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I have said that repeatedly on HN. Obamacare is a terrible idea and we need another solution.

by Mz 9y ago

HillaryBriss 9y ago
well. ok. but, i don't see placing the blame on Obamacare. i mean that was not the origin of the concept of health insurance.
- Mz 9y ago
  Yes, but health insurance worked differently before Obamacare. Insurance companies simply did not cover chronically ill people or people with preexisting conditions, thus they were able to arrange a "bet." Obamacare removes the element of a "bet" from the system. Just like the government provides fire protection in the form of fire departments, the government needs to provide health care. What we are doing currently is broken.
  - Joeri 9y ago
    Structuring healthcare as an insurance doesn't work because pretty much everyone needs it at some point. It needs to be structured like a tax, because the rate at which you pay in has no correspondance with how much you need to get back out, but in aggregate the total sum paid matches the total care provided. That's why the successful healthcare systems in the world are typically single payer systems. However, such systems are politically untenable in the U.S. and so you get obamacare. I'm sure if it was within the overton window of acceptable political thought obamacare would have been a single payer system.
    - HillaryBriss 9y ago
      > Structuring healthcare as an insurance doesn't work because pretty much everyone needs it at some point. It needs to be structured like a tax, because the rate at which you pay in has no correspondance with how much you need to get back out, but in aggregate the total sum paid matches the total care provided. you've just outlined a money-losing system run by the government. the reason private health insurance systems fail is not merely because everyone needs it at some point. it's because everyone uses much more of it than they've paid for with their premiums. (which is why, pre-Obamacare, insurance companies used to reject applicants with pre-existing conditions and why they put lifetime caps on benefits paid.) but a government run single-payer system is not magic. the extra cash must come from somewhere. one way a single-payer system could obtain the additional funds needed is by taking cash from some other government source (which is exactly what Obamacare does when it provides refundable tax credits to help low income people pay their otherwise unaffordable health insurance premiums.) but there's no end to the amount of money that could require. another thing the government can do is limit services to patients, i.e. take a certain amount of decision making authority, by law, away from individuals, especially old individuals who are very sick. ("i'm sorry, but we're not paying for that new chemotherapy. it's hospice care for you.") in addition, a single-payer system can also uniformly limit the prices health care providers, pharma companies, hospitals, etc can charge. (i.e take some decision making authority away from that sector of the economy, again, by law.)
      - Joeri 9y ago
        I live in a single payer system country and it's nothing like what you describe. First, how it is paid. It's text book socialism. People pay into it based on ability and receive benefits based on need. It doesn't run at a loss. Second, the level of care. Basically the government puts a lower bound on health care and uses taxation to do it. You're guaranteed a basic level of care regardless of your situation. You can opt for private insurance that stacks on top of that. A basic level of treatment is covered by the government, but anything experimental or exorbitant you will likely have to pay yourself, unless you have the aforementioned gold-plated insurance. Insurance is much cheaper because it only needs to cover unusual care, but of course I do pay a lot of taxes. It's not different from a private system, because you can't receive unlimited care, but unlike a private system you're always guaranteed a minimum care.
        HillaryBriss 9y ago
        that sounds a lot like what i described. it avoids being a money-losing system by limiting how much care people can receive.
  - davrosthedalek 9y ago
    If I'm not mistaken, they also had yearly or life-time limits, removing the "losing" part of the betting from the system. Insurances are not bets, not more than other commercial undertakings. They are, for the insured, hedges against bets. The bet is: I will not get sick with something that will ruin me financially. Or: My house will not burn down. You pay a steady, comparably small (to the risk) amount of money. Still the total amount of money paid by everybody is bigger than the total amount of pay-outs. In the case of these massive flooding, it's hard to make the pool big enough. That's why reinsurance companies exist, which can mix the risk pool of different types and locals.
    - dragonwriter 9y ago
      > they also had yearly or life-time limits Usually, both. Plus, if you had high expenses they'd actively search for an (even unrelated) pre-existing condition as a pretext to cancel your coverage (recission).
    - Mz 9y ago
      Insurances are not bets Origin story for Lloyd's of London: The patrons bet, for example, on whether Admiral John Byng would be shot for his incompetence in a naval battle with the French. He was. The gentlemen of Lloyd's would have had no qualms about taking my bet on my own life. Edward Lloyd realised his customers were as thirsty for information to fuel their bets as they were for coffee, and began to assemble a network of informants and a newsletter full of information about foreign ports, tides, and the comings and goings of ships. His newsletter became known as Lloyd's List. Lloyd's coffee house hosted ship auctions, and gatherings of sea captains who would share stories. If someone wished to insure a ship, that could be done too: a contract would be drawn up, and the insurer would sign his name underneath - hence the term "underwriter". It became hard to say quite where coffee-house gambling ended and formal insurance began. http://www.bbc.com/news/business-38905963 http://www.bbc.com/news/business-38905963 https://news.ycombinator.com/item?id=13911451#13912524 https://news.ycombinator.com/item?id=13911451#13912524
gnaritas 9y ago
Obamacare is not a terrible idea, it's a transitional idea as we're already doing this with insurance; it's an evolution of the system in the right direction, it's not a final solution. Add a national exchange, offer a public option, bam medicade for all.
- Mz 9y ago
  bam medicade for all. That is called single payer, government provided coverage. I would support that. That is not remotely what Obamacare does. Obamacare requires private insurance to cover people with pre-existing conditions and it requires everyone to buy private insurance. It is busted as all fuck and I would like to see it go die in a fire. I am aware what we were doing before Obamacare sucks and we need a real solution and to not simply go back to that. But this is not a real solution.
  - gnaritas 9y ago
    Of course it's not what Obamacare does, you can't go from a private insurance market to a single payer government system in one single step. Obamacare is the transition between the two. > Obamacare requires private insurance to cover people with pre-existing conditions and it requires everyone to buy private insurance. So does single payer, we just call "buying" taxes and we replace insurers with government. You're still forced to pay and the insurer is still forced to provide for everyone regardless of pre-existing conditions. So it would seem you're simply against the name Obamacare. > But this is not a real solution. It's not supposed to be, everyone isn't blind, they see that single payer is the solution, but you can't simply declare the private insurance industry we already have dead in one fell swoop. Obamacare or something just like Obamacare is a necessary step to get to single payer. We need to get everyone into a public option, and then have that option slowly kill off private insurance by simply operating cheaper than they can until the public option is pretty much what is insuring everyone, at that point, it's effectively single payer.

