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It's amazing that someone can go through this and come to the conclusion, at the end, that the solution is that this is a business opportunity that would make a

It's amazing that someone can go through this and come to the conclusion, at the end, that the solution is that this is a business opportunity that would make a lot of money if someone could just make it more efficient. Trying to make money off of healthcare is exactly how we have gotten the absolute mess that is the American medical system. All the incredibly complex rules exist so that health insurance companies can elect _not_ to pay for things that were deemed necessary by a medical professional. If insurance companies would be willing to pay for the services that were needed, there would be no 1600 page rule books. Of course, a system that actually paid for the care that people needed wouldn't be so obscenely profitable for them, and so they lobby massively against it.

conanbatt 9y ago
It isn't profit-seeking what makes healthcare what it is. Its the incredibly burdensome regulation and restrictions. If profit-seeking destroyed markets for profit, we would all be starving.
- evgen 9y ago
  No, it is profit-seeking that created this cluster-fuck. It only seems to be a problem in third-world nations like the US; the rest of the world seems to be blissfully free of broken profit-seeking institutions that cannot talk to other profit-seeking institutions so that they can collectively figure out the least amount of healthcare they can provide to the patient (so that both can maintain their profit.)
  - conanbatt 9y ago
    I am from a partially socialist country that has free healthcare. I have had private healthcare, along with most of my socio-economic class, my entire life. Making it socialized does not mean it will be better. Coldly, see it as a different system with different consequences. Bringing it to the US: look at how much medicare costs today: 3.6% of gdp, servicing 56 million americans. If you extended medicare to the entire population at the same per capita, it would be 26% of GDP.
    - trowawee 9y ago
      Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending.[1] Medicare as it is currently formulated is specifically targeted towards at-risk populations that have higher incidences of medical usage than the general population; you can't just apply the exact same per capita spending across the American population. 80 year-olds use more health care than 25 year-olds. [1]: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective http://www.commonwealthfund.org/publications/issue-briefs/20...
      - ferongr 9y ago
        I live in a "first world nation" and 10 years ago (before the global financial crisis even) public vs private healthcare meant the difference between leg amputation and implantation. The public system is only good for routine diagnosis and minor surgery. For everything else, care quality goes down the toilet. Not to mention on the effectively complete lack of dental care.
        trowawee 9y ago
        I'm not sure where you live and you're not providing any links or statistics to back this claim up, so it's difficult for me to respond to what you're trying to claim here. If you read the link I provided, you would see that they use cancer, heart disease, and diabetes mortality as a shorthand for patient outcomes in significant health events, and that while the US healthcare system ranks reasonably well in cancer treatment, it is significantly behind other developed nations in treating heart disease and diabetes. They also provide statistics regarding mortality rates in various populations, and the US lags other developed nations in basically all of those populations. Your point about dentistry is interesting, although also mostly unsupported, and I'm having a difficult time finding good statistics about dental care, spending, and outcomes. Anecdotally, dental care in the United States is sharply linked to money; people with money have good/great teeth and excellent dental care, people without it frequently have major issues with their teeth. I don't know how that compares to other countries.
- frgtpsswrdlame 9y ago
  You know those regulations are there for a reason right? Would you like to go back to the days where people are kicked off insurance for extremely dubious pre-existing conditions? >If profit-seeking destroyed markets for profit, we would all be starving. It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the sense that it's the ill who have to die or go bankrupt to support it.
  - conanbatt 9y ago
    >You know those regulations are there for a reason right? The road to hell is paved with good intentions. > It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the sense that it's the ill who have to die or go bankrupt to support it. The measure of the health of a market is not the profits of the industry in it. A better rule of thumb would be how many people get serviced and at what relative cost. In that sense, the american healthcare market is very unhealthy.
    - frgtpsswrdlame 9y ago
      >The road to hell is paved with good intentions. Oh come on, this platitude applies to people saying 'less regulation' just as much as it does me. >The measure of the health of a market is not the profits of the industry in it. A better rule of thumb would be how many people get serviced and at what relative cost. In that sense, the american healthcare market is very unhealthy. Sure, but in that sense we can look around and see that healthcare markets are generally less healthy when they are (1) more private and (2) less regulated.
