4 ms·

"More importantly, the 'price fixing' approach to health insurance simply isn't going to happen in the US." Why wouldn't it? Would there be riots in the street

"More importantly, the 'price fixing' approach to health insurance simply isn't going to happen in the US." Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund? The more important question is: Why hasn't that happened worldwide, in places where there truly _is_ universal/free/government healthcare? "What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat." And, nobody but the rich and upper-middle class will be able to afford healthcare by Market. We can already see that today, with over 50 million uninsured Americans, up from 37 million just two years ago. How many will it be next year?

Groxx 16y ago
I think the goal was more to state that our government is heavily influenced by rich special interest groups, who won't let it happen here, even if it costs them billions of dollars every year to fight it off. Funny mental picture though :D In my head they're wearing those stereotypical nurse hats and brought their own stretchers to carry off the wounded / exhausted / weaponry.
tptacek 16y ago
No, there won't be riots in the streets, because it would take amendments to the Constitution to institute price-fixed health care. Clinton's wildest single-payer fantasy (which, coincidentally, is one of my wild fantasies) would be easier to accomplish, and it, too, is D.O.A. My objection to your point is twofold: (1) It is total wishful thinking. (2) It's wishful thinking in the face of pragmatic solutions that could resolve the problems we have now without utterly restructuring the market for health care.† I'd also appreciate it if you wouldn't attempt to frame any critique of your comments in terms of "you're either with me or against health care reform". As you can see from a casual glance at this vast, Reddit-like thread, few opponents of health care reform would dare poke their head up on HN these days. I'm not an opponent of reform. † Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance, an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today), and broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics.
- muhfuhkuh 16y ago
  "Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance" Guaranteed-issue meaning "you have to get it, but we [the insurer] can charge whatever the hell we want. So, you, small biz of 10 employees with one person who had cancer, you premium is now more money than the GDP of Haiti, per month. Thanks and come again!" That kind of practice can be fixed by either 1) price-fixing or 2) subsidies forever, the latter of which is really, REALLY expensive. "an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today)" The one that the Obama administration just gave $240 million to 7 states (Kansas $31.5 million, Maryland $6.2 million, Massachusetts $35.6 million, New York $27.4 million, Oklahoma $54.6 million, Oregon $48.1 million and Wisconsin $37.8 million) to implement as part of the healthcare overhaul passed last year? I think it'll work, too. Funny how that needs federal dollars, though. Shouldn't the free market sort this stuff out without the magic hand of socialism? "Broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics." That I'll agree with, big time along with EMR mandates. That with HIPAA are a big step toward alleviating alot of the administrative burdens in healthcare management, especially tracking and billing.
  - tptacek 16y ago
    When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up. It's hard for me to take you seriously. You sound like a DailyKos diarist. I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat. So, first, you attempt to paint me as against all reform and in favor of people dying instead of companies going into debt. Now, you've tried to reframe the discussion so that you're either in favor of market-based approaches or a "socialist". And, after you've done your level best to suck all the oxygen out of the conversation, it turns out... you agree with me. Please stop writing like this on HN.
    - muhfuhkuh 16y ago
      "When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up." I didn't say they did. I said 10-person startup. And, regardless of the existence of an "exchange" or not, policies of that size will still be meted out case-by-case, and those little start-ups will get squeezed, especially if they have someone on board with a pre-existing condition. There's no getting around that problem unless each state acts as a group insurance pool. You will ALWAYS run into the small business, part-timer, or self-employed worker problem. Full stop. No arguments. "it turns out... you agree with me." Let's get this out of the way from square one: I don't agree. At all. In principle or in general. I may agree in some finer details, but my ultimate pie-in-the-sky wish for America is for us to implement a mandatory system in which every man, woman, and child, regardless of age or infirmity can get covered for a nominal price, unless they are a religious or conscientious objector and chooses to opt-out, but must themselves still pay, like we do with defense. "I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat." And, I disagreed that the free market cannot correct what is here _in practice_. Not some theoretical America where we didn't have a glacially large government or a sedentary populace with 50 Million uninsured that didn't eat Cheetos and Mountain Dew for dinner. I'm talking about the reality of the situation and how it will take more than EMR and telemedicine changes to close that 50 Million (and counting) gap, though I do agree that technology can play a non-trivial role in cutting administrative costs. See, I have wiggle room and patience for negotiation. "Please stop writing like this on HN." You, I can see, don't.

