125 ms·

Imagine if grocery stores forced us to choose one of a few dozen grocery "insurance" memberships to buy groceries, and negotiated directly with the insurers. No

• pmart123 7y ago
  This isn't a bad analogy actually.
• plughs 7y ago
  Then imagine that there are some people who can't afford the food they need in the grocery store and are going to die. Alternatives and transparent pricing isn't going to make brain surgery affordable to the average consumer.
  • kbutler 7y ago
    There are people who can't afford groceries now - we don't fund that by having the government pay for all groceries for everyone.
    • sabujp 7y ago
      universal healthcare is sort of the equivalent of free food. What if your medical condition is malnourishment?
      • bhupy 7y ago
        Food stamps (or the equivalent value in cash). Now s/food/health
  • Spivak 7y ago
    Solving the problem of care that a person can’t afford is a completely different issue than fixing the problem of routine affordable care being exorbitantly expensive.
  • kuzimoto 7y ago
    According to Wikipedia, there are only .5% of all physicians in the US who can perform neurosurgery. So it's probably safe to say the demand for brain surgery is much higher than the supply. This incentivises people to become doctors that perform such complecated procedures as it takes a lot of time and a lot of money to be able to do those things. If you were to force doctors to perform work on people that can't afford it, then presumably they will earn less money. If they earn less money, there is less incentive to do that kind of work as they will pick something easier and more profitable. You will end up with fewer people to do brain surgery.
    • rubidium 7y ago
      If money were the only incentive to life no one would become a schoool teacher. Your summary is missing something.
      • aianus 7y ago
        Someone will still become a school teacher, they'll just be incompetent at it: https://www.thestar.com/yourtoronto/education/2016/05/13/for-many-teachers-math-just-doesnt-add-up.html https://www.thestar.com/yourtoronto/education/2016/05/13/for...
      • kuzimoto 7y ago
        That is true, but if you're the type of person that likes to help others it's much easier to become a teacher than doctor. Also, if you are a doctor and your primary motivation is helping people, wouldn't you want to help many people with simple problems, than few people with highly complex problems (which most likely have a higher risk of failure)? There is already a shortage of doctors doing the easy stuff. I just don't see the incentive for doing difficult procedures other than with money.
        • tanr54ok 7y ago
          > Also, if you are a doctor and your primary motivation is helping people, wouldn't you want to help many people with simple problems, than few people with highly complex problems (which most likely have a higher risk of failure)? Your analysis completely falls flat here. Not all doctors are motivated by the same things and yet most of them would consider their primary motivation helping people. Neurosurgeons are a prime example. They would very much prefer few complex cases (not everyone gets a brain tumor thankfully) as their way to maximize benefit rather than manage cholesterol meds for 100s. Speciality surgeons by their nature are motivated by a certain degree of risk. The incentive for doing difficult procedures is often because they are challenging. Compensation for doctors in the US isn’t fully correlated with difficulty either... with no offense to my dermatology colleagues making more than most general surgery sub specialists.
  • maerF0x0 7y ago
    No, but alternatives and transparent pricing allow us to weigh alternatives and to have an adult conversation about all of us will die someday (save singularity). Then we get to negotiate about what it's worth to extend that date of death forward 1, 2 .. N days for $N . Next we look to that "scorecard" (bank account) which is the value provided but not called upon and get to see if we can call in enough "favors" to afford the healthcare
  • bigtunacan 7y ago
    Then imagine there is a government aid program to help those people. For the sake of argument we'll use the term "food stamps".
  • adrianN 7y ago
    As I see it, there are two solutions. Either all medical costs are "free" for the consumer and paid for via a tax, or you have a proper insurance system where consumers participate in a transparent market for non-urgent medical care and buy insurance only for things they can't afford. The latter needs some extra regulations for emergency care where you can't compare prices.
• Apes 7y ago
  Consumers using grocery insurance would have no real say or insensitive in what groceries they get - it doesn't matter if all they need is some chicken and a cheap wine. All the grocery store sells are filet mignon and Dom Perignon, and that's what everyone gets.