      - conanbatt 9y ago
        > Oh come on, this platitude applies to people saying 'less regulation' just as much as it does me I didn't argue that regulations are good because there was a purpose to them nor its opposite. So it doesnt really apply to my stance so far. > Sure, but in that sense we can look around and see that healthcare markets are generally less healthy when they are (1) more private and (2) less regulated. I disagree with that statement, and I am sure that you will find examples of private markets that are more efficient than public markets, of the which you only need 1 to disprove the idea that public > private on health.
- dragonwriter 9y ago
  Profit seeking destroys markets with large externalities or where utility isn't readily discernable at low relative cost, and where for either or both of those reasons the rational choice model doesn't reasonably approximate actual behavior in the market. Lots of real goods don't face that problem, but healthcare definitely does.
  - conanbatt 9y ago
    Whats the externality of providing healthcare, and in regards to the diffuseness of utility, food has the same problem and its a relatively very efficient market.
    - dragonwriter 9y ago
      > in regards to the diffuseness of utility, food has the same problem and its a relatively very efficient market. Food is a frequently repeated purchase with significant immediately-apparent utility and disutility, and so discovery of utilities is quick and the market reasonably efficient in terms of immediate utilities. (There are long-term utilities and disutilities that are less immediately experienced with consumption, and the food market is hardly efficient in terms of those.) Healthcare products are infrequently purchased, and the relative utilities of different options are far from apparent. It's not at all similar to the aspects of the food market that can reasonably be described as relatively efficient.
      - conanbatt 9y ago
        I would argue that food escapes its measure of utility because otherwise, we would all be eating only the cheapest and healthiest option all the time, but our constant hunger also makes us purchase things against our long term interest. If so, you would expect the market to be really inefficient, but at least in terms of satisfying demand, its very hard to make money producing food. Its true healthcare has less frequency so you cant be a sophisticated consumer: but its more frequent than a car, which is also a necessity in many cases, and the lack of sophistry does not make it an inefficient market. Im not even sure healthcare is a special market, certainly not for infrequency, or because you must pay with your life (i.e. that you make a decision of life and death for resources). Not for restrictive application of labor (lawyers have that), not for the high costs of technology in its application (consumer tech? space exploration?). I think at this point what makes the healthcare market unique is the common belief of the people that it is unique. It forces the consumer to consciously think of the cost of life, a question we are somehow bred all our lives to hate to ask, but that we answer every day unconsciously.
- iaw 9y ago
  Libertarian arguments only hold for free markets. Even eliminating all regulations and restrictions imposed by the government, healthcare does not become a free market for two reasons: 1) Information is not symmetric, contractual obligations are made before pricing information can be discovered (thereby compared and moving into market dynamics) 2) Services are requested under the duress of health problems without the ability to end the agreement. Not everything is a free market.
  - conanbatt 9y ago
    I think we can agree that there are degrees of freedom in a market, and that the us healthcare market is far from a the freest possible version of healthcare. Im not sure about the information asymmetry argument: insurance companies also lack lots of information. And some of that the patient knows and the insurance doesn't. (pre-existing conditions for example). Also, there's plenty of markets with information asymmetry that dont show the backwardness of US Health care. > Services are requested under the duress of health problems without the ability to end the agreement. That is the nature of any insurance market. You cant bargain with your fire insurance when your house is burning down. Well, not effectively, if you look at the richest man in old rome.
    - iaw 9y ago
      Definitely agree that there are degrees of freedom, I'm just not confident that a removal of regulations in the healthcare market would lead to a positive outcome (higher quality/less expensive healthcare). >> Services are requested under the duress of health problems without the ability to end the agreement. >That is the nature of any insurance market. I was actually thinking about when medical treatment is being received. Once you're under a hospitals care you're largely subject to their pricing for services (e.g. I can't choose to use the cheaper MRI machine down the street). There's a bundling of services at a healthcare provider that seems to contradict free market arguments as well, but I was mainly trying to get at the (effectively) binding agreement to use a particular facility once you are checked into it. Edit: To be a little more concise, you agree to a particular payment structure for services without knowing what the cost of the services are or which services you'll be receiving when checking into a hospital, this opacity in hospital pricing also means that different parties are paying different rates for the same service at the discretion of the billing department.
