7 ms·

How do we get rid of all this layer of inneficiency? Must be possible but nobody is talking about getting rid of this but "fixing" it. Fixing may not be possibl

How do we get rid of all this layer of inneficiency? Must be possible but nobody is talking about getting rid of this but "fixing" it. Fixing may not be possible or too expensive. As consumers we should avoid paying as few middle man as possible. Today I just found out my health insurance is,of course, going up.

fzeroracer 7y ago
The only way to get around this inefficiency is in my opinion to move towards single-payer and circumvent the system entirely. Otherwise you'd have to excise all of the rent-seeking parasitical behavior in our current system which I don't think is possible. Even if you attempted to make the costs of things more transparent to consumers, there's an inherent information asymmetry between a consumer and a insurer due to the economy of scale. There's also a lot of things a consumer can't know until it's too late.
- toomuchtodo 7y ago
  If your Congressional representative does not support Medicare For All (single payer), run against them in the next election cycle or donate & volunteer for a competitor who does. That is all that is getting in the way of policy implementation, having enough votes to pass the bill in the House and the Senate. We'll get there! I'm working on a site that will obtain attestation from Congressional reps as to their support for M4A, and for those who don't attest support, campaign funding will be funneled to competitors of said representatives who do. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... (S.1129 - Medicare for All Act of 2019)
  - aabeshou 7y ago
    > I'm working on a site very cool idea. I suggest posting it on /r/socialistprogrammers if you need help or if you just want to spread the word :)
    - toomuchtodo 7y ago
      Thank you! I will keep that in mind when I’m ready to go live.
- Ididntdothis 7y ago
  Medicare for All seems to be the way to go. If people want fancier health care they can add something on top but we need a base level of affordable and accessible health care.
- aabeshou 7y ago
  weird that you're getting downvoted. probably for the use of the word "parasitical" which I assume some of the HN crowd deems combative or divisive. but it's just true. there's a whole pointless middleman industry whose entire purpose is to derive profit from healthcare by denying coverage and increasing premiums, which of course have real world consequences of people dying or going bankrupt.
  - lotsofpulp 7y ago
    In the absence of taxpayer funded healthcare, insurance companies are the only ones negotiating pricing and protecting their customers from being fleeced.
    - aabeshou 7y ago
      that seems plausible. but I consider that a reason why we need taxpayer-funded healthcare, just like so many other countries have had for years. not a reason why insurance is a necessary/lesser evil. I don't see how it's better for insurance to be fleecing people rather than medical providers
    - abeppu 7y ago
      But ... doesn't medicare do a more effective job negotiating than the private insurance companies? Like, my understanding is that typically for a given procedure medicare pays the least, private insurance pays somewhat higher, the uninsured pay way more.
      - lotsofpulp 7y ago
        Unfortunately, the voters of the US have determined only people over 65 are eligible to receive that pricing. Medicare might pay the least, but I assume they must still be a net profit center if healthcare providers accept them.
        aabeshou 7y ago
        voters of the US overwhelmingly support universal healthcare and a majority supports medicare for all. it's not the voters. it's the politicians who are bought and who deceive voters into thinking they are on their side, who tell lies about what things are possible because it hurts their donors. Clyburn, the congressman from South Carolina whose endorsement arguably delivered Joe Biden a landslide victory, has received millions of dollars from big pharma [0] [0] https://khn.org/news/democrats-taking-key-leadership-jobs-have-pocketed-millions-from-pharma/ https://khn.org/news/democrats-taking-key-leadership-jobs-ha...
danans 7y ago
> How do we get rid of all this layer of inneficiency? The world is replete with examples of how to deal with this problem, but I suspect the issue isn't with lack of better approaches, but rather, in the US, what you refer to as inefficiency in healthcare is the industry's profits (as in, returns to shareholders/capital, dividends, etc, not as much wages paid to doctors, nurses, etc). Ironically, this has only become an issue of interest in recent years because it has started to cause economic stress to the middle class - i.e. many who post to this board - due to rising healthcare costs coupled with wage growth not keeping pace with life's major costs (housing, education, and of course, healthcare). Poorer segments of the population have been facing this situation for much longer, but they don't have the same voice.
- A4ET8a8uTh0 7y ago
  Just to add to this. The industry as a whole recognized how quickly things could turn from politicians and focus on healthcare as its failure will be very visible and easy to pin point. When your SO is dying for the right of the industry to charge whatever insurance will bear, people tend to be less charitable in their judgment. Hence, ads about how we are all in this together. It would be funny to watch as I do not even know how to satire this, but it is still upsetting that it likely will work on a subset of population.
- mancerayder 7y ago
  > Ironically, this has only become an issue of interest in recent years because it has started to cause economic stress to the middle class - i.e. many who post to this board - due to rising healthcare costs coupled with wage growth not keeping pace with life's major costs (housing, education, and of course, healthcare). Poorer segments of the population have been facing this situation for much longer, but they don't have the same voice. That's only partially true. Yes, rising healthcare costs. No, it hits the poorest the most, well not exactly. Medicaid isn't horrible, but you really need to be at the bottom of the income stream. Once you hit a certain age you get Medicare, which itself covers quite a bit. The people most shafted are minimum wage workers and people who work retail jobs that don't provide healthcare. The working poor. And part of this is regional, too, it should be said. For example, this debt collector stuff where they can directly deduct from your paycheck or place liens or whatnot - that's not legal in all states. Where I live, a very large city, even a homeless person can go to a hospital and get healthcare. This is a law - you cannot be refused. The middle class have for a long time been the ones to be shafted in the U.S. They don't have enough capital or income to avoid financial insecurity (one hospital bill, one accident away from tragedy). They don't have the right jobs where they can deduct huge amounts from their income (unlike self-employed / business owners), and they don't make their income through capital investments where they can pay a lower income tax (cap gains instead of ordinary income). They're trapped in their employer's healthcare choices, and if they lose their employer their only choice are a watered-down state-managed set of healthcare options that our executive branch helped drown. I'm not rich, but perhaps upper-income, and still a wage slave; the way I've dealt with the healthcare question is to live in the shadows of the rich (working in tech in financial services).
Ididntdothis 7y ago
You could fix it but get ready for a battle with the people who profit from these inefficiencies. One person’s inefficiency is another person’s livelihood and profit.
packet_nerd 7y ago
In the Bullshit Jobs book, he quotes then president Obama as defending not streamlining healthcare because millions of jobs depend on it's inefficiencies.
- Wowfunhappy 7y ago
  Wait, as in Walter Isaacson's Steve Jobs bio? Really? I don't remember that!
  - packet_nerd 7y ago
    Bullshit Jobs: A Theory by David Graeber https://www.goodreads.com/book/show/34466958-bullshit-jobs https://www.goodreads.com/book/show/34466958-bullshit-jobs
bobthepanda 7y ago
Step 1 would probably be remove the employer tax exemption on healthcare benefits. Once regular people have to actually start understanding the implications of the insurance they're buying, and are no longer bound by the whims of their employers with specialized employees who understand insurance jargon, I would expect massive consumer-driven simplification.

