9 ms·

There is pretty much nothing that infuriates me more than the health insurance system. Here is just one example (other than your ambulance example, which is li

• domenzain 9y ago
  It makes good financial sense for insurers to push the insured to take preventative measures. An insurer should provide incentive to bring a building up to code to avoid a costly fire. The option to simply raise prices accounting for the fire leaves out the business of those who cannot afford it: the people leaving in a building that's not up to code.
  • elgenie 9y ago
    > "It makes good financial sense for insurers to push the insured to take preventative measures." This is only true in a well-designed system. In a system in which insurance policies are for a one-year term and can be declined or premium-hiked as necessary after that term is up, encouraging preventive checkups can be counterproductive if the risk of being on the hook for problems discovered in the checkups is higher than the preventive benefit during the duration of the policy.
  • uoaei 9y ago
    The point seems to be more that "insurance" as a word betrays the original intention of the service while the current state of affairs demonstrates how much the concept has been bastardized. Insurance is for those events where you don't expect a gruesome injury and need to insure, or hedge, against those one-offs. Preventative care isn't the same idea because you expect to get older and things to fail slowly. But barring any conditions or disorders, this isn't insurance against external sources of damage but just an action taken against inevitable consequences of having an organic body that tries to keep itself in a delicate and easily-broken balance for 50+ years.
• karmelapple 9y ago
  You described a big example in the book “Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It.” Highly recommend it. It’s got some great ideas.
• briandear 9y ago
  Insurance should be used for what it is — an financial instrument to protect against unforeseen and catastrophic financial loss. Car insurance doesn’t pay for tires or oil while it could be argued that bad tires increase the risk of accident. However tires and oil are an inextricable requirements to owning a car. This idea that health care should be paid for by someone else has always puzzled me. It’s the equivalent of food being “free.” For the legitimately poor, there is definitely a role for government just as governments don’t let people starve to death, but for everyone else — its just wacky that the government ought to be involved at all beyond safety regulation. We went wrong when some groups started claiming health care as a right — nobody has a “right” to the labor of other people. In other words — I don’t have a right to make you produce something for me. Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.
  • somebadguy 9y ago
    Oh do fuck off. Ignorant loser
  • skrause 9y ago
    > Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education. No, they have spiralled out of control because health care is something where no real market can exists, so you need good regulation (which the USA doesn't have). If you have an urgent and life-threatening health problem you can't shop around for a cheaper hospital or decide to go to none at all if the alternative is death. So they can charge whatever they want if there is no regulation.
    • saint_fiasco 9y ago
      Why not? You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available. There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you wouldn't need to shop around, you would decide based on each hospital's reputation. Unfortunately hospitals don't publish their median wait times, patient outcomes or even their prices. If they were forced to publish those things, maybe a market would emerge.
• kalleboo 9y ago
  It's more like your car warranty paying for an oil change, so they won't have to pay for a seized engine years later.
• dantheman 9y ago
  The health insurance system in the US is about as far away as you can get from capitalism. It's heavily regulated, a cartel, the prices are not transparent, and there is no competition (existing hospitals have to approve new hospitals, etc).
  • dpwm 9y ago
    You can't disown capitalism from its problems that easily. It's not hard to see that it is in short-term self interest to form cartels, lobby for regulation, crush competition and treat their (now captive) customers with contempt. This is a pattern we have seen time and again. Describing this as "about as far away as you can get from capitalism" is the no true Scotsman fallacy. Perhaps it doesn't match how you believe capitalism should work or you have a very different definition of capitalism to the more regular meaning of the term.
    • dmichulke 9y ago
      > It's not hard to see that it is in short-term self interest to form cartels Cartels are only a problem if no new suppliers can enter the market. > lobby for regulation This is a problem of any representative system. Convince them and you're set. No capitalism involved. > crush competition Just a consequence of the abovementioned. Summary: step 2 is the crucial problem, it's usually corruption or idiocy and a governance problem - not a capitalist problem.
