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We Need to Design Health Care Reform That Puts Patients Before Profits

85 points by howard941 7y ago

claudeganon 7y ago
> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care, our health care system can directly benefit the well-being of low- and middle-income people—not just the holders of for-profit hospital stock. No, we need to get rid of private insurance with Medicare for All. The amount of money, corruption, and lobbying insurance companies engage in is staggering, especially given that their whole profit model is designed around limiting or denying access to healthcare. Denying access to treatment for the disabled, the chronically ill, and others, often unto their deaths or bankruptcy. In a more civilized country, corporations that have behaved like US insurance companies have would have been done away with along time ago.
- kapuasuite 7y ago
  Other countries, yes even in Europe, have better healthcare than us with multi-payer systems. Medicare for All is a joke.
  - ska 7y ago
    Other countries have better healthcare with single payer systems also.
    - tptacek 7y ago
      Doesn't that strongly suggest that the structure of the payer side is not as outcome-determinative as advocates (for M4A, or for conservative reforms like across-state-lines insurance) make it out to be? What if payer structure really is a sideshow? What if we can make single payer work, or make private insurance work, but doing either job perfectly doesn't make care affordable in the US?
  - bduerst 7y ago
    Medicare for all doesn't eliminate other payers, and is more similar to the European system than what we have now.
    - dragonwriter 7y ago
      > Medicare for all doesn't eliminate other payers The Sanders bill does eliminate most other payers (except for the VA). Other candidates with plans (or vague descriptions of plans) borrowing the name sometimes do, and sometimes do not, and sometimes are not entirely clear (or consistent over time) as to which category they fall into.
    - rayiner 7y ago
      There is no "European system." Many European countries don't have a single payer, or even a "public option." The Netherlands has something quite close to ACA, for example. Germany has non-profit, but numerous, insurance companies.
- dsfyu404ed 7y ago
  >No, we need to get rid of private insurance Insurance works well for rare events. Using insurance for an annual physical (or any other routine thing) is just pissing money away. Cutting insurance out of routine and preventative care will require far less political capital and should have a massive impact on costs. No need to go all the way to eliminating private insurance. A government option would have benefits but there's no reason private insurance can't exist also.
  - claudeganon 7y ago
    It’s possible that there could be some boutique secondary private insurance market, like what compliments the NHS in the UK, although I think given the vast, predatory behavior of US health insurance companies, it’s better that they’re just done away with. It’s not as if they haven’t show themselves to be bad actors, preying on the vulnerable as much as is legally possible, time and time again. Costs and the barrier to care they impose are primary problem in the US. Mixed systems perform far worse at controlling them (look at the history of South Africa’s transition to a mixed system as an example). Given how far things have gone with costs in the US, I don’t see how a “public option” would resolve them, short of the kind of literal government price setting as is done in Japan, in which case, a single payer system is more efficient anyway.
  - headcanon 7y ago
    Seems like a reasonable ask. Gov't pays for preventative care like physicals, flu shots, and STI testing (sort of already happening on the last bit through Planned Parenthood), insurance takes care of traumatic events. Seems to me though the greatest cost in healthcare, and thus causing the greatest amount of contention, are chronic ailments that can't really be classified as preventative or traumatic, and require constant doctor visits to treat. Care for the elderly is a similar story since they make up most doctor visits and are the biggest consumers of medications overall.
    - balls187 7y ago
      What if we pay for affordable preventative care, and the government covers the cost of traumatic events?
- refurb 7y ago
  Umm.. a good part of Medicare is run by private insurers. Medicare Part C and D. Are you saying get rid of those too?
  - claudeganon 7y ago
    Yes. Medicare for All is different from Medicare and gets rid of the hollowing out of traditional Medicare services through these side channel attacks on it. https://www.congress.gov/bill/116th-congress/house-bill/1384 https://www.congress.gov/bill/116th-congress/house-bill/1384
    - refurb 7y ago
      Part D leverages the competitive nature of private, for profit markets. As a result, costs for Part D have been much lower than projected.its a very successful program.
  - bduerst 7y ago
    And why do you think that is? Part C and D have privatized options because it offers gap coverage from Part A and B, so yes, privatized Part C and D would disappear if the gaps are closed.
    - refurb 7y ago
      Coverage gaps? Medicare Part C is just another option to get coverage. So you'd take that option away? And Medicare Part D is prescription drug coverage. You'd take that away?
    - tptacek 7y ago
      At the point where you're saying we simply "close the gaps" in existing Medicare, you're really not talking about Medicare anymore; you're just using it as a synonym for a hypothetical US NHS. That's fine, but you should be up front about it if you do; you're not just expanding Medicare to new customers, but building a fundamentally new system and giving it the old Medicare name.
- balls187 7y ago
  We do need Health Care reform, but I'm not convinced single payer government is going to lead to better outcomes. > No, we need to get rid of private insurance with Medicare for All. That would shift the incentivization from maximizing profits, to instead solely minimizing tax payer dollars. Lobbying would still exist (see defense industry). Denying care wouldn't be based on health reasons (dubious), but shift to class based reasons (see welfare). And, our healthcare will instead be subject to the whims of the politics, rather than the profits for Shareholders. Medicare works because it's beneficiaries are a strong voting block. There are population segments in America who aren't.
  - claudeganon 7y ago
    >And, our healthcare will instead be subject to the whims of the politics, rather than the profits for Shareholders. Medicare works because it's beneficiaries are a strong voting block. There are population segments in America who aren't. The point of Medicare for All is also to instantiate this new voting block across as much of the population as possible, to imbue them with this political power and free them from control by their employers and the profit-seeking of healthcare companies. You have the causation backwards: government provided healthcare among the elderly is what has created their defense of the system. Medicare for All extends the possibility of this defense to everyone.
  - creaghpatr 7y ago
    Medicare works because it is subsidized by private insurance payers. The system in its current form would collapse instantly if every American became covered exclusively by Medicare.
    - balls187 7y ago
      Also subsidized by current tax payers.
- deleted 7y ago
  [deleted]
- AimForTheBushes 7y ago
  I disagree with this. While it may be sometimes true, it is certainly a good thing that there are checks and balances to treatment. Otherwise providers of care are able to get a blank check. That is part of the problem now- say a physical therapist prescribes 5 sessions a week @ $300 per session but in reality the patient only needs 2 sessions a week. Insurance companies provide a checks/balance system with the ability for care providers to fight back when insurance companies deny care.
wildchild 7y ago
You need to design new country.
helpPeople 7y ago