- zipwitch 9y ago
  https://www.scientificamerican.com/article/world-hunger-is-increasing-thanks-to-wars-and-climate-change/ https://www.scientificamerican.com/article/world-hunger-is-i...
TheAdamAndChe 9y ago
We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a profitable business that meets the needs of our citizens. That's just how capitalism works. Edit: To those downvoting me, can you please explain? What flaw do I have in my logic?
- ceejayoz 9y ago
  > Edit: To those downvoting me, can you please explain? What flaw do I have in my logic? The idea that we're in a "capitalistic society". Every country in the world lives somewhere on the spectrum between capitalism and socialism. The US is further towards the capitalistic side than Europe, but we've plenty of non-capitalist aspects of our society. We already accept a wide array of socialist policies in the form of Medicare, Social Security, etc. We've also plenty of evidence from the rest of the developed world that the socialist approach to healthcare provides similar outcomes at greatly reduced cost. "We're capitalists, deal with it" is a fundamentally silly reason to avoid healthcare reforms.
  - TheAdamAndChe 9y ago
    I'm not saying that we shouldn't continue pushing for reform. I'm just saying that our government has proven incapable of reformation, and we should be pushing towards non-governmental approaches until they can get their act together. If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything.
    - toomuchtodo 9y ago
      Can you explain your logic about pushing for non-government reform if "government has proven incapable of reformation"? There is no healthcare fix without government reform. If you provide healthcare, you must adhere to government regulation. You must accept Medicare/Medicaid reimbursement rates. If you provide insurance, you are at the whim of the government and what each new year brings [+]. > If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything. You cannot improve this with capitalism. You can only improve this by replacing politicians who are married to a broken system through vested interests. [+] Healthcare startup Oscar is going through the grinder: https://www.bloomberg.com/news/articles/2017-08-15/obamacare-startup-oscar-posts-57-6-million-first-half-loss https://www.bloomberg.com/news/articles/2017-08-15/obamacare...
JimboOmega 9y ago
Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more. Consider the example the OP gives is a patient who they're paying thousands of dollars a day for, rather than hundreds. They're paying several people to work for days just to figure out how the rules work. It's only marginally working for them. And let's not forget that they are also fighting profiteering on the other side; is it inherently wrong that your insurance might not pay for a new brand-name medicine that costs 100x as much as a generic with only the barest minimum difference they could sneak past the FDA and get a patent for? I have Kaiser. Kaiser is a special beast, but one thing it does do pretty well is talk to itself. Combining providers and insurance under one roof provides a lot of upside in knowing what will be covered (though it has the downside that you really don't have options if Kaiser isn't getting the job done). I recently had the experience of setting up a procedure done by an entirely private (accepts no insurance) practice, because Kaiser wasn't coming through for me. I was shocked how easy it was. In one phone call, I was able to set up a consult, and even a tentative date, for a fairly complicated (day-long) surgery. Craziest of all? I got a price estimate. (It was 5 figures, but I expected that) That was something I thought just wasn't possible in the medical world. There's so many variables, they haven't seen my X-Rays, etc, etc, etc. But still they did that. Entirely for profit, though. I'm not saying for profit is the answer to everything or anything - someone less fortunate than me wouldn't even be able to consider going outside of Kaiser. Just that there aren't any easy solutions. I'm surprised by the system almost every time I interact with it.
- baobrain 9y ago
  > Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more. There is something like this for the wealthy [0]. Obviously, concierge medical services are very expensive, and morally questionable imo. [0] https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html https://www.nytimes.com/2017/06/03/business/economy/high-end...
  - JimboOmega 9y ago
    Let's not forget that most people get insurance through their employers, which really limits the choices. Paying up front for medical services - especially in today's "Chargemaster" world where nobody has a clue what anything really costs - requires you to be REALLY rich. A straightforward appendectomy for me required an overnight hospital stay which was billed at a $17K (the surgery, etc, was more). Funny thing about that link. It has a chart of "The average number of days to get a non-emergency doctor’s appointment". Los Angeles is pretty flat around 23 days. Guess what time limits the state of California places on that legally? (hint, it's less: http://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx http://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCare...)