      • mjburgess 9y ago
        really-existing capitalism involves co-opting local power structures (parliaments, legislatures, dictatorships, puppets, etc.) to protect your cartel. If capitalism is only capitalism when there is no conglomerated power structure then capitalism is impossible. Often enough today its the left who are defenders of capitalism (ie., of disentangling power structures from coporate control) whereas the right seems possessed by the idea that whatever a company does is by definition captailism. Capitalism was all about recognizing that business interests are anti-capitalist.
• Xylakant 9y ago
  It absolutely makes sense to insure routine medical examinations. If they’re not covered, people don’t do them. Many routine examinations uncover conditions that are not critical yet and easy to treat before they turn into a costly nightmare. (e.g. routine skin checks uncover potential cancer before it spreads, tooth checks uncover problems before they require expensive replacement) It’s an investment, not only health-wise, but also financially for the health insurance.
  • solatic 9y ago
    But that's the difference between buying insurance, which is an actuarial product you buy to guard against unfortunate events, and buying a service or subscription, which is available for your use when you desire to use it. Let's ask a simple question to determine which is which in the US: because attending your annual checkups reduces your risk of needing expensive treatment, somebody who attends their annual checkups are cheaper to insure. Are there any American insurance plans that effectively pay patients for attending their checkups? Are there any American insurance plans which say, well, your premiums are $1000/month, but if you go to your annual checkup, not only will your checkup be completely covered with no co-pay, but we'll reduce your next 12 monthly premiums to $950/month each? After all, if it reduces costs for the insurer, then the insurer is motivated to incentivize patients to go, right?
    • frangipane 9y ago
      >attending your annual checkups reduces your risk of needing expensive treatment Btw, there's no evidence of this. Zero...zip...zilch...none. http://www.bmj.com/content/352/bmj.h6080 http://www.bmj.com/content/352/bmj.h6080
      • jimktrains2 9y ago
        So, you're claiming that since certain cancer screenings are ineffective it therefore means that managing issues such as hypercholesterolemia, hypertension, and diabetes are also ineffective? That seems like a stretcher to me, and I'm not buying it.
• shados 9y ago
  To be fair, a lot of stuff work that way. Take an HVAC maintenance plan for example. For some fee (based on the model and age of your HVAC and the condition it's in), you get routine maintenance covered. They do what they can to prevent major hiccups, but if it breaks down, they'll repair it (after trying to weasel their way out of it). It's pretty darn common across a lot of industries.
  • mseebach 9y ago
    There's a pretty important difference between humans and HVACs, which is the reason the two systems end up being very different. You can always rip out the HVAC and put in a new, off the shelf unit with roughly the same specs (often better, because progress) at a fixed, known cost, and the customer will even often be happier if they end up doing that instead of repairs. If health care providers could trivially decide to euthanize and replace patients with expensive diseases, health care insurance would be as trivial as HVAC maintenance plans.
    • shados 9y ago
      What you say is totally true, but completely irrelevant to the point I was making. All i was saying is that it's pretty common/normal/etc for insurance (in any industry. Literal insurance or things that are insurance in practice but not literally) to offer routine exam/tests/maintenance/checks if it can prevent the worse case scenario $$$ from happening.
  • cookiecaper 9y ago
    Warranties are different because though they also depend on non-utilization, the defects they cover are generally likely to occur at some point (the guarantor is just hoping it will be after your warranty expires), and consequently higher utilization rates are expected. Insurance is based on the assumption that only an extremely small number of insured persons will ever make [significant] claims against the policy; insurance is for expensive potentialities that are very unlikely. The entire industry and regulatory framework is structured around that assumption because that is what the word "insurance" means in all contexts outside of health care. The problem is that pretty much everyone is going to need significant medical care at some point in their life, certainly as they age into their senior years if not earlier. Would you buy a "health maintenance plan" under the stipulations of health insurance policies, which are basically "Pay us a lot of money, and we'll make some farcically big numbers look smaller for you, but you'll still probably owe a lot of money; we won't know how much until you already owe it"? Of course not. The racket we call the American health system can only exist by masquerading as "insurance".