Until Americans find Physicians (and Pharmacists) as the enemy, it will never happen. They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices. Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)
- peterhadlaw 7y ago
  So you mean ... the government that enables such licensing, monopolistic behavior, and moat building?
  - wuliwong 7y ago
    Bingo. But we will still see more regulation implemented to attempt to resolve this.
- lotsofpulp 7y ago
  I don’t know any pharmacist making $200k, and their pay is getting crushed right now due to tons of supply since there is no limit on the number of new pharmacists. Anyone currently pursuing pharmacy is in a poor ROI situation, especially if they’re paying for school. Their pay is in now way comparable to doctors, who have a structural advantage due to the limited number of new doctors each year.
- jostmey 7y ago
  I think you're stumbling on a root cause of America's healthcare crisis. I think most American's don't understand just how much physicians make--and where did you get those figures because clinicians I know make a good deal more than 200-300k
  - snowwrestler 7y ago
    It's an uncomfortable subject because the vast majority of front-line medical professionals like doctors, specialists, surgeons, nurses etc. are doing that job with passion and honesty to help people. But it's also true, and I think well-known at least in a vague sense, that one can make a pretty good living in the medical field. For-profit insurance companies come in for the most hate since they are in the position to deny care. But their profit margins are not sky-high. Whether or not one believes that private health insurance is a terrible idea, the facts are pretty clear that there is a lot more to the high cost of U.S. healthcare than just private insurance. There is a lot of cost everywhere in the medical system... that's the other side of those professionals making a good living. I'm not going to pretend I have a good answer to this.
Zelphyr 7y ago
I know a medical provider who works for a small family medicine practice recently purchased by a large hospital group in our area. They're being told, "You guys need to be sending more people to our hospitals." So for these organizations, patients who are sick and suffering are seen as a product. A day of reckoning is coming for these organizations because the sick and suffering are getting fed up with being treated like a product.
- soup10 7y ago
  Not holding my breath on that one. The current health care system is institutionalized and is going resist reform every step of the way.
  - AnIdiotOnTheNet 7y ago
    I get the sense that "reckoning" in this case will be a little more "exciting" than reform.
- aaavl2821 7y ago
  Large hospitals systems have been forming regional monopolies for the last few decades. First they would buy other hospitals to increase negotiating leverage with insurers, then they started buying outpatient clinics to control patient flow. They can also increase the amount they charge at outpatient clinics once the larger hospital system buys them. Hospital spend represents 30% of US healthcare spend, and physician spend represents 20%. Physician employment by hospitals is at an all-time high. Busting local healthcare monopolies would do a ton to lower healthcare costs Unfortunately that is difficult. The hospital lobby spends about as much as the pharma lobby. But the hospital industry has much more "soft" political power. Hospitals are one of the biggest employers in almost every county. So for a politician to fight hospitals would mean fighting their largest employers. Hopefully more people become aware of this behavior by hospitals. You dont read much about it in the media. I'd imagine this has is because no one is incentivized to call out this behavior by hospitals
  - creaghpatr 7y ago
gnopgnip 7y ago
> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care, our health care system can directly benefit the well-being of low- and middle-income people—not just the holders of for-profit hospital stock. We have this already to an extent with managed care. The old system of fee for service incentivizes healthcare providers to treat the symptom and not the root cause. As of 2016 over 80% of Medicaid and Medicare patients patients are on a form of managed care plan instead of a fee for service. And Medicaid and Medicare are responsible for about 40% of Americans. Additionally there are systems like Kaiser that have similar incentives in the private market.
- Frost1x 7y ago
  There are still plenty of abuses in managed care plans that I've seen (I'm closely related to several healthcare professionals working in home healthcare and in/outpatient service providers). For example, often times, healthcare professionals are encouraged/pressured to report improvements during the managed care plan at ambiguous levels (lie) to continue regimes to the allowable extent before they're discharged. Those patients are frequently then readmitted for the same or other health problems after new hospital visits. Healthcare providers are often pressured to not report their judgement tells them a specific treatment program won't help a patient much in their professional opinion. Ultimately, the incentive for continued treatment to maximize profit is still there, the approaches just change/adapt to fit within new rule systems. It's really down to individual healthcare professionals to resist continual unethical business pressures concerned with profit over patient outcome which can put their employment/livelihood at risk if they don't have their own practice. This happens in large and small healthcare providers from my sample pool of 3 huge national providers, 3 local/regional hospitals, and several in home healthcare from varied business size. The only leverage healthcare professionals have is that they're in such high demand and under supplied that they can often resist these pressures. If that changes, their hours are often reduced or they're replaced by people with more ethical flexibility. So we (our society) still don't care about patient outcomes. We can pretend we do and often the healthcare professional working directly with you probably does care about your outcomes (most people aren't sociopaths) but they may have to frequently weight milking you and your insurance provider against their livelihoods which shouldn't be the case (healthcare will always have continual demand, pretty much guaranteed business).
4ntonius8lock 7y ago
I'm really not sure why this isn't mentioned: USA should commission a study of health care systems in other countries. Include costs, challenges, issues of bringing it to scale in US, etc. Then we can implement something based on real world experience and data. It seems that these highly complex topics are dealt at the ideological level only. Which is absurd, as details can make anything from any ideology horrible. It makes me think of times when other common sense issues that should be data driven were treated in such a way. In the end, the curvature of the world is really independent of any ideological constructs that were created, but the ideological constructs made discussing the data virtually impossible at the time.
- aaavl2821 7y ago
  There is plenty of data on this available. It isn't perfect but it's there. The problem isn't lack of data, its lack of awareness of the data. Most people learn about the healthcare system by reading newspapers and other media, and from what I've seen coverage of healthcare in most US media is very political and seldom data-driven Check out here to start, there are plenty of other resources: https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm
  - 4ntonius8lock 7y ago
    Raw data there is. I'm talking about a report that says: After analyzing the health care systems of X, Y and Z countries, a commission suggest A, B and C changes to the US healthcare system. A major commission organized and created by an organization that has proven capable of developing long term, large scale plans for the greater good of the country (think the army corp of engineers, but it doesn't have to be them, just something that is as objective as possible) I'm also a bit surprised that the ideological bend is so strong, even on 'hacker' news, that net-net I'm getting down-voted on a what I think is essentially a call to look at data and create cohesive reporting to guide public policy. Maybe there is such a study. I'd be glad to know about it.