  • souprock 7y ago
    With healthcare, it goes the other way too. When my kid gets a deep gash, disfiguring an eyebrow or messing with an important finger, I'd be willing to pay extra for a surgeon to sit there with a microscope putting all the little capillaries and nerves back together. I'm offered a staple, or some glue, or maybe a couple stitches. No, I really don't like zig-zag eyebrows and stiff numb fingers. Anybody know how to get the good treatment?
• doctorpangloss 7y ago
  This isn’t a very good analogy. In a just world, nobody would go hungry, nor would anyone die prematurely or suffer needlessly due to lack of care. We can obviously afford both, in this country, just like they can everywhere else in Europe or Canada. So this entire argument about insurance is a straw man. It’s not the doctors who set up this world. It’s people who want to pay less taxes, but blame doctors.
  • throwawaytoday5 7y ago
    Why shouldn't doctors and the medical industry take the blame in the US? They artificially limit the supply of Doctors in the US and have the audacity to claim that building more medical schools will ruin their already lucrative careers. The whole industry is a shame.
    • deleted 7y ago
      [deleted]
  • nine_k 7y ago
    Regarding Europe, which I happen to have friends all over: it's not exactly as rosy. European countries do have more doctors per capita, which is good. They don't have nearly as much resources in the system, though. Come to a doctor with a bad cough, get a prescription for Paracetamol. You got to have a pretty bad infection to get a prescription for an antibiotic. Endure a long discussion with a doctor to renew an antidepressant prescription made in another country. Lines are pretty long, too. Wait for two weeks to get an appointment about your coughing and sneezing. Have a deteriorating chronic condition and be prescribed painkillers and be told to wait for a year. You're not yet feeling so bad as the people who are currently being treated and who take up the capacity; these people also waited a long time. All are examples from my friends dealing with the health systems of Netherlands, Sweden, Germany. The US system has a ton of issues, but I still take it over these European systems. Have I been floored by medical bills? Yes, from my dentist, from my wife's heart surgery. But I somehow managed — and we both received instant, high-quality help. Even the Russian system is better, or used to be back in the day. You could buy local insurance, and the choice was reasonably wide. You could pay upfront in cash, and the sums were manageable — Moscow definitely not being a cheap city, more expensive than many EU capitals. Of course, I'm talking from a perspective of a well-earning software engineer who lives in metropolises, not in countryside. Still I think that either system has downsides, and the European systems are not superior, but just suck differently.
• throwaway66920 7y ago
  This is a good analogy because it highlights the important problem. Insurance companies are incentivized to have healthcare prices increase so long as they get a discount. Why? Because it increase their value to the consumer to the point of necessity.
  • xivzgrev 7y ago
    Also they are only allowed to make a certain profit margin: cost plus. One way to grow your profits is for the underlying cost to increase. "The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That's good in theory, but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here's how: Let's say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more." https://www.npr.org/sections/health-shots/2018/05/25/613685732/why-your-health-insurer-doesnt-care-about-your-big-bills https://www.npr.org/sections/health-shots/2018/05/25/6136857...
• closeparen 7y ago
  From the consumer perspective, calorie needs are stable and predictable, fundamentally different from what insurance is for. From the supply chain’s perspective, there is a very sophisticated insurance system to smooth out issues with crop yields, weather, etc. called the commodity futures market.
  • zwkrt 7y ago
    Both of your points are true of healthcare. No, not everyone will break a leg or need major surgery, but everyone gets old and dies. Flu shots come out at the same time as pumpkin spice lattes. From an aggregate standpoint I would wager healthcare needs and costs are predictable and forecastable, just like commodities.
• nextstep 7y ago
  This would be great if health choices were being made by rational consumers. But when I break my leg, I want services quickly and I don’t have time or energy to price compare ambulances. Healthcare is not a marketplace that will have compassionate outcomes if we allow deregulation.
  • mosselman 7y ago
    Yes, because in countries where health care prices are 3-100x lower it is total anarchy. People lie on the streets for hours, browsing price comparison websites while bleeding out.
    • baq 7y ago
      in most countries you don't get billed your quarterly wage when an ambulance picks you up for a 10 min drive to the hospital.
• kmjg88nvf8 7y ago
  Can you explain to a Non-American what forces this system of employer insurance onto the US? Why don't independent insurance companies emerge that offer other models of insurance?
