9y ago
How do you intend to ensure the fruits of your research will be used to benefit people rather than the large organizations who will (at least initially) control healthcare AI?
dreamcompiler 9y ago
Doctors per se are not the most critical problem in US healthcare. Premature optimization is the root of all evil. Find the real tentpoles and start there.