6 ms·

If folks are losing their jobs (assuming they don't have a nest egg which the majority of Americans do not have) how will they be better off being personally un

by munk-a 6y ago

If folks are losing their jobs (assuming they don't have a nest egg which the majority of Americans do not have) how will they be better off being personally unable to pay for health care instead of losing access to their employer provided insurance to pay for healthcare? Also - a lot of these benefits are things we'd generally consider "necessary" - if that's the case why would we open the door wider to allowing folks to continue being paid 7.25/hr and now not even have a chance at ever seeing a doctor? Or, if that money is personally controlled is it going to be secured against debt repayment? Will individuals have a guaranteed right to pay for medical care before any paycheck garnishing?

nightski 6y ago
I don't mean to speak for the parent but I'm pretty sure it's implied in this scenario that you'd move to universal health care.
- munk-a 6y ago
  I don't think so - the implication I read from "Pay me more and let me control my money." was an entirely private individual insurance market. If I misread the comment my apologies.
  - rbanffy 6y ago
    I had the same impression, which is an insane idea. The reason people should have universal healthcare and universal pensions and so on is to use society's size to shield everyone from individual risks.
    - nostrademons 6y ago
      It's not too unreasonable if we could also have a transparent, competitive, reasonably priced healthcare market. Doing that would require a lot of changes to how we conduct medical school admissions, residency, and medical licensing that'd be fought tooth & nail by the healthcare industry, though.
      - munk-a 6y ago
        I don't believe a transparent healthcare system is realistically achievable without essentially moving over to full government control - I wrote up a thing above[1] if it's of interest. 1. https://news.ycombinator.com/item?id=26187260 https://news.ycombinator.com/item?id=26187260
      - ska 6y ago
        The biggest drivers of health care cost have little to do with physicians, their training, or licensing although they do all contribute a bit. So to make any impact you'd need a much bigger list of things to change.
        amanaplanacanal 6y ago
        What are the biggest drivers? It feels like death from a thousand cuts.
        ska 6y ago
        I was maybe underemphasizing the labor costs - it's a real contribution. But you are right that everything is more expensive, and it's pretty interconnected. Big contributors: fee for service incentives, administration overhead, end of life care, inefficiencies due to fragmentation and licensing, insurance inefficiency (not the profit margin, but the tracking/coding level of detail), over subscription of expensive (e.g. capital heavy) procedures, pharmaceutical costs.
        vizzier 6y ago
        I'm reminded of https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost... when these discussions come up.
      - smogcutter 6y ago
        Part of the issue is that the insurance pool needs to include low risk individuals to work. If everyone under 30 says “I won’t shell out for private insurance, and if something catastrophic happens, fuck it, I’ll declare bankruptcy”, the system falls apart for everyone. Unpopular as it is, this is the logic behind the ACA mandate. It’s a terrible outcome, unless you’re rich enough not to care about insurance to begin with. You get coverage that’s unaffordable for higher risk people who need it, and uninsured “healthy” people one stroke of bad luck away from disaster.
    - JumpCrisscross 6y ago
      > which is an insane idea Swiss American here. It's not insane [1]. The state of healthcare in America is so poor, I would caution us from referring to anything as insane without empirical evidence. [1] https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
      - foolmeonce 6y ago
        If people are arguing over what I meant, this system is the one I was thinking of. The US already implemented tax penalties on no-coverage and could adapt them to be auto-enrollement in basic coverage at a high deductible. I have nothing against single payer, but I don't think it is worth fighting for the details of it in the US system when it can be emulated like it is in Switzerland. (But for pricing to be fair, the more important problem in to reverse the incentive for removing lower risk individuals into group plans and make sure everyone is considering the actual price of their insurance.)
  - lotsofpulp 6y ago
    It already exists, visit healthcare.gov. Pretty slick website too.
    - munk-a 6y ago
      I agree - but the comment above was, AFAICT specifically advocating for removing both Large and Small Group insurance pools provided by employers from the equation. Folks currently get insurance from a variety of sources, Medicare, Medicaid, Military Tri-care, Fed/State/County Insurance, Self-funded plans - there's a lot of variety here. I believe the comment above was advocating for closing Small and Large Group coverage (and probably self-funded pools as well) in favor of those customers being dumped on the Individual market which does exist - and does definitely have it's own problems. Oh, and the Individual insurance market predates the ACA and healthcare.gov - it was much harder to navigate before the ACA due to the pre-condition exclusions but there were a variety of plans on offer to individuals.
      - lotsofpulp 6y ago
        >I believe the comment above was advocating for closing Small and Large Group coverage (and probably self-funded pools as well) in favor of those customers being dumped on the Individual market which does exist - and does definitely have it's own problems. The only problems I know of in the individual market are due to the fact that so many healthy lives are locked up in the government/small/large business group plans. If everyone, and I mean everyone was dumped onto the market, then there would be sufficient healthy lives to balance the whole situation. Basically, it would be the same as taxpayer funded healthcare, except you get to choose your insurance company. >Oh, and the Individual insurance market predates the ACA and healthcare.gov - it was much harder to navigate before the ACA due to the pre-condition exclusions but there were a variety of plans on offer to individuals. The individual market pre-ACA and the one that exists now are completely different. It's actually possible to compare different insurances in the one that exists post ACA due to standardization and certain stipulations for being ACA compliant.
        ghaff 6y ago
  - deleted 6y ago
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  - deleted 6y ago
    [deleted]
cwkoss 6y ago
Medicare for all: individuals shouldn't be paying for healthcare personally.
- refurb 6y ago
  Medicare has premiums, deductibles, co-insurance and co-pays you realize?
  - Spivak 6y ago
    So does my PPO plan, that’s not the point. The point is that my healthcare doesn’t become more expensive when I’m unemployed.
  - toomuchtodo 6y ago
    It doesn’t have to, that’s simply a policy decision. Policy can and does change.
    - refurb 6y ago
      The why call it “Medicare for all” if it’s not Medicare? Is this like “defund the police” where we aren’t trying I actually defund them?
      - toomuchtodo 6y ago
        Marketing and branding. "Medicare" is what most are familiar with, even if there are some tweaks to make.
  - midasuni 6y ago
    Yet the cost per head in the US of Medicare is higher than the UK’s health system. That’s kot cost per head covered. That’s dividing government health spending by the US population. The US pays enough in taxes to provide great healthcare to every citizen. It chooses not to.
whiddershins 6y ago
We already have unemployment insurance, it’s easy to imagine something like government assisted cobra for recent job loss. We already have Medicaid for people who are chronically poor. It’s possible to decouple healthcare from a specific employer without moving to single payer or similar. I often like to point to Germany to show there is are much more varied solutions that can be tried than people are likely to say. Conflating all these different ideas makes it harder to find an optimal solution, IMO.
- mjevans 6y ago
  It's possible... Single bidder though. A reverse dutch auction in each market region for qualified providers to offer services, and if the price in that market isn't desired then short term bring in the military docs, and longer term fund the education of more doctors with the provision that they resettle among the target areas needing coverage.
  - imtringued 6y ago
    The problem with USA's private healthcare system is that it refuses to train enough doctors. You're supposed to overproduce doctors to drive prices down.