Groxx 16y ago

I think the goal was more to state that our government is heavily influenced by rich special interest groups, who won't let it happen here, even if it costs them billions of dollars every year to fight it off. Funny mental picture though :D In my head they're wearing those stereotypical nurse hats and brought their own stretchers to carry off the wounded / exhausted / weaponry.

tptacek 16y ago

No, there won't be riots in the streets, because it would take amendments to the Constitution to institute price-fixed health care. Clinton's wildest single-payer fantasy (which, coincidentally, is one of my wild fantasies) would be easier to accomplish, and it, too, is D.O.A. My objection to your point is twofold: (1) It is total wishful thinking. (2) It's wishful thinking in the face of pragmatic solutions that could resolve the problems we have now without utterly restructuring the market for health care.† I'd also appreciate it if you wouldn't attempt to frame any critique of your comments in terms of "you're either with me or against health care reform". As you can see from a casual glance at this vast, Reddit-like thread, few opponents of health care reform would dare poke their head up on HN these days. I'm not an opponent of reform. † Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance, an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today), and broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics.

muhfuhkuh 16y ago
"Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance" Guaranteed-issue meaning "you have to get it, but we [the insurer] can charge whatever the hell we want. So, you, small biz of 10 employees with one person who had cancer, you premium is now more money than the GDP of Haiti, per month. Thanks and come again!" That kind of practice can be fixed by either 1) price-fixing or 2) subsidies forever, the latter of which is really, REALLY expensive. "an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today)" The one that the Obama administration just gave $240 million to 7 states (Kansas $31.5 million, Maryland $6.2 million, Massachusetts $35.6 million, New York $27.4 million, Oklahoma $54.6 million, Oregon $48.1 million and Wisconsin $37.8 million) to implement as part of the healthcare overhaul passed last year? I think it'll work, too. Funny how that needs federal dollars, though. Shouldn't the free market sort this stuff out without the magic hand of socialism? "Broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics." That I'll agree with, big time along with EMR mandates. That with HIPAA are a big step toward alleviating alot of the administrative burdens in healthcare management, especially tracking and billing.
- tptacek 16y ago
  When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up. It's hard for me to take you seriously. You sound like a DailyKos diarist. I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat. So, first, you attempt to paint me as against all reform and in favor of people dying instead of companies going into debt. Now, you've tried to reframe the discussion so that you're either in favor of market-based approaches or a "socialist". And, after you've done your level best to suck all the oxygen out of the conversation, it turns out... you agree with me. Please stop writing like this on HN.
  - muhfuhkuh 16y ago
    "When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up." I didn't say they did. I said 10-person startup. And, regardless of the existence of an "exchange" or not, policies of that size will still be meted out case-by-case, and those little start-ups will get squeezed, especially if they have someone on board with a pre-existing condition. There's no getting around that problem unless each state acts as a group insurance pool. You will ALWAYS run into the small business, part-timer, or self-employed worker problem. Full stop. No arguments. "it turns out... you agree with me." Let's get this out of the way from square one: I don't agree. At all. In principle or in general. I may agree in some finer details, but my ultimate pie-in-the-sky wish for America is for us to implement a mandatory system in which every man, woman, and child, regardless of age or infirmity can get covered for a nominal price, unless they are a religious or conscientious objector and chooses to opt-out, but must themselves still pay, like we do with defense. "I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat." And, I disagreed that the free market cannot correct what is here _in practice_. Not some theoretical America where we didn't have a glacially large government or a sedentary populace with 50 Million uninsured that didn't eat Cheetos and Mountain Dew for dinner. I'm talking about the reality of the situation and how it will take more than EMR and telemedicine changes to close that 50 Million (and counting) gap, though I do agree that technology can play a non-trivial role in cutting administrative costs. See, I have wiggle room and patience for negotiation. "Please stop writing like this on HN." You, I can see, don't.