fzeroracer 7y ago

The only way to get around this inefficiency is in my opinion to move towards single-payer and circumvent the system entirely. Otherwise you'd have to excise all of the rent-seeking parasitical behavior in our current system which I don't think is possible. Even if you attempted to make the costs of things more transparent to consumers, there's an inherent information asymmetry between a consumer and a insurer due to the economy of scale. There's also a lot of things a consumer can't know until it's too late.

toomuchtodo 7y ago
If your Congressional representative does not support Medicare For All (single payer), run against them in the next election cycle or donate & volunteer for a competitor who does. That is all that is getting in the way of policy implementation, having enough votes to pass the bill in the House and the Senate. We'll get there! I'm working on a site that will obtain attestation from Congressional reps as to their support for M4A, and for those who don't attest support, campaign funding will be funneled to competitors of said representatives who do. https://www.congress.gov/bill/116th-congress/senate-bill/1129/text https://www.congress.gov/bill/116th-congress/senate-bill/112... (S.1129 - Medicare for All Act of 2019)
- aabeshou 7y ago
  > I'm working on a site very cool idea. I suggest posting it on /r/socialistprogrammers if you need help or if you just want to spread the word :)
  - toomuchtodo 7y ago
    Thank you! I will keep that in mind when I’m ready to go live.
Ididntdothis 7y ago
Medicare for All seems to be the way to go. If people want fancier health care they can add something on top but we need a base level of affordable and accessible health care.
aabeshou 7y ago
weird that you're getting downvoted. probably for the use of the word "parasitical" which I assume some of the HN crowd deems combative or divisive. but it's just true. there's a whole pointless middleman industry whose entire purpose is to derive profit from healthcare by denying coverage and increasing premiums, which of course have real world consequences of people dying or going bankrupt.
- lotsofpulp 7y ago
  In the absence of taxpayer funded healthcare, insurance companies are the only ones negotiating pricing and protecting their customers from being fleeced.
  - aabeshou 7y ago
    that seems plausible. but I consider that a reason why we need taxpayer-funded healthcare, just like so many other countries have had for years. not a reason why insurance is a necessary/lesser evil. I don't see how it's better for insurance to be fleecing people rather than medical providers
  - abeppu 7y ago
    But ... doesn't medicare do a more effective job negotiating than the private insurance companies? Like, my understanding is that typically for a given procedure medicare pays the least, private insurance pays somewhat higher, the uninsured pay way more.
    - lotsofpulp 7y ago
      Unfortunately, the voters of the US have determined only people over 65 are eligible to receive that pricing. Medicare might pay the least, but I assume they must still be a net profit center if healthcare providers accept them.
      - aabeshou 7y ago
        voters of the US overwhelmingly support universal healthcare and a majority supports medicare for all. it's not the voters. it's the politicians who are bought and who deceive voters into thinking they are on their side, who tell lies about what things are possible because it hurts their donors. Clyburn, the congressman from South Carolina whose endorsement arguably delivered Joe Biden a landslide victory, has received millions of dollars from big pharma [0] [0] https://khn.org/news/democrats-taking-key-leadership-jobs-have-pocketed-millions-from-pharma/ https://khn.org/news/democrats-taking-key-leadership-jobs-ha...