    - aaavl2821 7y ago
breck 7y ago
One of the key steps that needs to happen is to ditch Intellectual Monopoly laws. If you have a system that provides 100x+ the financial incentive to sell patented drugs, regardless of efficacy, then you will have many more people out hawking harmful drugs than the boring mainstream alternatives. See Purdue for a great case study on this. Anyone who talks about "drug development cost is expensive" yadada has no clue what they are talking about. The only reason it's expensive is because people are on a fishing expedition for novelties that have at least some contrived way of demonstrating efficacy (you only need to hoodwink the public with your drug long enough for you and your reps(dealers?) to make short run monopoly profits). In the age of big pharma Americans have gotten less healthy. Time for Intellectual Monopoly laws to go.
rayiner 7y ago
The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Pharmas-Profits https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar.... Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided. Many countries with costs much lower than ours have for-profit hospitals, pharmaceutical companies, etc. Public operation of the health system would surely eliminate the profit, but why do we have reason to believe it will reduce the other $3.3 billion? We can point to European countries that have much lower costs overall, but those countries seem to provide many public services at much lower cost than we do (education, transit, etc.). Canada's government expenditures (excluding defense for both countries), is somehow slightly lower than the U.S., even though Canada offers universal healthcare. The public rhetoric frustrates me as someone who favors universal healthcare. Demonizing corporations and rich people is red meat for partisans, but it’s not a solution. How do we pay for this system? How do we cut costs? Making healthcare into a public service in the US risks turning into the same thing we have with education, transit, and infrastructure. We spend tons of money, often more than European countries, and get very little in return. And the only solutions folks offer are to dismantle the public system (on the right), or to demand even more funding (on the left).
- abrichr 7y ago
  In 2017 (from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...):  Hospital Care (33 percent share)  Physician and Clinical Services (20 percent share)  Retail Prescription Drugs (10 percent share)  Other Health, Residential, and Personal Care Services (5 percent share)  Nursing Care Facilities and Continuing Care Retirement Communities (5 percent share)  Dental Services (4 percent share)  Home Health Care (3 percent share)  Other Professional Services (3 percent share)  Other Non-durable Medical Products (2 percent share)  Durable Medical Equipment (2 percent share)
- megiddo 7y ago
cmsonger 7y ago
It maybe is obvious, or maybe it's controversial, but patients will never be put before profits by for profit corporations.
- claudeganon 7y ago
  Agreed, which is why for profit companies should be kept as far away from healthcare as possible.
  - thaumasiotes 7y ago
    How does this distinguish healthcare from anything else?
  - mikem170 7y ago
    Are you taking into account that health care is being delivered in most western European countries by for-profit doctors, clinics and hospitals? (the UK being the big exception) Also the U.K. is not one of the better systems out there. I'd rather have the French system (minimal public + private mix), Sweden (minimal federal mandated controlled by their provinces), or German (similar to Obama-care). I don't hear any U.S. politicians who are really talking about reforming health care. How about tort reform? Patents? Cost transparency? No, all anyone talks about is how the federal government should get more involved, and everyone knows that lobbyist run the federal government, i.e. remember how the people representatives in congress didn't even have time to read the ACA?
- tptacek 7y ago
  Is it obvious? I went to a fancy Japanese dinner last night. It was, obviously, a for-profit venture. At any point during that dinner, was anyone in the restaurant worried about the restaurant putting its "profits" above its patrons?
  - thaumasiotes 7y ago
    They weren't worried about it, but it was happening anyway.
bashallah 7y ago
Like Japan, reward doctors when they _cure_ patients.
- AimForTheBushes 7y ago
  I don't like this because they may unknowingly introduce a biased form of triage.
  - bashallah 7y ago
    Don’t let the providing doctor triage. They should be providing care anyways. Nurses triage.
kryogen1c 7y ago
<yowling about free markets and capitalism> the profit motive is what has driven healthcare to what is possible today. if there is an uncoupling of health outcomes and profit motive, the solution is not to delete the profit motive! the government needs to enact only the necessary and sufficient regulation to realign making money with the desired results. avoid regulatory capture, make the information transparent and available. i dont understand this demonization of capitalism. the world involved in (and adjacent to) capitalism is, by almost _every.single.measure_, vastly better than even as recently as 50 years ago. communist china sure didnt do that. its capable of corruption! lets fix that corruption and not throw the baby out with the bathwater public schools and subsidized, inflated, university tuition are examples of roads we dont want to travel down.
Merrill 7y ago
This can be done by converting "for profit" corporations into "not for profit" corporations and having them finance investments with debt instead of equity.
- dgzl 7y ago
  And what about the rights of the stakeholders of those for-profit corporations?
  - TheOtherHobbes 7y ago
    What about the right of patients not to be bankrupted by a service they have been paying into for their entire working lives? Stakeholders don't get a magic pass on this. The polite view is that they're profiting from suffering. The less polite view is that the entire industry is a toxic, possibly even criminal, cartel, and needs to be split up and defanged in the same way that other toxic industries - tobacco, opioids - have been defanged.
  - zentiggr 7y ago
    If those stakeholders are sponsoring the cash grab mentality that has the health industry so messed up right now, then screw em. Sell off every private company involved and legally mandate that they can only sell to non-profit entities, and let every shareholder that's gouging everyone else scream or cry or whine however they want. The more noise they make, the more harm you know they were causing. Sick and tired of greed making all these layers of corporate corruption, market lockup, government process tailoring, and outright deception the status quo.
  - Merrill 7y ago
    We could do a debt for equity swap. Set up a Government Sponsored Entity like Fannie Mae to issue bonds equivalent to the market value of the equity. Essentially a government sponsored leveraged buyout.
chiefalchemist 7y ago
More than that, we need to design a system that puts general health/wellness before health care. That is, we need to live a more healthy and have a prevention mindset. If we prevent the preventable those resources can be used for the unpreventable. But if overall demand drops, so will price/cost.
dudul 7y ago
Honestly, I'm not gonna read this thing. This is just the usual weekly "health care is fucked" HN post. They always say the same thing, they always show the same data, rarely suggest any real path forward (one that works in the context of lobbies, corruption, for-profit institutions, etc). In my book (and I'm not an expert even though I've worked in the benefits industry), 2 things are completely fucked up in this domain: 1) insurance being tied to your employer, 2) not being able to know the cost of a procedure before hand. Fix that, and you're done.
tptacek 7y ago
