4 ms·

> I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Citat

> I mean, the most significant part of "health insurance reform" was to penalize people if they choose to opt out of patronizing these private companies. Citation needed for excess profits. As I understand it, now that that requirement has been removed, most companies have dropped out of the Obamacare-market. That seems to me like they were previously only making near the bare minimum that made it worth their while.

mindslight 8y ago
Leaving the "Obamacare-market" doesn't imply a health "insurance" company is then operating as some bastion of the free market. The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. In general, a lack of legibility to consumers means they are unable to choose efficiently, which implies that the other party is likely taking an outsized amount of profit. Much of that profit goes to paying the paper pushers who keep the system opaque, but from the consumer's perspective that's little consolation.
- bovine3dom 8y ago
  > The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food, for example. It's a valid negotiating strategy; it means that offering a low price to one consumer doesn't mean that they have to offer it to another. I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). In the UK, the NHS is funded from taxes. I don't get a choice whether I pay that or not. Mandatory insurance (or an equivalent) for all is a common factor in well-run healthcare systems worldwide. Without it, it's a bit like allowing car drivers to not purchase insurance until after they've crashed.
  - chimeracoder 8y ago
    > I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). You've got it completely backwards - the providers and payers are dramatically less connected in the US compared to the NHS in the UK. In general, the US is moving towards more captitated models, but if anything, this is bringing their incentive structure closer in line to what providers in the NHS already experience.
    - bovine3dom 8y ago
      Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Care provider was probably a poor choice of words. Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone.
      - chimeracoder 8y ago
        > Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Yes, and this is exactly what I'm talking about. > Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone. NICE is many things, but they're certainly not "nice". And where that shows the most is in treatments for complex conditions (especially cancer). But beyond that: providers under the NHS have dramatic leeway in determining appropriate steps for care (that's inherent to the practice of medicine itself), and they are both explicitly and implicitly expected to consider costs as a factor in that decision-making.
  - mindslight 8y ago
    > Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food Supermarkets do publish the amount they charge people for food. In fact, they often push it to you every week whether you want it or not! It seems like you're trying to flip around the analogy and apply it to insurance companies rather than medical providers. But my point is that in a functioning market, we would expect there to be cash customers for many services - people who have the means to accept a higher variance for a higher expected value and thus forgo some level of insurance. The lack of uniform transparent pricing discourages this, pushing such customers into buying "insurance" to avoid being ripped off in an uncompetitive consumer market. And yes, opaque pricing is certainly a "negotiating technique" - right out of Oracle's playbook. This is not a justification though!
- chimeracoder 8y ago
  > In general, a lack of legibility to consumers means they are unable to choose efficiently, which implies that the other party is likely taking an outsized amount of profit. This is wrong. Not only is it possible for an inefficient market to produce a state that is suboptimal for both buyers and sellers, but in fact this is literally the textbook definition of economic inefficiency. Just because the consumers are suffering from the inefficiency, that doesn't mean that the insurers aren't as well. It's not surprising that neither insurers nor patients are happy with the situation.

mindslight 8y ago

Leaving the "Obamacare-market" doesn't imply a health "insurance" company is then operating as some bastion of the free market. The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. In general, a lack of legibility to consumers means they are unable to choose efficiently, which implies that the other party is likely taking an outsized amount of profit. Much of that profit goes to paying the paper pushers who keep the system opaque, but from the consumer's perspective that's little consolation.

bovine3dom 8y ago
> The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food, for example. It's a valid negotiating strategy; it means that offering a low price to one consumer doesn't mean that they have to offer it to another. I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). In the UK, the NHS is funded from taxes. I don't get a choice whether I pay that or not. Mandatory insurance (or an equivalent) for all is a common factor in well-run healthcare systems worldwide. Without it, it's a bit like allowing car drivers to not purchase insurance until after they've crashed.
- chimeracoder 8y ago
  > I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). You've got it completely backwards - the providers and payers are dramatically less connected in the US compared to the NHS in the UK. In general, the US is moving towards more captitated models, but if anything, this is bringing their incentive structure closer in line to what providers in the NHS already experience.
  - bovine3dom 8y ago
    Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Care provider was probably a poor choice of words. Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone.
    - chimeracoder 8y ago
      > Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Yes, and this is exactly what I'm talking about. > Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone. NICE is many things, but they're certainly not "nice". And where that shows the most is in treatments for complex conditions (especially cancer). But beyond that: providers under the NHS have dramatic leeway in determining appropriate steps for care (that's inherent to the practice of medicine itself), and they are both explicitly and implicitly expected to consider costs as a factor in that decision-making.
- mindslight 8y ago
  > Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food Supermarkets do publish the amount they charge people for food. In fact, they often push it to you every week whether you want it or not! It seems like you're trying to flip around the analogy and apply it to insurance companies rather than medical providers. But my point is that in a functioning market, we would expect there to be cash customers for many services - people who have the means to accept a higher variance for a higher expected value and thus forgo some level of insurance. The lack of uniform transparent pricing discourages this, pushing such customers into buying "insurance" to avoid being ripped off in an uncompetitive consumer market. And yes, opaque pricing is certainly a "negotiating technique" - right out of Oracle's playbook. This is not a justification though!
chimeracoder 8y ago
> In general, a lack of legibility to consumers means they are unable to choose efficiently, which implies that the other party is likely taking an outsized amount of profit. This is wrong. Not only is it possible for an inefficient market to produce a state that is suboptimal for both buyers and sellers, but in fact this is literally the textbook definition of economic inefficiency. Just because the consumers are suffering from the inefficiency, that doesn't mean that the insurers aren't as well. It's not surprising that neither insurers nor patients are happy with the situation.