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When I read these stories it always strikes me how arbitrary the system is. You can have insurance but you still may lose everything. There really is no way to

When I read these stories it always strikes me how arbitrary the system is. You can have insurance but you still may lose everything. There really is no way to do it right. It's a pure gamble.

toufiqbarhamov 8y ago
That’s maddening, because of course that’s just the kind of horrible, random outcome insurance and the modern social safety net was supposed to prevent. Are we going to have to go fully Victorian before the pendulum swings back?
twoquestions 8y ago
We're willing to endure incredible pain to ensure that nobody gets a free ride.
- Waterluvian 8y ago
  Giving people a free ride can be a valid selfish act. When I enjoy paying all my tax that covers social systems like healthcare and decent schools and welfare, it's not because I'm altruistic. It's because I believe it's the cheapest way to not get stabbed and robbed that also doesn't feel like a dystopian gated community. Or put more absurdly: I want quality NPCs in my world. (not that they're mindless automatons, but that I want prosperity for all those people who make up the backdrop of my experience, even if they're not immediate friends, family, colleagues)
  - tedunangst 8y ago
    I think this is a compelling argument, but the advocates for more social services never seem to use it.
  - twoquestions 8y ago
    Completely agree here, except for the "quality NPCs" bit. Remember, "There, but for the grace of God, go I". It both enrages and saddens me that people will willingly suffer more pain trying to keep "free riders" out than save the bureaucratic labor and just let everyone in and "buy in bulk". Other countries get better care for less per person, in some cases much less. Americans are irrationally, short-sightedly selfish and cheap when it comes to medical threats to our well-being. If only we could frame this as a national security issue...
    - maxxxxx 8y ago
      " If only we could frame this as a national security issue... " If you framed it that way you would just end up paying even more without better results. Just look at the high incarceration rates and the prison costs that follow.
- maxxxxx 8y ago
  I have to say the "Medicare for all" movement looks more and more attractive.
- mc32 8y ago
  It's not that simple. The indigent get a free ride, people over a certain age get a free ride. It's the people who work for workplaces who offer no coverage who get screwed --the working poor. Now, medicine for all is not a panacea either, but it may be better than what we have now. I think one answer might be a two tiered system. One that is no strings attached[1] basic healthcare for all and a second tier for those who want 'premium' healthcare through their employer or other private means. Reason is even in places with universal coverage, often times people will get private coverage for a multitude of reasons from quality of care, to wait times, to experience of staff (low incidence of malpractice), etc. [1] Lest anyone be overenthusiastic, this often means your doctor has final say in options, treatment, etc. which is why a 'premium' private market thrives alongside the universal option.
  - maxxxxx 8y ago
    "I think one answer might be a two tiered system. One that is no strings attached basic healthcare for all and a second tier for those who want 'premium' healthcare through their employer or other private means. Reason is even in places with universal coverage, often times people will get private coverage for a multitude of reasons from quality of care, to wait times, to experience of staff, etc. " Exactly. That's how it works in most of Europe.
zozbot123 8y ago
"Insurance" can't solve the issue of sky-high healthcare costs. In fact, the closest thing to a quick solution (a real solution would require draining the swamp altogether, by reforming the entire healthcare sector essentially from the ground up) is its very opposite, namely price transparency, with the end-user paying directly for their health care. This doesn't mean doing away with insurance entirely, but it will have to be catastrophic insurance, the main purpose of which will be dealing with truly rare health conditions/medical emergencies, albeit with a sub-component of subsidizing cheap preventive care.
- Spooky23 8y ago
  That sounds great except that people who account for the most spending are the least receptive to pricing pressures. My dad had the misfortune to suffer from a serious stroke. He needs a lot of medical care, and frankly doesn’t have the ability to broker deals between various medical providers. There are many many people in similar situations. Even in a world where scum companies didn’t charge usurious prices for drugs like epipens, denying someone care is a moral travesty that should be handled in a fair way.
  - maxxxxx 8y ago
    "There are many many people in similar situations. Even in a world where scum companies didn’t charge usurious prices for drugs like epipens, denying someone care is a moral travesty that should be handled in a fair way. " At least there should be a clear, well documented way for people to avoid these problems. Right now you can get insurance and do everything right but you still may get screwed.
- dontreact 8y ago
  It can, and it does in other countries. The U.S. is a huge outlier in the developed world in letting insurance companies run as for-profit entities with 20% administrative overhead. We pay ~18% of GDP for healthcare (1st in the world) and yet are nowhere near the top in terms of overall outcomes. In Japan, insurance companies have ~3% administrative overhead and run a non-profits. They pay 11% as a fraction of GDP, despite a huge relative proportion of elderly and an extremely high usage rate (no one goes to the doctor more than the Japanese)

When I read these stories it always strikes me how arbitrary the system is. You can have insurance but you still may lose everything. There really is no way to do it right. It's a pure gamble.

toufiqbarhamov 8y ago

That’s maddening, because of course that’s just the kind of horrible, random outcome insurance and the modern social safety net was supposed to prevent. Are we going to have to go fully Victorian before the pendulum swings back?

twoquestions 8y ago

We're willing to endure incredible pain to ensure that nobody gets a free ride.

