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They are not - the effect these prices have on the poor is an unintended[1] consequence of the true aim. Extracting the most money possible from insurance payo

by munk-a 7y ago

They are not - the effect these prices have on the poor is an unintended[1] consequence of the true aim. Extracting the most money possible from insurance payors - honestly, if hospitals could bill "You owe us 50$ or as much of that that your insurance would cover" then they would. Nobody actively wants to impoverish the poor (except for a small number of utterly terrible people) but payors force cost pass on to their subscribers as a way to keep the costs from getting too crazy and and the uninsured get hit by the full bill that providers want to extract out of payors simply because it's impossible for them to under bill without getting hit by lawsuits. That paragraph was an attempt to be really fairly voiced so just to follow up - this system is utterly rotten and terrible, the US has one of the worst health care systems in the world when it comes to the non-super rich - and even for them there are better options - and it needs to be fixed. 1. Edit note: Originally I used "unavoidable" here which was a poor word choice that's been pointed out below.

lostgame 7y ago
Unadvoidable? That’s disgusting, untrue, and exactly what I believe they’d say. It’s unavoidable to charge me $50 for an Advil? When I’ve paid $740 for the doctor to see me and identify the issue? Give me a f*ing break. If you really think that’s the case maybe you should analyze what costs are actually like for health care in other countries. That’s disgusting. Just no. EDIT: Do you work for the US health industry? :/ EDIT 2: Yes, this commenter works for the industry.
- munk-a 7y ago
  I work adjacent to the industry and can clearly see what a rotten pile of crap it is - I'm also actually a US/Canadian border straddler, I emigrated from the US to come up here in fact. Please don't take any of my statement above as any sort of excuse for the market's behavior, these companies hold profit over the well being of patients - otherwise they wouldn't be so willing to stick poor people with such high bills. But, it is a private market and what's happening is all that can be expected. Again, the US really needs to look at Medicare for All - partially just because it'd end up providing better care for less money. Canada's system isn't perfect, I supported the NDP in their push for national Dental and Pharma, and I'll continue to do so, but it's worlds better than the US.
  - lostgame 7y ago
    I literally knew you must’ve been part of the industry. You might want to think your word ‘unavoidable’. It caused me so much rage I literally couldn’t make it through the rest of your post until after I made mine. I completely inteperet your post as an excuse - the word unavoidable alone gives that away. Canada’s system isn’t perfect - but it also isn’t literally raping the lower class on purpose. Just look up Martin Shkreli if you need to be educated. I have nothing but passionate hatred for the way the US enslaves it’s lower class through this. It’s utterly, incomprehensibly pathetic and lower than human.
    - kyleee 7y ago
      You are not parsing the original post you replied to very well, you should read it a few times more and ask questions to the person who wrote it instead of going off the rails with hasty conclusions
    - munk-a 7y ago
      "Unavoidable" was probably a poor word choice, "Unintended" would likely have been better. That all said, the system is broken, the reasons it is broken are pretty clear to me sitting where I am and I think the comment above lays out just why this system is terrible in a clear and relatively neutral tone which I consider to be the most productive manner in which to highlight just how terrible the system is and open up a discussion on how these issues effect us and might be addressed.
      - kyleee 7y ago
        No reason to change your wording on account of someone who has clearly not read your post closely. As you've noted the intention of the parties involved is to extract as much money as possible from payors, thus the word "unintended" is clearly a poor fit.
- crispinb 7y ago
  You're exploiting an ambiguity in the word 'unavoidable'. Of course any individual manager (hospital or insurance industry) could 'avoid' predatory pricing. But the system of capitalism is designed to prevent people who would practise such avoidance doing so - either by excluding them from management roles (the sewage farm metaphor), or forcing them to conform to the ideology of greed. An unmitigated exploitative capitalist system cannot 'avoid' overcharging, because it would be counter to its deepest nisus.
  - deleted 7y ago
    [deleted]
- kortilla 7y ago
  A shill accusation never goes over well. The commenter just pointed out that this is an emergent property of the incentives with the insurance system and pricing laws. Nobody is doing it intentionally to “hurt the poor”.
  - lostgame 7y ago
    Look up Martin Shkreli. You are patently wrong.
- dang 7y ago
  Personal attacks and flamewar like this are not allowed on HN, regardless of how right you are or feel you are, or how wrong someone is or you feel they are. We've had to ask you before to stop breaking the site guidelines. We ban accounts that keep doing that, so please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and use HN in the intended spirit (curious conversation) from now on.
cosmie 7y ago
Also good to point out - payors actually benefit from crazy costs. Insurance companies had their profitability capped as a percentage of premiums collected[1][2]. The easiest path to profit growth is just to let claims balloon, then use that to justify premium increases. [1] Technically it's a cap on all non-medical spending, rather than profit margin specifically. But in effect it's a cap on profits, as there's only so much overhead you can cut. [2] https://www.aeaweb.org/research/regulating-health-insurers-aca-medical-loss-ratio https://www.aeaweb.org/research/regulating-health-insurers-a...

