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"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 swam

"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)
- maxxxxx 8y ago
  Add to that overhead the huge billing departments most doctors have.
amoorthy 8y ago
I'm not sure why you conclude insurance cannot solve healthcare. Private insurance, where there's a profit motive, may be inappropriate but insurance - as a concept of spreading risk over a large population - seems logical for a generally healthy population with occasional health issues. The problem with healthcare is it's not a good like others which are insured. Even with price transparency the patient isn't qualified to decide what treatment to get at what price (your doctor is), and often the patient isn't at their best physically or mentally when treatment decisions need to be made. Comparing the US healthcare cost to other countries is slightly misleading as much of the world free-rides off US pharma research. If we want affordable insurance we should let people with chronic or debilitating diseases die rather than treat them with expensive medications/procedures that increase cost on us all. But when it's your loved one that's sick it's extremely hard to be this cavalier about the decision to not treat at any cost. I know I couldn't make that call.
- maxxxxx 8y ago
  "Comparing the US healthcare cost to other countries is slightly misleading as much of the world free-rides off US pharma research." I want to see hard numbers on this. I strongly believe that this is just self-serving propaganda to justify ripping off people in the US.
  - amoorthy 8y ago
    Fair request on hard data. I don't have it and don't want to suggest this is a well-researched point on my part by simply Googling some random report. I was going off comments from some post-doc friends who immigrated to the US because they said medical research funding here is much better than elsewhere. (As an aside I think some replies to my comment misunderstood my point. I believe government insurance is highly appropriate for a good like healthcare. Just that it's not without it's downsides and being Canadian I've seen those first-hand).
- HarryHirsch 8y ago
  much of the world free-rides off US pharma research Hospitals do research now? The rest of the world gets free rides off US-made plaster casts for broken arms?
perl4ever 8y ago
I don't think there is a very significant difference between "catastrophic insurance" and my ACA plan which has a deductible of something like $5500/year. And I don't think my monthly (individual) premium of around $400 is particularly unreasonable; I think that's what healthcare costs. Subsidies are a separate issue.

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)

maxxxxx 8y ago
Add to that overhead the huge billing departments most doctors have.

amoorthy 8y ago

I'm not sure why you conclude insurance cannot solve healthcare. Private insurance, where there's a profit motive, may be inappropriate but insurance - as a concept of spreading risk over a large population - seems logical for a generally healthy population with occasional health issues. The problem with healthcare is it's not a good like others which are insured. Even with price transparency the patient isn't qualified to decide what treatment to get at what price (your doctor is), and often the patient isn't at their best physically or mentally when treatment decisions need to be made. Comparing the US healthcare cost to other countries is slightly misleading as much of the world free-rides off US pharma research. If we want affordable insurance we should let people with chronic or debilitating diseases die rather than treat them with expensive medications/procedures that increase cost on us all. But when it's your loved one that's sick it's extremely hard to be this cavalier about the decision to not treat at any cost. I know I couldn't make that call.

maxxxxx 8y ago
"Comparing the US healthcare cost to other countries is slightly misleading as much of the world free-rides off US pharma research." I want to see hard numbers on this. I strongly believe that this is just self-serving propaganda to justify ripping off people in the US.
- amoorthy 8y ago
  Fair request on hard data. I don't have it and don't want to suggest this is a well-researched point on my part by simply Googling some random report. I was going off comments from some post-doc friends who immigrated to the US because they said medical research funding here is much better than elsewhere. (As an aside I think some replies to my comment misunderstood my point. I believe government insurance is highly appropriate for a good like healthcare. Just that it's not without it's downsides and being Canadian I've seen those first-hand).
HarryHirsch 8y ago
much of the world free-rides off US pharma research Hospitals do research now? The rest of the world gets free rides off US-made plaster casts for broken arms?

perl4ever 8y ago

I don't think there is a very significant difference between "catastrophic insurance" and my ACA plan which has a deductible of something like $5500/year. And I don't think my monthly (individual) premium of around $400 is particularly unreasonable; I think that's what healthcare costs. Subsidies are a separate issue.