Waterluvian 8y ago
Giving people a free ride can be a valid selfish act. When I enjoy paying all my tax that covers social systems like healthcare and decent schools and welfare, it's not because I'm altruistic. It's because I believe it's the cheapest way to not get stabbed and robbed that also doesn't feel like a dystopian gated community. Or put more absurdly: I want quality NPCs in my world. (not that they're mindless automatons, but that I want prosperity for all those people who make up the backdrop of my experience, even if they're not immediate friends, family, colleagues)
- tedunangst 8y ago
  I think this is a compelling argument, but the advocates for more social services never seem to use it.
- twoquestions 8y ago
  Completely agree here, except for the "quality NPCs" bit. Remember, "There, but for the grace of God, go I". It both enrages and saddens me that people will willingly suffer more pain trying to keep "free riders" out than save the bureaucratic labor and just let everyone in and "buy in bulk". Other countries get better care for less per person, in some cases much less. Americans are irrationally, short-sightedly selfish and cheap when it comes to medical threats to our well-being. If only we could frame this as a national security issue...
  - maxxxxx 8y ago
    " If only we could frame this as a national security issue... " If you framed it that way you would just end up paying even more without better results. Just look at the high incarceration rates and the prison costs that follow.
maxxxxx 8y ago
I have to say the "Medicare for all" movement looks more and more attractive.
mc32 8y ago
It's not that simple. The indigent get a free ride, people over a certain age get a free ride. It's the people who work for workplaces who offer no coverage who get screwed --the working poor. Now, medicine for all is not a panacea either, but it may be better than what we have now. I think one answer might be a two tiered system. One that is no strings attached[1] basic healthcare for all and a second tier for those who want 'premium' healthcare through their employer or other private means. Reason is even in places with universal coverage, often times people will get private coverage for a multitude of reasons from quality of care, to wait times, to experience of staff (low incidence of malpractice), etc. [1] Lest anyone be overenthusiastic, this often means your doctor has final say in options, treatment, etc. which is why a 'premium' private market thrives alongside the universal option.
- maxxxxx 8y ago
  "I think one answer might be a two tiered system. One that is no strings attached basic healthcare for all and a second tier for those who want 'premium' healthcare through their employer or other private means. Reason is even in places with universal coverage, often times people will get private coverage for a multitude of reasons from quality of care, to wait times, to experience of staff, etc. " Exactly. That's how it works in most of Europe.

zozbot123 8y ago

"Insurance" can't solve the issue of sky-high healthcare costs. In fact, the closest thing to a quick solution (a real solution would require draining the swamp altogether, by reforming the entire healthcare sector essentially from the ground up) is its very opposite, namely price transparency, with the end-user paying directly for their health care. This doesn't mean doing away with insurance entirely, but it will have to be catastrophic insurance, the main purpose of which will be dealing with truly rare health conditions/medical emergencies, albeit with a sub-component of subsidizing cheap preventive care.

Spooky23 8y ago
That sounds great except that people who account for the most spending are the least receptive to pricing pressures. My dad had the misfortune to suffer from a serious stroke. He needs a lot of medical care, and frankly doesn’t have the ability to broker deals between various medical providers. There are many many people in similar situations. Even in a world where scum companies didn’t charge usurious prices for drugs like epipens, denying someone care is a moral travesty that should be handled in a fair way.
- maxxxxx 8y ago
  "There are many many people in similar situations. Even in a world where scum companies didn’t charge usurious prices for drugs like epipens, denying someone care is a moral travesty that should be handled in a fair way. " At least there should be a clear, well documented way for people to avoid these problems. Right now you can get insurance and do everything right but you still may get screwed.
dontreact 8y ago
It can, and it does in other countries. The U.S. is a huge outlier in the developed world in letting insurance companies run as for-profit entities with 20% administrative overhead. We pay ~18% of GDP for healthcare (1st in the world) and yet are nowhere near the top in terms of overall outcomes. In Japan, insurance companies have ~3% administrative overhead and run a non-profits. They pay 11% as a fraction of GDP, despite a huge relative proportion of elderly and an extremely high usage rate (no one goes to the doctor more than the Japanese)