The problem with US health care is that it costs too much. The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. However we structure payment, we're still going to have overprescription of outpatient procedures, a shortage of doctors who as a result make drastically more than their counterparts in Europe, bed vacancies in inefficiently provisioned hospitals, diagnostic procedures that vary wildly between providers just a few miles from each other, and a total lack of price transparency to enable consumers (and their doctors) to collaborate and make decisions about care. There's not much evidence that our government-run health programs (Medicare in particular) is up to the task of solving these problems; Medicare has a central role in how the current health care system is organized, and some of these problems stem directly from decisions made by Medicare.
- TaylorAlexander 7y ago
  There’s always room for critique, but millions of Americans need something to change. How can we get coverage to the poorest people effectively?
  - tptacek 7y ago
    I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.
    - TaylorAlexander 7y ago
      Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!
disabled 7y ago
As an American with 2 rare immune-mediated neurological diseases, that affect my peripheral nervous system, I can almost guarantee you that decent health care reform will not happen in the foreseeable future. By the way, both of these diseases are in pharmaceutical remission, due to taking a blood product that has immunomodulatory properties. I will have to take it for life. My medical insurance literally pays hundreds of thousands of dollars per year, under contract, for it. The Affordable Care Act is practically guaranteed to be either partially or completely overturned next year (Summer 2020), based on previous rare cases in modern history where the Solicitor General did not defend a case at the Supreme Court. My whole life is literally riding on whatever the Supreme Court churns out next year, due to the complexity of my care. In the case of a partial or complete overturn, I will most likely have to leave the US. But, I am fortunate to be an EU citizen. I have been making plans for leaving the US for a couple of years now. The matter is extremely complicated with my health care needs, and I literally cannot afford to make a mistake. Frankly, I do not feel welcome anymore in my homeland (the United States) either.
- Scoundreller 7y ago
  Do be sure to check that any new country will pay for the same thing. Single-payer/socialized healthcare can mean “Just Saying No” to expensive interventions.
  - disabled 7y ago
    Yes, and this is one of the main issues. Overall it is a logistical disaster. But, I have to say that engineering school helps you tackle logistical nightmares like this.
legitster 7y ago
I have a non-profit healthcare plan and go to a non-profit hospital. It costs the same. This completely misses the issue.
OliverJones 7y ago
The situation is slightly more complex than this article recognizes. 1. When a hospital, either for-profit or not-for-profit, must provide free care to a patient, it comes out of their hide. Enough of this free care can force the hospital to demand higher rates. See https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm Medicare and Medicaid foots part of the free care bill. And, yes, patients who turn up at emergency departments get some free care. It makes the news when a hospital kicks patients to the curb because they can't pay. 2. Enough free care can bankrupt a hospital or force it to close. In under-served areas (rural) this is, umm, not good for the community served by the hospital. 3. Corporations -- hey fellow HN readers, our employers -- must offer private health insurance. This is a HUGE pain in the neck for executives (some HN readers, that's you and me). They have to scare up health plans their companies and employees can afford, so they must waste their time doing that instead of, I dunno, designing products or calling on prospective customers. Sure, we get entrepreneurs trying to help with this. Zenefits. Need I say more? It's time-wasting madness. 4. Corporations must pay insane amounts of money for health plans for their people. And it's compound insanity. That's like compound interest, but worse. 5. Employees (that's you and me, HN readers) have to waste our time and spend our money on our part of health insurance costs. 6. "Medicare for all" invokes a health-care payment system that's proven to work at scale, and is reasonably accountable to all its stakeholders. (Except for part D / drugs / the subject of another rant for another day.) My point: in the long run, being business-centric is the SAME THING as being patient-centric. In this area, Mitt Romney was right: "corporations are people." I am baffled by politicians' complaints that some kind of government option for paying for health care is bad because it will raise taxes. Don't they know what we know? Paying for health care is already a massive tax on both employers and employees. It's just hidden by a shell game. It's not actually a tax, it's a tax deduction. If you believe this, maybe I can rent you a some space in the huge dirigible hangar at Moffett Field. Cheap. Send me your bitcoin. Can you imagine how much more successful a YC company might be if they didn't have to sweat this health-insurance stuff? Can you imagine how much more successful GM and Tesla would be if they knew their workers' health care was covered? How come captains of industry and bigshot VCs aren't demanding better? Yeah, some companies will suffer when this changes. But almost all companies suffer now.
zarro 7y ago
Contrarian viewpoint: NOT focusing on the profits is the cause of the problem. Hypothesis: Prices are high because of inefficiencies in the markets caused by bad laws attempting to subsidize one class of people by another. Hospitals aren't able to refuse treatment by law to those that can't afford to pay for their services and insurance companies are coerced to insure unprofitable people by law and the net effect is to try and coerce people into a redistribution of money from people that require more care from those that require less care to cover these expenditures. Because there is no mechanism to coerce people to do this willingly that's efficient enough for the increasing demands of those requiring care, both industries to give the invoices to the government (who created the problem) thereby getting rid of the requirement to think about how they will fund their expenditures - making it the governments problem to figure out. This thereby allows them to continue uncontrolled expenditure resulting in exuberant prices in an ever increasing downward spiral to catastrophe as in effect they are spending 'other peoples money' in the hopes that "eventually these invoices will be paid" through some sort of government sponsored coercion mechanism forcing socialized heath care or some other such method with the same result. Its really quite simple and clever and funny how it still works. -5% of the population accounts for more than half of all health spending. -50% of the population with the lowest spending accounts for only 3% of all total health spending. Edit: Anytime I share this viewpoint, a bunch of either misguided or prejudiced people downvote me. I'm guessing its because they don't understand the argument completely, or see its logic, but disagree with its implications.
pimmen 7y ago
I don’t understand the American obsession with designing new systems yourselves when there’s already plenty of alternatives out there that have been tried and true for generations. Health care that’s affordable, offers longer life expectancy, costs less as a percentage of GDP and available to even the poorest citizens have already been implemented in countries across the globe, in Europe and East Asia in particular but also in Canada and Australia. Why is it that if a US politician says ”our system is bad, the system from France/Germany/UK/Sweden/Japan is beating us in almost every metric, let’s switch” is met with boos but someone who says ”I have an completely untested idea that’s our old system with some quirks that looks like it was designed by a committee without a vision, let’s try it” is met with cheers?
deleted 7y ago
[deleted]
alexandernst 7y ago
You don’t need to design anything because that already exists in Europe. It’s called public health care.

