7 ms·

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the t

In my previous career, I was an accountant, and I worked for a health insurance company, you are straight up uniformed if you do not think that ACA raised the the cost of insurance. With that said, as a type 1 diabetic, without ACA it would be impossible for me to get insurance outside of employment, so i think there is some good in it, just needs to be actually thought through, unlike what the administration did that put it in place.

bliblah 7y ago
>> just needs to be actually thought through, It's impossible because you both political parties want exclusively mutual results You can't have cheap insurance without making it mandatory since only the sick will get it You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs You can't have good insurance if you aren't willing to pay the market price which happens to be very inflated in the US You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Overall, it's a shitshow that will keep being patchworked every time the administration changes between parties.
- civility 7y ago
  > You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction of what they charge for humans. The process is performed in a sterile environment by professionals in either case. We're smarter than animals on average, but our bodies and medical needs aren't vastly different. The problem is price gouging because the providers and insurance companies know we have no real ability to shop around. They conspire with each other to publish false rates when the true costs are much lower after you agree to them. You could maybe solve this with regulation on prices (a socialist approach), but you could also solve it by mandating they advertise true prices and re-enable competition (a capitalist approach). Either way could fix this, and the problem is corruption (lobbying) not party ideology.
  - URSpider94 7y ago
    You don't even have to go all the way to veterinary medicine. This is an old article, but compare the $100,000 cost for a joint replacement in the USA vs. $13,000 for that same procedure in Belgium. https://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html https://www.nytimes.com/2013/08/04/health/for-medical-touris...
  - Buttons840 7y ago
    They do have to publish prices, right? See: https://www.google.com/search?q=doctors+and+hospitals+must+publish+costs https://www.google.com/search?q=doctors+and+hospitals+must+p... Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work. What kind of knee surgery am I having? Will I have to pay extra for the anesthesiologist? What kind of anesthesia will they be using? What about surgery preparation? What costs do I need to include for that? What about post surgery? There's probably a dozen cost items to add to the total for post surgery. The nurse brought me a glass of water. I'm not sure if that comes with a charge or not? Presumably someone has to pay for the plastic cup. Etc.
    - dsfyu404ed 7y ago
      >Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work. This is exactly the problem. They publish "prices" but those prices don't mean anything.
    - snowwrestler 7y ago
      Published medical prices are not real because most procedures are paid by collective programs like private insurance or Medicare, which use their bargaining power to pay less--sometimes MUCH less--than the public "list price". You're right that the complexity of medical billing also makes it difficult to anticipate and compare prices. However, that might be more of a side effect of how the billing is done, rather than an unavoidable attribute of medical care. Arguably, medical providers have the information and capability to package procedures and publish what it actually costs to do them. But they have no incentive to do so, and many incentives to not do so.
- masonic 7y ago
  It's impossible because you both political parties want exclusively mutual results You can't blame ACA's flaws on party disputes -- Republicans were allowed no input to the process, and it passed on Democrat votes alone. Republicans and rank-and-file Democrats* weren't even given the final bill to read before the vote*.
qqqwerty 7y ago
lol, You might want to take in account who you are replying to. tptacek is one of the more prolific commenters on HN. And just to be clear, he was talking about 'rate of growth` in costs, not absolute costs.
- mieseratte 7y ago
  Being a "prolific commenter" does not preclude one being uninformed on a topic. Quantity != quality.
Someone1234 7y ago
> you are straight up uniformed if you do not think that ACA raised the the cost of insurance. The post you replied to said: > the ACA in fact reduced the rate of growth in health care costs. Meaning the RATE of increase slowed. The Department of health & Human Services estimates that the ACA saved $2.3T up through 2017 ($650B in 2017 alone). Premiums haven't gone down, and they weren't estimated to.
BeetleB 7y ago
Anecdote, but the two years pre ACA my premiums went up about 9% each year. After ACA it was about 6% each year. Pre ACA my employer said "Sorry. Premiums went up from insurance companies." Post ACA employer said "Blame Obamacare." Employees being people bought the "Obamacare made my premiums go up!"
brazzledazzle 7y ago
You're laying the blame at the administration's feet but you're ignoring the complete shit show in the legislature that resulted in what we have today. They compromised and compromised and finally surrendered major concessions to someone in their own party to get it passed. I'm shocked it did any good at all.

