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I agree. This system is no secret. We all know this is how it works so why do people make poor choices and then later complain about their insurance? With that

I agree. This system is no secret. We all know this is how it works so why do people make poor choices and then later complain about their insurance? With that said, having a massive middle man (private health insurance) to act as bloat and added friction on the economy is bad for everyone. You may not be directly affected but you are definitely affected in other ways that aren't as obvious. I find this sort of thing is common in America. There is always an industry set up as a middle man that needs to get paid.

LarryDarrell 8y ago
"I got mine" "Don't make poor choices" I'm glad this isn't some sort of late stage capitalism drinking game.
- kpU8efre7r 8y ago
  Thanks for adding to the discussion. I was going to add to my comment but didn't that: This is all an incredibly privileged mindset. Many people don't start on the same level with the same chances, that we do. It's hard to blame poor choices when it's not a choice. But at the end of the day that's a big appeal to emotion. The logical argument, is that the current system is a big honking added step in the system that adds nothing but subtracts a lot and whether or not "you've got yours" you are still affected by those who don't. Poor choices or not it's still in your own interest for the people to your left and right to be covered and get healthcare.
conanbatt 8y ago
The massive middle man is the state, not private insurance. For all the complaints about private health insurance profits, all combined are a blip of the federal health expenditures.
- hedora 8y ago
  What “federal health expenditures” are you talking about? The Obamacare tax was something like 3%, and only for the extremely wealthy. In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. Source on 17%: https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... Now, the entire federal government is currently spending 37% of GDP (though that includes deficit spending), so you posit that at least ~ 1/6th (6/37) of government spending is some healthcare program. Source on 37%: https://tradingeconomics.com/united-states/government-spending-to-gdp https://tradingeconomics.com/united-states/government-spendi... Medicare and health costs ~ $1T of the government’s $3.8T budget, which is a bit over 1/4th of the federal budget. That does meet the threshold of your claim, but only if much less than half of Medicare spending goes to actual health care. Source on 1T Medicare, etc spending: https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/ https://www.nationalpriorities.org/budget-basics/federal-bud... This study from 2001 concluded Medicare is about 80% efficient (20% waste): https://www.nber.org/papers/w8395 https://www.nber.org/papers/w8395 Note that the 20% Medicare waste number from the NBER study is not apples to apples with the 33% administrative overhead number, since it includes ineffective medical care (and all other wasted spending) that did not improve patient outcomes in the 20%, but the 33% number for insurers only counts useless paper pushing, and not ineffective care, etc, etc. So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government.
  - deleted 8y ago
    [deleted]
  - conanbatt 8y ago
    > In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. 6% of GDP to private insurance? Math doesn't add up on this back-of-the-napkin math. That's an entire Apple of operating costs every year. The biggest insurance company, UnitedHealthcare, is worth 200 bill in the market. The gov could buy the big 5 insurance companies with half its yearly medicare budget. Don't confound paying to insurance and paying to providers! > So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government. I will answer seriously in a second, but for real: how is it so obvious that the private market beats the government on almost anything at any time, even this very government (for example, education) and still, the level of debate is "government is more efficient". Government is never more efficient, because it doesn't care about efficiency. The comparison of efficiency between medicare and private insurance is grossly misrepresented by Bernie Sanders. First of all, there are some disingenuous numbers: it uses a measure of efficiency of total cost/admin costs, but that skewes severely in favor of medicare bacuse it has an older population that has more expensive treatment. Some economists looked into this and the cost of administration per patient is similar. Second, a great part of why medicare has less admin burden is that its collections are done through payroll taxes. This means the admin staff is included in other government agencies. This is not a public-advantage, because you can also use payroll taxes to pay for private insurance if you wish so, something that exists in some other countries. ( to my dismay, for the following topic). Another trick here is that medicare collects from everyone and pays for a few. That is a great way to never have to market, administrate or manage people on your plan: you are not going to use it? tough luck. You dont like it? tough luck. You don't have quality coverage in your area? Tough luck. This trick is so pervasive that even Bernie Sanders claims how medicare patients are so happy: why wouldn't they, the premium they should pay to maintain it is about 1k a month, and they pay 150! Forth, it is key to understand that medicare offerings are not market competitive. They pay half of what private insurance pays, and there is no way in hell you make that work. Private insurance subsidizes medicare patients, and doctors would abandon the network if they were forced to accept medicare rates. This is a long topic, but to re-frame the conversation: what makes healthcare in the us expensive is NOT private insurance. Most of the world has private insurance! even Canada! Even France! Spain, Norway, etc. US healthcare is expensive because it is one of the most tight regulated expensive markets in the US.