85 points by howard941 7y ago

> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care, our health care system can directly benefit the well-being of low- and middle-income people—not just the holders of for-profit hospital stock. No, we need to get rid of private insurance with Medicare for All. The amount of money, corruption, and lobbying insurance companies engage in is staggering, especially given that their whole profit model is designed around limiting or denying access to healthcare. Denying access to treatment for the disabled, the chronically ill, and others, often unto their deaths or bankruptcy. In a more civilized country, corporations that have behaved like US insurance companies have would have been done away with along time ago.

kapuasuite 7y ago
Other countries, yes even in Europe, have better healthcare than us with multi-payer systems. Medicare for All is a joke.
- ska 7y ago
  Other countries have better healthcare with single payer systems also.
  - tptacek 7y ago
    Doesn't that strongly suggest that the structure of the payer side is not as outcome-determinative as advocates (for M4A, or for conservative reforms like across-state-lines insurance) make it out to be? What if payer structure really is a sideshow? What if we can make single payer work, or make private insurance work, but doing either job perfectly doesn't make care affordable in the US?
- bduerst 7y ago
  Medicare for all doesn't eliminate other payers, and is more similar to the European system than what we have now.
  - dragonwriter 7y ago
    > Medicare for all doesn't eliminate other payers The Sanders bill does eliminate most other payers (except for the VA). Other candidates with plans (or vague descriptions of plans) borrowing the name sometimes do, and sometimes do not, and sometimes are not entirely clear (or consistent over time) as to which category they fall into.
  - rayiner 7y ago
    There is no "European system." Many European countries don't have a single payer, or even a "public option." The Netherlands has something quite close to ACA, for example. Germany has non-profit, but numerous, insurance companies.
dsfyu404ed 7y ago
>No, we need to get rid of private insurance Insurance works well for rare events. Using insurance for an annual physical (or any other routine thing) is just pissing money away. Cutting insurance out of routine and preventative care will require far less political capital and should have a massive impact on costs. No need to go all the way to eliminating private insurance. A government option would have benefits but there's no reason private insurance can't exist also.
- claudeganon 7y ago
  It’s possible that there could be some boutique secondary private insurance market, like what compliments the NHS in the UK, although I think given the vast, predatory behavior of US health insurance companies, it’s better that they’re just done away with. It’s not as if they haven’t show themselves to be bad actors, preying on the vulnerable as much as is legally possible, time and time again. Costs and the barrier to care they impose are primary problem in the US. Mixed systems perform far worse at controlling them (look at the history of South Africa’s transition to a mixed system as an example). Given how far things have gone with costs in the US, I don’t see how a “public option” would resolve them, short of the kind of literal government price setting as is done in Japan, in which case, a single payer system is more efficient anyway.
- headcanon 7y ago
  Seems like a reasonable ask. Gov't pays for preventative care like physicals, flu shots, and STI testing (sort of already happening on the last bit through Planned Parenthood), insurance takes care of traumatic events. Seems to me though the greatest cost in healthcare, and thus causing the greatest amount of contention, are chronic ailments that can't really be classified as preventative or traumatic, and require constant doctor visits to treat. Care for the elderly is a similar story since they make up most doctor visits and are the biggest consumers of medications overall.
  - balls187 7y ago
    What if we pay for affordable preventative care, and the government covers the cost of traumatic events?
refurb 7y ago
Umm.. a good part of Medicare is run by private insurers. Medicare Part C and D. Are you saying get rid of those too?
- claudeganon 7y ago
  Yes. Medicare for All is different from Medicare and gets rid of the hollowing out of traditional Medicare services through these side channel attacks on it. https://www.congress.gov/bill/116th-congress/house-bill/1384 https://www.congress.gov/bill/116th-congress/house-bill/1384
  - refurb 7y ago
    Part D leverages the competitive nature of private, for profit markets. As a result, costs for Part D have been much lower than projected.its a very successful program.
- bduerst 7y ago
  And why do you think that is? Part C and D have privatized options because it offers gap coverage from Part A and B, so yes, privatized Part C and D would disappear if the gaps are closed.
  - refurb 7y ago
    Coverage gaps? Medicare Part C is just another option to get coverage. So you'd take that option away? And Medicare Part D is prescription drug coverage. You'd take that away?
  - tptacek 7y ago
    At the point where you're saying we simply "close the gaps" in existing Medicare, you're really not talking about Medicare anymore; you're just using it as a synonym for a hypothetical US NHS. That's fine, but you should be up front about it if you do; you're not just expanding Medicare to new customers, but building a fundamentally new system and giving it the old Medicare name.
balls187 7y ago
We do need Health Care reform, but I'm not convinced single payer government is going to lead to better outcomes. > No, we need to get rid of private insurance with Medicare for All. That would shift the incentivization from maximizing profits, to instead solely minimizing tax payer dollars. Lobbying would still exist (see defense industry). Denying care wouldn't be based on health reasons (dubious), but shift to class based reasons (see welfare). And, our healthcare will instead be subject to the whims of the politics, rather than the profits for Shareholders. Medicare works because it's beneficiaries are a strong voting block. There are population segments in America who aren't.
- claudeganon 7y ago
  >And, our healthcare will instead be subject to the whims of the politics, rather than the profits for Shareholders. Medicare works because it's beneficiaries are a strong voting block. There are population segments in America who aren't. The point of Medicare for All is also to instantiate this new voting block across as much of the population as possible, to imbue them with this political power and free them from control by their employers and the profit-seeking of healthcare companies. You have the causation backwards: government provided healthcare among the elderly is what has created their defense of the system. Medicare for All extends the possibility of this defense to everyone.
- creaghpatr 7y ago
  Medicare works because it is subsidized by private insurance payers. The system in its current form would collapse instantly if every American became covered exclusively by Medicare.
  - balls187 7y ago
    Also subsidized by current tax payers.
deleted 7y ago
[deleted]
AimForTheBushes 7y ago
I disagree with this. While it may be sometimes true, it is certainly a good thing that there are checks and balances to treatment. Otherwise providers of care are able to get a blank check. That is part of the problem now- say a physical therapist prescribes 5 sessions a week @ $300 per session but in reality the patient only needs 2 sessions a week. Insurance companies provide a checks/balance system with the ability for care providers to fight back when insurance companies deny care.

wildchild 7y ago

You need to design new country.