by munk-a 7y ago

lostgame 7y ago

Unadvoidable? That’s disgusting, untrue, and exactly what I believe they’d say. It’s unavoidable to charge me $50 for an Advil? When I’ve paid $740 for the doctor to see me and identify the issue? Give me a f*ing break. If you really think that’s the case maybe you should analyze what costs are actually like for health care in other countries. That’s disgusting. Just no. EDIT: Do you work for the US health industry? :/ EDIT 2: Yes, this commenter works for the industry.

munk-a 7y ago
I work adjacent to the industry and can clearly see what a rotten pile of crap it is - I'm also actually a US/Canadian border straddler, I emigrated from the US to come up here in fact. Please don't take any of my statement above as any sort of excuse for the market's behavior, these companies hold profit over the well being of patients - otherwise they wouldn't be so willing to stick poor people with such high bills. But, it is a private market and what's happening is all that can be expected. Again, the US really needs to look at Medicare for All - partially just because it'd end up providing better care for less money. Canada's system isn't perfect, I supported the NDP in their push for national Dental and Pharma, and I'll continue to do so, but it's worlds better than the US.
- lostgame 7y ago
  I literally knew you must’ve been part of the industry. You might want to think your word ‘unavoidable’. It caused me so much rage I literally couldn’t make it through the rest of your post until after I made mine. I completely inteperet your post as an excuse - the word unavoidable alone gives that away. Canada’s system isn’t perfect - but it also isn’t literally raping the lower class on purpose. Just look up Martin Shkreli if you need to be educated. I have nothing but passionate hatred for the way the US enslaves it’s lower class through this. It’s utterly, incomprehensibly pathetic and lower than human.
  - kyleee 7y ago
    You are not parsing the original post you replied to very well, you should read it a few times more and ask questions to the person who wrote it instead of going off the rails with hasty conclusions
  - munk-a 7y ago
    "Unavoidable" was probably a poor word choice, "Unintended" would likely have been better. That all said, the system is broken, the reasons it is broken are pretty clear to me sitting where I am and I think the comment above lays out just why this system is terrible in a clear and relatively neutral tone which I consider to be the most productive manner in which to highlight just how terrible the system is and open up a discussion on how these issues effect us and might be addressed.
    - kyleee 7y ago
      No reason to change your wording on account of someone who has clearly not read your post closely. As you've noted the intention of the parties involved is to extract as much money as possible from payors, thus the word "unintended" is clearly a poor fit.
crispinb 7y ago
You're exploiting an ambiguity in the word 'unavoidable'. Of course any individual manager (hospital or insurance industry) could 'avoid' predatory pricing. But the system of capitalism is designed to prevent people who would practise such avoidance doing so - either by excluding them from management roles (the sewage farm metaphor), or forcing them to conform to the ideology of greed. An unmitigated exploitative capitalist system cannot 'avoid' overcharging, because it would be counter to its deepest nisus.
- deleted 7y ago
  [deleted]
kortilla 7y ago
A shill accusation never goes over well. The commenter just pointed out that this is an emergent property of the incentives with the insurance system and pricing laws. Nobody is doing it intentionally to “hurt the poor”.
- lostgame 7y ago
  Look up Martin Shkreli. You are patently wrong.
dang 7y ago
Personal attacks and flamewar like this are not allowed on HN, regardless of how right you are or feel you are, or how wrong someone is or you feel they are. We've had to ask you before to stop breaking the site guidelines. We ban accounts that keep doing that, so please review https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and use HN in the intended spirit (curious conversation) from now on.

cosmie 7y ago

Also good to point out - payors actually benefit from crazy costs. Insurance companies had their profitability capped as a percentage of premiums collected[1][2]. The easiest path to profit growth is just to let claims balloon, then use that to justify premium increases. [1] Technically it's a cap on all non-medical spending, rather than profit margin specifically. But in effect it's a cap on profits, as there's only so much overhead you can cut. [2] https://www.aeaweb.org/research/regulating-health-insurers-aca-medical-loss-ratio https://www.aeaweb.org/research/regulating-health-insurers-a...