  • watertom 7y ago
    Big business likes the level of control. Employees are limited in their job mobility, especially to small companies. It restricts competition, it also suppressed wages. Big business in the U.S. gets what it wants, and if they didn’t want employer provided healthcare it would be gone, but it’s not gone so it means they like it. If there was universal healthcare in the U.S. there would be an explosion of small business. Most small business can’t afford to provide healthcare, and if you have an existing health condition there is no guarantee that the plan from your new employer, if they have a plan, will include your doctor, or that they agree with the old doctor’s treatment plan.
    • kmjg88nvf8 7y ago
      How can "big business" prevent alternative insurance companies?
      • kelnos 7y ago
        Lobbying for preferred tax treatment. If insurance costs $500/mo, either your company can pay the premium for you directly, with no taxable event for you; or, they can give you $500 more as a part of your salary, but the government will take $150 of that (or whatever, depending on your tax bracket), and then you have $350 to cover a $500 expense. Individuals can deduct medical/insurance payments on their taxes every year, but: 1) the rules are complicated with some payment minimums that mean a lot of people couldn't take the deduction at all, and 2) you have to come up with the extra $150 every month for 12 months before you get that money back (since the US tax system is pay-as-you-go with per-paycheck withholding), which is a real burden for many Americans. Alternatively, your company can give you $715 per month, the government will take $215 of that in taxes, and then you have $500 left over to pay your $500 insurance bill, but: 1) your company would very much rather pay $500 instead of give you $715, and 2) that $715 is actually not a hard number, but will vary depending on each employee's personal tax situation, which can change throughout the year, and your company likely doesn't care to deal with that (this is less of a big deal, since it could be outsourced to a piece of software written by a payroll company). Why do Americans put up with this? Many of them (most?) just don't understand how this all works, and so don't even know they're getting screwed. Many have no concept of systems in other countries that handle this better, in part because they don't travel and don't have friends or family abroad, but more because of concerted misinformation campaigns around any kind of changes to our health care system that would threaten the incumbents. I guess big business doesn't "prevent" alternative insurance companies; there are plenty of available options for insurance that individuals can purchase on their own. But it generally costs more (because you're not an HR benefits person negotiating on behalf of your 500-, 1000-, 50000-person company), and you end up with the bad tax consequences described above. If you're an enterprising individual who wants to set up an alternative insurance company that charges very low premiums for great plans, you run into the problem of having no negotiating power with health care providers, who are used to charging high prices because the traditional insurers will pay them.
• BrainInAJar 7y ago
  > but that it would have to be much _more_ like grocery stores to call it a free market. Except not really. If I'm poor I can choose to eat nothing but ramen. I might not like it, it might not be the best for me, but it'll keep me alive. If I'm poor and have a heart attack I can't choose to just take tylenol, I do need that bypass surgery. The ability to walk away from a transaction entirely is what makes the market free, and because health care is life or death there is simply no way to make it a free market, you are compelled by your life to make (many? most?) of the transactions.
  • kelnos 7y ago
    I don't think that's a great analogy. There are plenty of medical conditions where there are several options for how to manage it. With insurance, people usually choose based on risk of failure or complications, recovery time, etc. Without insurance, someone might choose primarily based on price, and a poor person might go for the cheapest option. For some non-life-threatening issues, a poor person might refuse treatment if the cost for even the most minimal intervention is too high. This is obviously not what we want -- ideally, we want some reasonably-high minimum level of care so people don't have to choose between, say, starvation and permanent disfigurement -- so, as the parent says, we don't want health care to be exactly like a grocery store, but this kind of thing would be more like a free market for health care. (And even in your example, you still have to buy and eat that ramen. Sure, you don't have to pay for steak, but you have to buy something. You can't just walk away from the transaction entirely.)
    • mattkrause 7y ago
      Have you ever actually tried to do this? It is hard. A family friend, a smart guy with excellent insurance, was recently diagnosed with Parkinson’s Disease. Since I’m a neuroscience researcher, he asked me for advice. Despite working in an immediately adjacent field, at a Parkinson’s Centre of Excellence, with access to experts and tons of relevant training and literature, I found it very difficult to make a recommendation, even between the options his doctors had already laid out. I can only imagine how hard this would be if I had to consider the price of these treatments too.