helpPeople 7y ago

Until Americans find Physicians (and Pharmacists) as the enemy, it will never happen. They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices. Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)

peterhadlaw 7y ago
So you mean ... the government that enables such licensing, monopolistic behavior, and moat building?
- wuliwong 7y ago
  Bingo. But we will still see more regulation implemented to attempt to resolve this.
lotsofpulp 7y ago
I don’t know any pharmacist making $200k, and their pay is getting crushed right now due to tons of supply since there is no limit on the number of new pharmacists. Anyone currently pursuing pharmacy is in a poor ROI situation, especially if they’re paying for school. Their pay is in now way comparable to doctors, who have a structural advantage due to the limited number of new doctors each year.
jostmey 7y ago
I think you're stumbling on a root cause of America's healthcare crisis. I think most American's don't understand just how much physicians make--and where did you get those figures because clinicians I know make a good deal more than 200-300k
- snowwrestler 7y ago
  It's an uncomfortable subject because the vast majority of front-line medical professionals like doctors, specialists, surgeons, nurses etc. are doing that job with passion and honesty to help people. But it's also true, and I think well-known at least in a vague sense, that one can make a pretty good living in the medical field. For-profit insurance companies come in for the most hate since they are in the position to deny care. But their profit margins are not sky-high. Whether or not one believes that private health insurance is a terrible idea, the facts are pretty clear that there is a lot more to the high cost of U.S. healthcare than just private insurance. There is a lot of cost everywhere in the medical system... that's the other side of those professionals making a good living. I'm not going to pretend I have a good answer to this.

Zelphyr 7y ago

I know a medical provider who works for a small family medicine practice recently purchased by a large hospital group in our area. They're being told, "You guys need to be sending more people to our hospitals." So for these organizations, patients who are sick and suffering are seen as a product. A day of reckoning is coming for these organizations because the sick and suffering are getting fed up with being treated like a product.

soup10 7y ago
Not holding my breath on that one. The current health care system is institutionalized and is going resist reform every step of the way.
- AnIdiotOnTheNet 7y ago
  I get the sense that "reckoning" in this case will be a little more "exciting" than reform.
aaavl2821 7y ago
Large hospitals systems have been forming regional monopolies for the last few decades. First they would buy other hospitals to increase negotiating leverage with insurers, then they started buying outpatient clinics to control patient flow. They can also increase the amount they charge at outpatient clinics once the larger hospital system buys them. Hospital spend represents 30% of US healthcare spend, and physician spend represents 20%. Physician employment by hospitals is at an all-time high. Busting local healthcare monopolies would do a ton to lower healthcare costs Unfortunately that is difficult. The hospital lobby spends about as much as the pharma lobby. But the hospital industry has much more "soft" political power. Hospitals are one of the biggest employers in almost every county. So for a politician to fight hospitals would mean fighting their largest employers. Hopefully more people become aware of this behavior by hospitals. You dont read much about it in the media. I'd imagine this has is because no one is incentivized to call out this behavior by hospitals
- creaghpatr 7y ago

gnopgnip 7y ago

> We can and must design the next round of insurance reforms with patients as a priority. With low deductibles that actually facilitate the consumption of care, our health care system can directly benefit the well-being of low- and middle-income people—not just the holders of for-profit hospital stock. We have this already to an extent with managed care. The old system of fee for service incentivizes healthcare providers to treat the symptom and not the root cause. As of 2016 over 80% of Medicaid and Medicare patients patients are on a form of managed care plan instead of a fee for service. And Medicaid and Medicare are responsible for about 40% of Americans. Additionally there are systems like Kaiser that have similar incentives in the private market.

Frost1x 7y ago
There are still plenty of abuses in managed care plans that I've seen (I'm closely related to several healthcare professionals working in home healthcare and in/outpatient service providers). For example, often times, healthcare professionals are encouraged/pressured to report improvements during the managed care plan at ambiguous levels (lie) to continue regimes to the allowable extent before they're discharged. Those patients are frequently then readmitted for the same or other health problems after new hospital visits. Healthcare providers are often pressured to not report their judgement tells them a specific treatment program won't help a patient much in their professional opinion. Ultimately, the incentive for continued treatment to maximize profit is still there, the approaches just change/adapt to fit within new rule systems. It's really down to individual healthcare professionals to resist continual unethical business pressures concerned with profit over patient outcome which can put their employment/livelihood at risk if they don't have their own practice. This happens in large and small healthcare providers from my sample pool of 3 huge national providers, 3 local/regional hospitals, and several in home healthcare from varied business size. The only leverage healthcare professionals have is that they're in such high demand and under supplied that they can often resist these pressures. If that changes, their hours are often reduced or they're replaced by people with more ethical flexibility. So we (our society) still don't care about patient outcomes. We can pretend we do and often the healthcare professional working directly with you probably does care about your outcomes (most people aren't sociopaths) but they may have to frequently weight milking you and your insurance provider against their livelihoods which shouldn't be the case (healthcare will always have continual demand, pretty much guaranteed business).

4ntonius8lock 7y ago

I'm really not sure why this isn't mentioned: USA should commission a study of health care systems in other countries. Include costs, challenges, issues of bringing it to scale in US, etc. Then we can implement something based on real world experience and data. It seems that these highly complex topics are dealt at the ideological level only. Which is absurd, as details can make anything from any ideology horrible. It makes me think of times when other common sense issues that should be data driven were treated in such a way. In the end, the curvature of the world is really independent of any ideological constructs that were created, but the ideological constructs made discussing the data virtually impossible at the time.

aaavl2821 7y ago
There is plenty of data on this available. It isn't perfect but it's there. The problem isn't lack of data, its lack of awareness of the data. Most people learn about the healthcare system by reading newspapers and other media, and from what I've seen coverage of healthcare in most US media is very political and seldom data-driven Check out here to start, there are plenty of other resources: https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm
- 4ntonius8lock 7y ago
  Raw data there is. I'm talking about a report that says: After analyzing the health care systems of X, Y and Z countries, a commission suggest A, B and C changes to the US healthcare system. A major commission organized and created by an organization that has proven capable of developing long term, large scale plans for the greater good of the country (think the army corp of engineers, but it doesn't have to be them, just something that is as objective as possible) I'm also a bit surprised that the ideological bend is so strong, even on 'hacker' news, that net-net I'm getting down-voted on a what I think is essentially a call to look at data and create cohesive reporting to guide public policy. Maybe there is such a study. I'd be glad to know about it.
  - aaavl2821 7y ago

breck 7y ago

One of the key steps that needs to happen is to ditch Intellectual Monopoly laws. If you have a system that provides 100x+ the financial incentive to sell patented drugs, regardless of efficacy, then you will have many more people out hawking harmful drugs than the boring mainstream alternatives. See Purdue for a great case study on this. Anyone who talks about "drug development cost is expensive" yadada has no clue what they are talking about. The only reason it's expensive is because people are on a fishing expedition for novelties that have at least some contrived way of demonstrating efficacy (you only need to hoodwink the public with your drug long enough for you and your reps(dealers?) to make short run monopoly profits). In the age of big pharma Americans have gotten less healthy. Time for Intellectual Monopoly laws to go.

