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What strikes me as disingenuous about your posture is this: You are basically arguing that the insurers are introducing lifetime caps (making life much worse fo

by FabHK 8y ago

What strikes me as disingenuous about your posture is this: You are basically arguing that the insurers are introducing lifetime caps (making life much worse for the affected individuals, basically nullifying the whole point of insurance) not out of concern for their profit margin, but out of the goodness of their hearts to keep the premiums low for the paying public. That strikes me as unlikely. Of course, if you don't impose these limits, the costs must be borne by the collective insured. However, if there is one government/single payer insurer, nobody would ever dream up the insane idea of saying, hey, if you're really fucked, we'll stop paying your health bills, so we can shave off a few dollars of everyone's premiums.

rayiner 8y ago
> not out of concern for their profit margin, but out of the goodness of their hearts to keep the premiums low for the paying public. Lowering premiums allows insurers to win customers away from competing insurers. It's e.g. why HP sells business laptops with awful LCD panels. It's not because HP makes fat profits on each laptop (their margins are razor thin). It's because the lower price allows them to take sales away from competitors. > However, if there is one government/single payer insurer, nobody would ever dream up the insane idea of saying, hey, if you're really fucked, we'll stop paying your health bills, so we can shave off a few dollars of everyone's premiums. Of course they would! You think government bureaucrats aren't under pressure to control outlays? https://www.dailykos.com/stories/2017/5/8/1660050/-Death-Panels-are-a-feature-of-any-healthcare-system https://www.dailykos.com/stories/2017/5/8/1660050/-Death-Pan... > In the UK, the NHS has a system based on QALYs — quality-of-life years. In crude terms, it values a year of normal health at £30,000, so if the proposed course of treatment will cost £150,000, the patient would need to have good prospects of having five years of normal life once the treatment is over to get it. For a patient who would need assistance to live because they can’t walk more than a few steps or what have you, the QALY figure might drop to £15,000, so the patient would have to have an expectancy of 10 years of assisted life to get the treatment. Note that in the example in the story, the lifetime limit was $500,000, or 380,000 pounds. In the UK, the guy would've needed to live 12-13 years to justify spending that much. He had an aggressive cancer and died a year later, while receiving treatment. Under the U.K. system, the NHS would've been willing to pay well under $100,000 with that prognosis. The idea that "one government/single payer insurer" systems wouldn't have these sorts of limits is the product of the exact gas-lighting I was complaining about. By focusing on the insurance companies, and the fictional fat profit margins out of which benefits can be paid for with no cost to rate payers, it totally obscures the fact that, at the end of the day, a functioning healthcare system needs to make decisions about when to cut off care.
- FabHK 8y ago
  I appreciate the informative reply. > Lowering premiums allows insurers to win customers away from competing insurers. Absolutely. That's what leads to competition with insurance plans that are superficially more attractive ("hey, cheaper premiums"), while basically nullifying the benefits of insurance (by making you and your family broke when things turn bad - and then you die). The alternate system doesn't need to optimise for "optics" & sales, but can optimise eg for QALYs. Of course neither system can overcome the fundamental issue that you can't pay for unlimited treatment for all. But quite evidently, the US system leads to harrowing quandaries for many ill people and their families, worse overall health outcomes, higher overall costs, and richer health insurance CEOs than what's done in all other developed countries; and I still don't understand why you appear to defend it.
  - chimeracoder 8y ago
    > But quite evidently, the US system leads to harrowing quandaries for many ill people and their families, worse overall health outcomes, higher overall costs, and richer health insurance CEOs than what's done in all other developed countries; and I still don't understand why you appear to defend it. We're specifically talking about cancer treatment in this thread, where the data is pretty clear: the US has dramatically better survival rates for cancer in the US, and the gap is even wider for forms of cancer which are considered highly treatable. Yes, people in the US pay a lot for cancer treatment, but the overall outcomes are not worse.
    - DanBC 8y ago
      > the US has dramatically better survival rates for cancer in the US, No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life.
      - refurb 8y ago
        Overdiagnoses? I thought the US had bad preventative healthcare. Any sources you’d like to share? Sounds like BS.

by FabHK 8y ago

rayiner 8y ago

> not out of concern for their profit margin, but out of the goodness of their hearts to keep the premiums low for the paying public. Lowering premiums allows insurers to win customers away from competing insurers. It's e.g. why HP sells business laptops with awful LCD panels. It's not because HP makes fat profits on each laptop (their margins are razor thin). It's because the lower price allows them to take sales away from competitors. > However, if there is one government/single payer insurer, nobody would ever dream up the insane idea of saying, hey, if you're really fucked, we'll stop paying your health bills, so we can shave off a few dollars of everyone's premiums. Of course they would! You think government bureaucrats aren't under pressure to control outlays? https://www.dailykos.com/stories/2017/5/8/1660050/-Death-Panels-are-a-feature-of-any-healthcare-system https://www.dailykos.com/stories/2017/5/8/1660050/-Death-Pan... > In the UK, the NHS has a system based on QALYs — quality-of-life years. In crude terms, it values a year of normal health at £30,000, so if the proposed course of treatment will cost £150,000, the patient would need to have good prospects of having five years of normal life once the treatment is over to get it. For a patient who would need assistance to live because they can’t walk more than a few steps or what have you, the QALY figure might drop to £15,000, so the patient would have to have an expectancy of 10 years of assisted life to get the treatment. Note that in the example in the story, the lifetime limit was $500,000, or 380,000 pounds. In the UK, the guy would've needed to live 12-13 years to justify spending that much. He had an aggressive cancer and died a year later, while receiving treatment. Under the U.K. system, the NHS would've been willing to pay well under $100,000 with that prognosis. The idea that "one government/single payer insurer" systems wouldn't have these sorts of limits is the product of the exact gas-lighting I was complaining about. By focusing on the insurance companies, and the fictional fat profit margins out of which benefits can be paid for with no cost to rate payers, it totally obscures the fact that, at the end of the day, a functioning healthcare system needs to make decisions about when to cut off care.

FabHK 8y ago
I appreciate the informative reply. > Lowering premiums allows insurers to win customers away from competing insurers. Absolutely. That's what leads to competition with insurance plans that are superficially more attractive ("hey, cheaper premiums"), while basically nullifying the benefits of insurance (by making you and your family broke when things turn bad - and then you die). The alternate system doesn't need to optimise for "optics" & sales, but can optimise eg for QALYs. Of course neither system can overcome the fundamental issue that you can't pay for unlimited treatment for all. But quite evidently, the US system leads to harrowing quandaries for many ill people and their families, worse overall health outcomes, higher overall costs, and richer health insurance CEOs than what's done in all other developed countries; and I still don't understand why you appear to defend it.
- chimeracoder 8y ago
  > But quite evidently, the US system leads to harrowing quandaries for many ill people and their families, worse overall health outcomes, higher overall costs, and richer health insurance CEOs than what's done in all other developed countries; and I still don't understand why you appear to defend it. We're specifically talking about cancer treatment in this thread, where the data is pretty clear: the US has dramatically better survival rates for cancer in the US, and the gap is even wider for forms of cancer which are considered highly treatable. Yes, people in the US pay a lot for cancer treatment, but the overall outcomes are not worse.
  - DanBC 8y ago
    > the US has dramatically better survival rates for cancer in the US, No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life.
    - refurb 8y ago
      Overdiagnoses? I thought the US had bad preventative healthcare. Any sources you’d like to share? Sounds like BS.