I have said that repeatedly on HN. Obamacare is a terrible idea and we need another solution.

by Mz 9y ago

I have said that repeatedly on HN. Obamacare is a terrible idea and we need another solution.

well. ok. but, i don't see placing the blame on Obamacare. i mean that was not the origin of the concept of health insurance.

Mz 9y ago
Yes, but health insurance worked differently before Obamacare. Insurance companies simply did not cover chronically ill people or people with preexisting conditions, thus they were able to arrange a "bet." Obamacare removes the element of a "bet" from the system. Just like the government provides fire protection in the form of fire departments, the government needs to provide health care. What we are doing currently is broken.
- Joeri 9y ago
  Structuring healthcare as an insurance doesn't work because pretty much everyone needs it at some point. It needs to be structured like a tax, because the rate at which you pay in has no correspondance with how much you need to get back out, but in aggregate the total sum paid matches the total care provided. That's why the successful healthcare systems in the world are typically single payer systems. However, such systems are politically untenable in the U.S. and so you get obamacare. I'm sure if it was within the overton window of acceptable political thought obamacare would have been a single payer system.
  - HillaryBriss 9y ago
    > Structuring healthcare as an insurance doesn't work because pretty much everyone needs it at some point. It needs to be structured like a tax, because the rate at which you pay in has no correspondance with how much you need to get back out, but in aggregate the total sum paid matches the total care provided. you've just outlined a money-losing system run by the government. the reason private health insurance systems fail is not merely because everyone needs it at some point. it's because everyone uses much more of it than they've paid for with their premiums. (which is why, pre-Obamacare, insurance companies used to reject applicants with pre-existing conditions and why they put lifetime caps on benefits paid.) but a government run single-payer system is not magic. the extra cash must come from somewhere. one way a single-payer system could obtain the additional funds needed is by taking cash from some other government source (which is exactly what Obamacare does when it provides refundable tax credits to help low income people pay their otherwise unaffordable health insurance premiums.) but there's no end to the amount of money that could require. another thing the government can do is limit services to patients, i.e. take a certain amount of decision making authority, by law, away from individuals, especially old individuals who are very sick. ("i'm sorry, but we're not paying for that new chemotherapy. it's hospice care for you.") in addition, a single-payer system can also uniformly limit the prices health care providers, pharma companies, hospitals, etc can charge. (i.e take some decision making authority away from that sector of the economy, again, by law.)
    - Joeri 9y ago
      I live in a single payer system country and it's nothing like what you describe. First, how it is paid. It's text book socialism. People pay into it based on ability and receive benefits based on need. It doesn't run at a loss. Second, the level of care. Basically the government puts a lower bound on health care and uses taxation to do it. You're guaranteed a basic level of care regardless of your situation. You can opt for private insurance that stacks on top of that. A basic level of treatment is covered by the government, but anything experimental or exorbitant you will likely have to pay yourself, unless you have the aforementioned gold-plated insurance. Insurance is much cheaper because it only needs to cover unusual care, but of course I do pay a lot of taxes. It's not different from a private system, because you can't receive unlimited care, but unlike a private system you're always guaranteed a minimum care.
      - HillaryBriss 9y ago