LarryDarrell 8y ago

"I got mine" "Don't make poor choices" I'm glad this isn't some sort of late stage capitalism drinking game.

kpU8efre7r 8y ago
Thanks for adding to the discussion. I was going to add to my comment but didn't that: This is all an incredibly privileged mindset. Many people don't start on the same level with the same chances, that we do. It's hard to blame poor choices when it's not a choice. But at the end of the day that's a big appeal to emotion. The logical argument, is that the current system is a big honking added step in the system that adds nothing but subtracts a lot and whether or not "you've got yours" you are still affected by those who don't. Poor choices or not it's still in your own interest for the people to your left and right to be covered and get healthcare.

conanbatt 8y ago

The massive middle man is the state, not private insurance. For all the complaints about private health insurance profits, all combined are a blip of the federal health expenditures.

hedora 8y ago
What “federal health expenditures” are you talking about? The Obamacare tax was something like 3%, and only for the extremely wealthy. In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. Source on 17%: https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/ https://www.statista.com/statistics/184968/us-health-expendi... Now, the entire federal government is currently spending 37% of GDP (though that includes deficit spending), so you posit that at least ~ 1/6th (6/37) of government spending is some healthcare program. Source on 37%: https://tradingeconomics.com/united-states/government-spending-to-gdp https://tradingeconomics.com/united-states/government-spendi... Medicare and health costs ~ $1T of the government’s $3.8T budget, which is a bit over 1/4th of the federal budget. That does meet the threshold of your claim, but only if much less than half of Medicare spending goes to actual health care. Source on 1T Medicare, etc spending: https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/ https://www.nationalpriorities.org/budget-basics/federal-bud... This study from 2001 concluded Medicare is about 80% efficient (20% waste): https://www.nber.org/papers/w8395 https://www.nber.org/papers/w8395 Note that the 20% Medicare waste number from the NBER study is not apples to apples with the 33% administrative overhead number, since it includes ineffective medical care (and all other wasted spending) that did not improve patient outcomes in the 20%, but the 33% number for insurers only counts useless paper pushing, and not ineffective care, etc, etc. So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government.
- deleted 8y ago
  [deleted]
- conanbatt 8y ago
  > In contrast, 33% of US healthcare costs go to insurance overhead, and >17% of our GDP goes to health care, so nearly 6% of the gdp goes to private insurance middle men. 6% of GDP to private insurance? Math doesn't add up on this back-of-the-napkin math. That's an entire Apple of operating costs every year. The biggest insurance company, UnitedHealthcare, is worth 200 bill in the market. The gov could buy the big 5 insurance companies with half its yearly medicare budget. Don't confound paying to insurance and paying to providers! > So, private insurers really are squandering many more healthcare dollars, and are also much less efficient than the federal government. I will answer seriously in a second, but for real: how is it so obvious that the private market beats the government on almost anything at any time, even this very government (for example, education) and still, the level of debate is "government is more efficient". Government is never more efficient, because it doesn't care about efficiency. The comparison of efficiency between medicare and private insurance is grossly misrepresented by Bernie Sanders. First of all, there are some disingenuous numbers: it uses a measure of efficiency of total cost/admin costs, but that skewes severely in favor of medicare bacuse it has an older population that has more expensive treatment. Some economists looked into this and the cost of administration per patient is similar. Second, a great part of why medicare has less admin burden is that its collections are done through payroll taxes. This means the admin staff is included in other government agencies. This is not a public-advantage, because you can also use payroll taxes to pay for private insurance if you wish so, something that exists in some other countries. ( to my dismay, for the following topic). Another trick here is that medicare collects from everyone and pays for a few. That is a great way to never have to market, administrate or manage people on your plan: you are not going to use it? tough luck. You dont like it? tough luck. You don't have quality coverage in your area? Tough luck. This trick is so pervasive that even Bernie Sanders claims how medicare patients are so happy: why wouldn't they, the premium they should pay to maintain it is about 1k a month, and they pay 150! Forth, it is key to understand that medicare offerings are not market competitive. They pay half of what private insurance pays, and there is no way in hell you make that work. Private insurance subsidizes medicare patients, and doctors would abandon the network if they were forced to accept medicare rates. This is a long topic, but to re-frame the conversation: what makes healthcare in the us expensive is NOT private insurance. Most of the world has private insurance! even Canada! Even France! Spain, Norway, etc. US healthcare is expensive because it is one of the most tight regulated expensive markets in the US.