bliblah 7y ago

>> just needs to be actually thought through, It's impossible because you both political parties want exclusively mutual results You can't have cheap insurance without making it mandatory since only the sick will get it You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs You can't have good insurance if you aren't willing to pay the market price which happens to be very inflated in the US You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Overall, it's a shitshow that will keep being patchworked every time the administration changes between parties.

civility 7y ago
> You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction of what they charge for humans. The process is performed in a sterile environment by professionals in either case. We're smarter than animals on average, but our bodies and medical needs aren't vastly different. The problem is price gouging because the providers and insurance companies know we have no real ability to shop around. They conspire with each other to publish false rates when the true costs are much lower after you agree to them. You could maybe solve this with regulation on prices (a socialist approach), but you could also solve it by mandating they advertise true prices and re-enable competition (a capitalist approach). Either way could fix this, and the problem is corruption (lobbying) not party ideology.
- URSpider94 7y ago
  You don't even have to go all the way to veterinary medicine. This is an old article, but compare the $100,000 cost for a joint replacement in the USA vs. $13,000 for that same procedure in Belgium. https://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html https://www.nytimes.com/2013/08/04/health/for-medical-touris...
- Buttons840 7y ago
  They do have to publish prices, right? See: https://www.google.com/search?q=doctors+and+hospitals+must+publish+costs https://www.google.com/search?q=doctors+and+hospitals+must+p... Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work. What kind of knee surgery am I having? Will I have to pay extra for the anesthesiologist? What kind of anesthesia will they be using? What about surgery preparation? What costs do I need to include for that? What about post surgery? There's probably a dozen cost items to add to the total for post surgery. The nurse brought me a glass of water. I'm not sure if that comes with a charge or not? Presumably someone has to pay for the plastic cup. Etc.
  - dsfyu404ed 7y ago
    >Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work. This is exactly the problem. They publish "prices" but those prices don't mean anything.
  - snowwrestler 7y ago
    Published medical prices are not real because most procedures are paid by collective programs like private insurance or Medicare, which use their bargaining power to pay less--sometimes MUCH less--than the public "list price". You're right that the complexity of medical billing also makes it difficult to anticipate and compare prices. However, that might be more of a side effect of how the billing is done, rather than an unavoidable attribute of medical care. Arguably, medical providers have the information and capability to package procedures and publish what it actually costs to do them. But they have no incentive to do so, and many incentives to not do so.
masonic 7y ago
It's impossible because you both political parties want exclusively mutual results You can't blame ACA's flaws on party disputes -- Republicans were allowed no input to the process, and it passed on Democrat votes alone. Republicans and rank-and-file Democrats* weren't even given the final bill to read before the vote*.

qqqwerty 7y ago

lol, You might want to take in account who you are replying to. tptacek is one of the more prolific commenters on HN. And just to be clear, he was talking about 'rate of growth` in costs, not absolute costs.

mieseratte 7y ago
Being a "prolific commenter" does not preclude one being uninformed on a topic. Quantity != quality.

Someone1234 7y ago

> you are straight up uniformed if you do not think that ACA raised the the cost of insurance. The post you replied to said: > the ACA in fact reduced the rate of growth in health care costs. Meaning the RATE of increase slowed. The Department of health & Human Services estimates that the ACA saved $2.3T up through 2017 ($650B in 2017 alone). Premiums haven't gone down, and they weren't estimated to.

BeetleB 7y ago

Anecdote, but the two years pre ACA my premiums went up about 9% each year. After ACA it was about 6% each year. Pre ACA my employer said "Sorry. Premiums went up from insurance companies." Post ACA employer said "Blame Obamacare." Employees being people bought the "Obamacare made my premiums go up!"

brazzledazzle 7y ago

You're laying the blame at the administration's feet but you're ignoring the complete shit show in the legislature that resulted in what we have today. They compromised and compromised and finally surrendered major concessions to someone in their own party to get it passed. I'm shocked it did any good at all.