rayiner 7y ago

The U.S. spends $3.5 trillion annually on healthcare. Worldwide profits for the 112 publicly traded healthcare industry companies amount to $50 billion per quarter: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Pharmas-Profits https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar.... Even if all those profits are allocated to the U.S., that's about 5.7% of healthcare spending. (And completely consistent with most other industries.) Hyper-focusing on profits is misguided. Many countries with costs much lower than ours have for-profit hospitals, pharmaceutical companies, etc. Public operation of the health system would surely eliminate the profit, but why do we have reason to believe it will reduce the other $3.3 billion? We can point to European countries that have much lower costs overall, but those countries seem to provide many public services at much lower cost than we do (education, transit, etc.). Canada's government expenditures (excluding defense for both countries), is somehow slightly lower than the U.S., even though Canada offers universal healthcare. The public rhetoric frustrates me as someone who favors universal healthcare. Demonizing corporations and rich people is red meat for partisans, but it’s not a solution. How do we pay for this system? How do we cut costs? Making healthcare into a public service in the US risks turning into the same thing we have with education, transit, and infrastructure. We spend tons of money, often more than European countries, and get very little in return. And the only solutions folks offer are to dismantle the public system (on the right), or to demand even more funding (on the left).

abrichr 7y ago
In 2017 (from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...):  Hospital Care (33 percent share)  Physician and Clinical Services (20 percent share)  Retail Prescription Drugs (10 percent share)  Other Health, Residential, and Personal Care Services (5 percent share)  Nursing Care Facilities and Continuing Care Retirement Communities (5 percent share)  Dental Services (4 percent share)  Home Health Care (3 percent share)  Other Professional Services (3 percent share)  Other Non-durable Medical Products (2 percent share)  Durable Medical Equipment (2 percent share)
megiddo 7y ago

cmsonger 7y ago

It maybe is obvious, or maybe it's controversial, but patients will never be put before profits by for profit corporations.

claudeganon 7y ago
Agreed, which is why for profit companies should be kept as far away from healthcare as possible.
- thaumasiotes 7y ago
  How does this distinguish healthcare from anything else?
- mikem170 7y ago
  Are you taking into account that health care is being delivered in most western European countries by for-profit doctors, clinics and hospitals? (the UK being the big exception) Also the U.K. is not one of the better systems out there. I'd rather have the French system (minimal public + private mix), Sweden (minimal federal mandated controlled by their provinces), or German (similar to Obama-care). I don't hear any U.S. politicians who are really talking about reforming health care. How about tort reform? Patents? Cost transparency? No, all anyone talks about is how the federal government should get more involved, and everyone knows that lobbyist run the federal government, i.e. remember how the people representatives in congress didn't even have time to read the ACA?
tptacek 7y ago
Is it obvious? I went to a fancy Japanese dinner last night. It was, obviously, a for-profit venture. At any point during that dinner, was anyone in the restaurant worried about the restaurant putting its "profits" above its patrons?
- thaumasiotes 7y ago
  They weren't worried about it, but it was happening anyway.

bashallah 7y ago

Like Japan, reward doctors when they _cure_ patients.

AimForTheBushes 7y ago
I don't like this because they may unknowingly introduce a biased form of triage.
- bashallah 7y ago
  Don’t let the providing doctor triage. They should be providing care anyways. Nurses triage.

kryogen1c 7y ago

<yowling about free markets and capitalism> the profit motive is what has driven healthcare to what is possible today. if there is an uncoupling of health outcomes and profit motive, the solution is not to delete the profit motive! the government needs to enact only the necessary and sufficient regulation to realign making money with the desired results. avoid regulatory capture, make the information transparent and available. i dont understand this demonization of capitalism. the world involved in (and adjacent to) capitalism is, by almost _every.single.measure_, vastly better than even as recently as 50 years ago. communist china sure didnt do that. its capable of corruption! lets fix that corruption and not throw the baby out with the bathwater public schools and subsidized, inflated, university tuition are examples of roads we dont want to travel down.

Merrill 7y ago

This can be done by converting "for profit" corporations into "not for profit" corporations and having them finance investments with debt instead of equity.

dgzl 7y ago
And what about the rights of the stakeholders of those for-profit corporations?
- TheOtherHobbes 7y ago
  What about the right of patients not to be bankrupted by a service they have been paying into for their entire working lives? Stakeholders don't get a magic pass on this. The polite view is that they're profiting from suffering. The less polite view is that the entire industry is a toxic, possibly even criminal, cartel, and needs to be split up and defanged in the same way that other toxic industries - tobacco, opioids - have been defanged.
- zentiggr 7y ago
  If those stakeholders are sponsoring the cash grab mentality that has the health industry so messed up right now, then screw em. Sell off every private company involved and legally mandate that they can only sell to non-profit entities, and let every shareholder that's gouging everyone else scream or cry or whine however they want. The more noise they make, the more harm you know they were causing. Sick and tired of greed making all these layers of corporate corruption, market lockup, government process tailoring, and outright deception the status quo.
- Merrill 7y ago
  We could do a debt for equity swap. Set up a Government Sponsored Entity like Fannie Mae to issue bonds equivalent to the market value of the equity. Essentially a government sponsored leveraged buyout.

chiefalchemist 7y ago

More than that, we need to design a system that puts general health/wellness before health care. That is, we need to live a more healthy and have a prevention mindset. If we prevent the preventable those resources can be used for the unpreventable. But if overall demand drops, so will price/cost.

dudul 7y ago

Honestly, I'm not gonna read this thing. This is just the usual weekly "health care is fucked" HN post. They always say the same thing, they always show the same data, rarely suggest any real path forward (one that works in the context of lobbies, corruption, for-profit institutions, etc). In my book (and I'm not an expert even though I've worked in the benefits industry), 2 things are completely fucked up in this domain: 1) insurance being tied to your employer, 2) not being able to know the cost of a procedure before hand. Fix that, and you're done.

tptacek 7y ago

The problem with US health care is that it costs too much. The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. However we structure payment, we're still going to have overprescription of outpatient procedures, a shortage of doctors who as a result make drastically more than their counterparts in Europe, bed vacancies in inefficiently provisioned hospitals, diagnostic procedures that vary wildly between providers just a few miles from each other, and a total lack of price transparency to enable consumers (and their doctors) to collaborate and make decisions about care. There's not much evidence that our government-run health programs (Medicare in particular) is up to the task of solving these problems; Medicare has a central role in how the current health care system is organized, and some of these problems stem directly from decisions made by Medicare.