        that sounds a lot like what i described. it avoids being a money-losing system by limiting how much care people can receive.
- davrosthedalek 9y ago
  If I'm not mistaken, they also had yearly or life-time limits, removing the "losing" part of the betting from the system. Insurances are not bets, not more than other commercial undertakings. They are, for the insured, hedges against bets. The bet is: I will not get sick with something that will ruin me financially. Or: My house will not burn down. You pay a steady, comparably small (to the risk) amount of money. Still the total amount of money paid by everybody is bigger than the total amount of pay-outs. In the case of these massive flooding, it's hard to make the pool big enough. That's why reinsurance companies exist, which can mix the risk pool of different types and locals.
  - dragonwriter 9y ago
    > they also had yearly or life-time limits Usually, both. Plus, if you had high expenses they'd actively search for an (even unrelated) pre-existing condition as a pretext to cancel your coverage (recission).
  - Mz 9y ago
    Insurances are not bets Origin story for Lloyd's of London: The patrons bet, for example, on whether Admiral John Byng would be shot for his incompetence in a naval battle with the French. He was. The gentlemen of Lloyd's would have had no qualms about taking my bet on my own life. Edward Lloyd realised his customers were as thirsty for information to fuel their bets as they were for coffee, and began to assemble a network of informants and a newsletter full of information about foreign ports, tides, and the comings and goings of ships. His newsletter became known as Lloyd's List. Lloyd's coffee house hosted ship auctions, and gatherings of sea captains who would share stories. If someone wished to insure a ship, that could be done too: a contract would be drawn up, and the insurer would sign his name underneath - hence the term "underwriter". It became hard to say quite where coffee-house gambling ended and formal insurance began. http://www.bbc.com/news/business-38905963 http://www.bbc.com/news/business-38905963 https://news.ycombinator.com/item?id=13911451#13912524 https://news.ycombinator.com/item?id=13911451#13912524

gnaritas 9y ago

Obamacare is not a terrible idea, it's a transitional idea as we're already doing this with insurance; it's an evolution of the system in the right direction, it's not a final solution. Add a national exchange, offer a public option, bam medicade for all.

Mz 9y ago
bam medicade for all. That is called single payer, government provided coverage. I would support that. That is not remotely what Obamacare does. Obamacare requires private insurance to cover people with pre-existing conditions and it requires everyone to buy private insurance. It is busted as all fuck and I would like to see it go die in a fire. I am aware what we were doing before Obamacare sucks and we need a real solution and to not simply go back to that. But this is not a real solution.
- gnaritas 9y ago
  Of course it's not what Obamacare does, you can't go from a private insurance market to a single payer government system in one single step. Obamacare is the transition between the two. > Obamacare requires private insurance to cover people with pre-existing conditions and it requires everyone to buy private insurance. So does single payer, we just call "buying" taxes and we replace insurers with government. You're still forced to pay and the insurer is still forced to provide for everyone regardless of pre-existing conditions. So it would seem you're simply against the name Obamacare. > But this is not a real solution. It's not supposed to be, everyone isn't blind, they see that single payer is the solution, but you can't simply declare the private insurance industry we already have dead in one fell swoop. Obamacare or something just like Obamacare is a necessary step to get to single payer. We need to get everyone into a public option, and then have that option slowly kill off private insurance by simply operating cheaper than they can until the public option is pretty much what is insuring everyone, at that point, it's effectively single payer.