conanbatt 9y ago

It isn't profit-seeking what makes healthcare what it is. Its the incredibly burdensome regulation and restrictions. If profit-seeking destroyed markets for profit, we would all be starving.

evgen 9y ago
No, it is profit-seeking that created this cluster-fuck. It only seems to be a problem in third-world nations like the US; the rest of the world seems to be blissfully free of broken profit-seeking institutions that cannot talk to other profit-seeking institutions so that they can collectively figure out the least amount of healthcare they can provide to the patient (so that both can maintain their profit.)
- conanbatt 9y ago
  I am from a partially socialist country that has free healthcare. I have had private healthcare, along with most of my socio-economic class, my entire life. Making it socialized does not mean it will be better. Coldly, see it as a different system with different consequences. Bringing it to the US: look at how much medicare costs today: 3.6% of gdp, servicing 56 million americans. If you extended medicare to the entire population at the same per capita, it would be 26% of GDP.
  - trowawee 9y ago
    Actually, the first world nations that have socialized healthcare systems experience better outcomes than the United States with less per capita spending.[1] Medicare as it is currently formulated is specifically targeted towards at-risk populations that have higher incidences of medical usage than the general population; you can't just apply the exact same per capita spending across the American population. 80 year-olds use more health care than 25 year-olds. [1]: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective http://www.commonwealthfund.org/publications/issue-briefs/20...
    - ferongr 9y ago
      I live in a "first world nation" and 10 years ago (before the global financial crisis even) public vs private healthcare meant the difference between leg amputation and implantation. The public system is only good for routine diagnosis and minor surgery. For everything else, care quality goes down the toilet. Not to mention on the effectively complete lack of dental care.
      - trowawee 9y ago
        I'm not sure where you live and you're not providing any links or statistics to back this claim up, so it's difficult for me to respond to what you're trying to claim here. If you read the link I provided, you would see that they use cancer, heart disease, and diabetes mortality as a shorthand for patient outcomes in significant health events, and that while the US healthcare system ranks reasonably well in cancer treatment, it is significantly behind other developed nations in treating heart disease and diabetes. They also provide statistics regarding mortality rates in various populations, and the US lags other developed nations in basically all of those populations. Your point about dentistry is interesting, although also mostly unsupported, and I'm having a difficult time finding good statistics about dental care, spending, and outcomes. Anecdotally, dental care in the United States is sharply linked to money; people with money have good/great teeth and excellent dental care, people without it frequently have major issues with their teeth. I don't know how that compares to other countries.
frgtpsswrdlame 9y ago
You know those regulations are there for a reason right? Would you like to go back to the days where people are kicked off insurance for extremely dubious pre-existing conditions? >If profit-seeking destroyed markets for profit, we would all be starving. It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the sense that it's the ill who have to die or go bankrupt to support it.
- conanbatt 9y ago
  >You know those regulations are there for a reason right? The road to hell is paved with good intentions. > It depends on what you mean by 'destroy markets.' The market is functioning well in the sense that healthcare stocks keep going up. It's functioning poorly in the sense that it's the ill who have to die or go bankrupt to support it. The measure of the health of a market is not the profits of the industry in it. A better rule of thumb would be how many people get serviced and at what relative cost. In that sense, the american healthcare market is very unhealthy.
  - frgtpsswrdlame 9y ago
    >The road to hell is paved with good intentions. Oh come on, this platitude applies to people saying 'less regulation' just as much as it does me. >The measure of the health of a market is not the profits of the industry in it. A better rule of thumb would be how many people get serviced and at what relative cost. In that sense, the american healthcare market is very unhealthy. Sure, but in that sense we can look around and see that healthcare markets are generally less healthy when they are (1) more private and (2) less regulated.
    - conanbatt 9y ago
      > Oh come on, this platitude applies to people saying 'less regulation' just as much as it does me I didn't argue that regulations are good because there was a purpose to them nor its opposite. So it doesnt really apply to my stance so far. > Sure, but in that sense we can look around and see that healthcare markets are generally less healthy when they are (1) more private and (2) less regulated. I disagree with that statement, and I am sure that you will find examples of private markets that are more efficient than public markets, of the which you only need 1 to disprove the idea that public > private on health.