TaylorAlexander 7y ago
There’s always room for critique, but millions of Americans need something to change. How can we get coverage to the poorest people effectively?
- tptacek 7y ago
  I think it's easy to misread what I wrote as saying that the current system is OK, or there aren't giant, urgent problems that need to be addressed. There are huge problems. The concern I have is that payer-side reforms are a sideshow.
  - TaylorAlexander 7y ago
    Sorry, I didn’t mean to suggest that you had taken this position. I just really want to move the conversation forward. So there are problems with Medicare, but you seem to know about this so I’m curious what you would suggest we do to provide coverage to millions of poor Americans currently going without. I’m no policy expert and I thought M4A is a great idea. Thanks!

disabled 7y ago

As an American with 2 rare immune-mediated neurological diseases, that affect my peripheral nervous system, I can almost guarantee you that decent health care reform will not happen in the foreseeable future. By the way, both of these diseases are in pharmaceutical remission, due to taking a blood product that has immunomodulatory properties. I will have to take it for life. My medical insurance literally pays hundreds of thousands of dollars per year, under contract, for it. The Affordable Care Act is practically guaranteed to be either partially or completely overturned next year (Summer 2020), based on previous rare cases in modern history where the Solicitor General did not defend a case at the Supreme Court. My whole life is literally riding on whatever the Supreme Court churns out next year, due to the complexity of my care. In the case of a partial or complete overturn, I will most likely have to leave the US. But, I am fortunate to be an EU citizen. I have been making plans for leaving the US for a couple of years now. The matter is extremely complicated with my health care needs, and I literally cannot afford to make a mistake. Frankly, I do not feel welcome anymore in my homeland (the United States) either.

Scoundreller 7y ago
Do be sure to check that any new country will pay for the same thing. Single-payer/socialized healthcare can mean “Just Saying No” to expensive interventions.
- disabled 7y ago
  Yes, and this is one of the main issues. Overall it is a logistical disaster. But, I have to say that engineering school helps you tackle logistical nightmares like this.

legitster 7y ago

I have a non-profit healthcare plan and go to a non-profit hospital. It costs the same. This completely misses the issue.

OliverJones 7y ago

The situation is slightly more complex than this article recognizes. 1. When a hospital, either for-profit or not-for-profit, must provide free care to a patient, it comes out of their hide. Enough of this free care can force the hospital to demand higher rates. See https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm https://hmsa.com/portal/provider/zav_pel.fh.DIA.650.htm Medicare and Medicaid foots part of the free care bill. And, yes, patients who turn up at emergency departments get some free care. It makes the news when a hospital kicks patients to the curb because they can't pay. 2. Enough free care can bankrupt a hospital or force it to close. In under-served areas (rural) this is, umm, not good for the community served by the hospital. 3. Corporations -- hey fellow HN readers, our employers -- must offer private health insurance. This is a HUGE pain in the neck for executives (some HN readers, that's you and me). They have to scare up health plans their companies and employees can afford, so they must waste their time doing that instead of, I dunno, designing products or calling on prospective customers. Sure, we get entrepreneurs trying to help with this. Zenefits. Need I say more? It's time-wasting madness. 4. Corporations must pay insane amounts of money for health plans for their people. And it's compound insanity. That's like compound interest, but worse. 5. Employees (that's you and me, HN readers) have to waste our time and spend our money on our part of health insurance costs. 6. "Medicare for all" invokes a health-care payment system that's proven to work at scale, and is reasonably accountable to all its stakeholders. (Except for part D / drugs / the subject of another rant for another day.) My point: in the long run, being business-centric is the SAME THING as being patient-centric. In this area, Mitt Romney was right: "corporations are people." I am baffled by politicians' complaints that some kind of government option for paying for health care is bad because it will raise taxes. Don't they know what we know? Paying for health care is already a massive tax on both employers and employees. It's just hidden by a shell game. It's not actually a tax, it's a tax deduction. If you believe this, maybe I can rent you a some space in the huge dirigible hangar at Moffett Field. Cheap. Send me your bitcoin. Can you imagine how much more successful a YC company might be if they didn't have to sweat this health-insurance stuff? Can you imagine how much more successful GM and Tesla would be if they knew their workers' health care was covered? How come captains of industry and bigshot VCs aren't demanding better? Yeah, some companies will suffer when this changes. But almost all companies suffer now.

zarro 7y ago

Contrarian viewpoint: NOT focusing on the profits is the cause of the problem. Hypothesis: Prices are high because of inefficiencies in the markets caused by bad laws attempting to subsidize one class of people by another. Hospitals aren't able to refuse treatment by law to those that can't afford to pay for their services and insurance companies are coerced to insure unprofitable people by law and the net effect is to try and coerce people into a redistribution of money from people that require more care from those that require less care to cover these expenditures. Because there is no mechanism to coerce people to do this willingly that's efficient enough for the increasing demands of those requiring care, both industries to give the invoices to the government (who created the problem) thereby getting rid of the requirement to think about how they will fund their expenditures - making it the governments problem to figure out. This thereby allows them to continue uncontrolled expenditure resulting in exuberant prices in an ever increasing downward spiral to catastrophe as in effect they are spending 'other peoples money' in the hopes that "eventually these invoices will be paid" through some sort of government sponsored coercion mechanism forcing socialized heath care or some other such method with the same result. Its really quite simple and clever and funny how it still works. -5% of the population accounts for more than half of all health spending. -50% of the population with the lowest spending accounts for only 3% of all total health spending. Edit: Anytime I share this viewpoint, a bunch of either misguided or prejudiced people downvote me. I'm guessing its because they don't understand the argument completely, or see its logic, but disagree with its implications.

pimmen 7y ago

I don’t understand the American obsession with designing new systems yourselves when there’s already plenty of alternatives out there that have been tried and true for generations. Health care that’s affordable, offers longer life expectancy, costs less as a percentage of GDP and available to even the poorest citizens have already been implemented in countries across the globe, in Europe and East Asia in particular but also in Canada and Australia. Why is it that if a US politician says ”our system is bad, the system from France/Germany/UK/Sweden/Japan is beating us in almost every metric, let’s switch” is met with boos but someone who says ”I have an completely untested idea that’s our old system with some quirks that looks like it was designed by a committee without a vision, let’s try it” is met with cheers?

deleted 7y ago

[deleted]

alexandernst 7y ago

You don’t need to design anything because that already exists in Europe. It’s called public health care.