danans 7y ago

> How do we get rid of all this layer of inneficiency? The world is replete with examples of how to deal with this problem, but I suspect the issue isn't with lack of better approaches, but rather, in the US, what you refer to as inefficiency in healthcare is the industry's profits (as in, returns to shareholders/capital, dividends, etc, not as much wages paid to doctors, nurses, etc). Ironically, this has only become an issue of interest in recent years because it has started to cause economic stress to the middle class - i.e. many who post to this board - due to rising healthcare costs coupled with wage growth not keeping pace with life's major costs (housing, education, and of course, healthcare). Poorer segments of the population have been facing this situation for much longer, but they don't have the same voice.

A4ET8a8uTh0 7y ago
Just to add to this. The industry as a whole recognized how quickly things could turn from politicians and focus on healthcare as its failure will be very visible and easy to pin point. When your SO is dying for the right of the industry to charge whatever insurance will bear, people tend to be less charitable in their judgment. Hence, ads about how we are all in this together. It would be funny to watch as I do not even know how to satire this, but it is still upsetting that it likely will work on a subset of population.
mancerayder 7y ago
> Ironically, this has only become an issue of interest in recent years because it has started to cause economic stress to the middle class - i.e. many who post to this board - due to rising healthcare costs coupled with wage growth not keeping pace with life's major costs (housing, education, and of course, healthcare). Poorer segments of the population have been facing this situation for much longer, but they don't have the same voice. That's only partially true. Yes, rising healthcare costs. No, it hits the poorest the most, well not exactly. Medicaid isn't horrible, but you really need to be at the bottom of the income stream. Once you hit a certain age you get Medicare, which itself covers quite a bit. The people most shafted are minimum wage workers and people who work retail jobs that don't provide healthcare. The working poor. And part of this is regional, too, it should be said. For example, this debt collector stuff where they can directly deduct from your paycheck or place liens or whatnot - that's not legal in all states. Where I live, a very large city, even a homeless person can go to a hospital and get healthcare. This is a law - you cannot be refused. The middle class have for a long time been the ones to be shafted in the U.S. They don't have enough capital or income to avoid financial insecurity (one hospital bill, one accident away from tragedy). They don't have the right jobs where they can deduct huge amounts from their income (unlike self-employed / business owners), and they don't make their income through capital investments where they can pay a lower income tax (cap gains instead of ordinary income). They're trapped in their employer's healthcare choices, and if they lose their employer their only choice are a watered-down state-managed set of healthcare options that our executive branch helped drown. I'm not rich, but perhaps upper-income, and still a wage slave; the way I've dealt with the healthcare question is to live in the shadows of the rich (working in tech in financial services).

Ididntdothis 7y ago

You could fix it but get ready for a battle with the people who profit from these inefficiencies. One person’s inefficiency is another person’s livelihood and profit.

packet_nerd 7y ago

In the Bullshit Jobs book, he quotes then president Obama as defending not streamlining healthcare because millions of jobs depend on it's inefficiencies.

Wowfunhappy 7y ago
Wait, as in Walter Isaacson's Steve Jobs bio? Really? I don't remember that!
- packet_nerd 7y ago
  Bullshit Jobs: A Theory by David Graeber https://www.goodreads.com/book/show/34466958-bullshit-jobs https://www.goodreads.com/book/show/34466958-bullshit-jobs

bobthepanda 7y ago

Step 1 would probably be remove the employer tax exemption on healthcare benefits. Once regular people have to actually start understanding the implications of the insurance they're buying, and are no longer bound by the whims of their employers with specialized employees who understand insurance jargon, I would expect massive consumer-driven simplification.