dragonwriter 9y ago
Profit seeking destroys markets with large externalities or where utility isn't readily discernable at low relative cost, and where for either or both of those reasons the rational choice model doesn't reasonably approximate actual behavior in the market. Lots of real goods don't face that problem, but healthcare definitely does.
- conanbatt 9y ago
  Whats the externality of providing healthcare, and in regards to the diffuseness of utility, food has the same problem and its a relatively very efficient market.
  - dragonwriter 9y ago
    > in regards to the diffuseness of utility, food has the same problem and its a relatively very efficient market. Food is a frequently repeated purchase with significant immediately-apparent utility and disutility, and so discovery of utilities is quick and the market reasonably efficient in terms of immediate utilities. (There are long-term utilities and disutilities that are less immediately experienced with consumption, and the food market is hardly efficient in terms of those.) Healthcare products are infrequently purchased, and the relative utilities of different options are far from apparent. It's not at all similar to the aspects of the food market that can reasonably be described as relatively efficient.
    - conanbatt 9y ago
      I would argue that food escapes its measure of utility because otherwise, we would all be eating only the cheapest and healthiest option all the time, but our constant hunger also makes us purchase things against our long term interest. If so, you would expect the market to be really inefficient, but at least in terms of satisfying demand, its very hard to make money producing food. Its true healthcare has less frequency so you cant be a sophisticated consumer: but its more frequent than a car, which is also a necessity in many cases, and the lack of sophistry does not make it an inefficient market. Im not even sure healthcare is a special market, certainly not for infrequency, or because you must pay with your life (i.e. that you make a decision of life and death for resources). Not for restrictive application of labor (lawyers have that), not for the high costs of technology in its application (consumer tech? space exploration?). I think at this point what makes the healthcare market unique is the common belief of the people that it is unique. It forces the consumer to consciously think of the cost of life, a question we are somehow bred all our lives to hate to ask, but that we answer every day unconsciously.
iaw 9y ago
Libertarian arguments only hold for free markets. Even eliminating all regulations and restrictions imposed by the government, healthcare does not become a free market for two reasons: 1) Information is not symmetric, contractual obligations are made before pricing information can be discovered (thereby compared and moving into market dynamics) 2) Services are requested under the duress of health problems without the ability to end the agreement. Not everything is a free market.
- conanbatt 9y ago
  I think we can agree that there are degrees of freedom in a market, and that the us healthcare market is far from a the freest possible version of healthcare. Im not sure about the information asymmetry argument: insurance companies also lack lots of information. And some of that the patient knows and the insurance doesn't. (pre-existing conditions for example). Also, there's plenty of markets with information asymmetry that dont show the backwardness of US Health care. > Services are requested under the duress of health problems without the ability to end the agreement. That is the nature of any insurance market. You cant bargain with your fire insurance when your house is burning down. Well, not effectively, if you look at the richest man in old rome.
  - iaw 9y ago
    Definitely agree that there are degrees of freedom, I'm just not confident that a removal of regulations in the healthcare market would lead to a positive outcome (higher quality/less expensive healthcare). >> Services are requested under the duress of health problems without the ability to end the agreement. >That is the nature of any insurance market. I was actually thinking about when medical treatment is being received. Once you're under a hospitals care you're largely subject to their pricing for services (e.g. I can't choose to use the cheaper MRI machine down the street). There's a bundling of services at a healthcare provider that seems to contradict free market arguments as well, but I was mainly trying to get at the (effectively) binding agreement to use a particular facility once you are checked into it. Edit: To be a little more concise, you agree to a particular payment structure for services without knowing what the cost of the services are or which services you'll be receiving when checking into a hospital, this opacity in hospital pricing also means that different parties are paying different rates for the same service at the discretion of the billing department.
zipwitch 9y ago
https://www.scientificamerican.com/article/world-hunger-is-increasing-thanks-to-wars-and-climate-change/ https://www.scientificamerican.com/article/world-hunger-is-i...

TheAdamAndChe 9y ago

We can complain about capitalism all we want, but at the end of the day, in America, we still live in a capitalistic society. Good deeds that cannot happen profitably will not happen here en masse without subsidies, period. Given that our government has proven incapable of subsidizing healthcare in a way that promotes a combination of efficiency and effectiveness, it makes total sense that people would try to make a profitable business that meets the needs of our citizens. That's just how capitalism works. Edit: To those downvoting me, can you please explain? What flaw do I have in my logic?

ceejayoz 9y ago
> Edit: To those downvoting me, can you please explain? What flaw do I have in my logic? The idea that we're in a "capitalistic society". Every country in the world lives somewhere on the spectrum between capitalism and socialism. The US is further towards the capitalistic side than Europe, but we've plenty of non-capitalist aspects of our society. We already accept a wide array of socialist policies in the form of Medicare, Social Security, etc. We've also plenty of evidence from the rest of the developed world that the socialist approach to healthcare provides similar outcomes at greatly reduced cost. "We're capitalists, deal with it" is a fundamentally silly reason to avoid healthcare reforms.
- TheAdamAndChe 9y ago
  I'm not saying that we shouldn't continue pushing for reform. I'm just saying that our government has proven incapable of reformation, and we should be pushing towards non-governmental approaches until they can get their act together. If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything.
  - toomuchtodo 9y ago
    Can you explain your logic about pushing for non-government reform if "government has proven incapable of reformation"? There is no healthcare fix without government reform. If you provide healthcare, you must adhere to government regulation. You must accept Medicare/Medicaid reimbursement rates. If you provide insurance, you are at the whim of the government and what each new year brings [+]. > If we can improve the way things are through capitalism, that's still better than just yelling at politicians that don't do anything. You cannot improve this with capitalism. You can only improve this by replacing politicians who are married to a broken system through vested interests. [+] Healthcare startup Oscar is going through the grinder: https://www.bloomberg.com/news/articles/2017-08-15/obamacare-startup-oscar-posts-57-6-million-first-half-loss https://www.bloomberg.com/news/articles/2017-08-15/obamacare...

JimboOmega 9y ago

Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more. Consider the example the OP gives is a patient who they're paying thousands of dollars a day for, rather than hundreds. They're paying several people to work for days just to figure out how the rules work. It's only marginally working for them. And let's not forget that they are also fighting profiteering on the other side; is it inherently wrong that your insurance might not pay for a new brand-name medicine that costs 100x as much as a generic with only the barest minimum difference they could sneak past the FDA and get a patent for? I have Kaiser. Kaiser is a special beast, but one thing it does do pretty well is talk to itself. Combining providers and insurance under one roof provides a lot of upside in knowing what will be covered (though it has the downside that you really don't have options if Kaiser isn't getting the job done). I recently had the experience of setting up a procedure done by an entirely private (accepts no insurance) practice, because Kaiser wasn't coming through for me. I was shocked how easy it was. In one phone call, I was able to set up a consult, and even a tentative date, for a fairly complicated (day-long) surgery. Craziest of all? I got a price estimate. (It was 5 figures, but I expected that) That was something I thought just wasn't possible in the medical world. There's so many variables, they haven't seen my X-Rays, etc, etc, etc. But still they did that. Entirely for profit, though. I'm not saying for profit is the answer to everything or anything - someone less fortunate than me wouldn't even be able to consider going outside of Kaiser. Just that there aren't any easy solutions. I'm surprised by the system almost every time I interact with it.

baobrain 9y ago
> Theoretically, then, there should be a niche for an insurer who covers more, who treats you less shitty, but costs more. There is something like this for the wealthy [0]. Obviously, concierge medical services are very expensive, and morally questionable imo. [0] https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html https://www.nytimes.com/2017/06/03/business/economy/high-end...
- JimboOmega 9y ago
  Let's not forget that most people get insurance through their employers, which really limits the choices. Paying up front for medical services - especially in today's "Chargemaster" world where nobody has a clue what anything really costs - requires you to be REALLY rich. A straightforward appendectomy for me required an overnight hospital stay which was billed at a $17K (the surgery, etc, was more). Funny thing about that link. It has a chart of "The average number of days to get a non-emergency doctor’s appointment". Los Angeles is pretty flat around 23 days. Guess what time limits the state of California places on that legally? (hint, it's less: http://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx http://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCare...)