by munk-a 6y ago

nightski 6y ago

I don't mean to speak for the parent but I'm pretty sure it's implied in this scenario that you'd move to universal health care.

munk-a 6y ago
I don't think so - the implication I read from "Pay me more and let me control my money." was an entirely private individual insurance market. If I misread the comment my apologies.
- rbanffy 6y ago
  I had the same impression, which is an insane idea. The reason people should have universal healthcare and universal pensions and so on is to use society's size to shield everyone from individual risks.
  - nostrademons 6y ago
    It's not too unreasonable if we could also have a transparent, competitive, reasonably priced healthcare market. Doing that would require a lot of changes to how we conduct medical school admissions, residency, and medical licensing that'd be fought tooth & nail by the healthcare industry, though.
    - munk-a 6y ago
      I don't believe a transparent healthcare system is realistically achievable without essentially moving over to full government control - I wrote up a thing above[1] if it's of interest. 1. https://news.ycombinator.com/item?id=26187260 https://news.ycombinator.com/item?id=26187260
    - ska 6y ago
      The biggest drivers of health care cost have little to do with physicians, their training, or licensing although they do all contribute a bit. So to make any impact you'd need a much bigger list of things to change.
      - amanaplanacanal 6y ago
        What are the biggest drivers? It feels like death from a thousand cuts.
        ska 6y ago
        I was maybe underemphasizing the labor costs - it's a real contribution. But you are right that everything is more expensive, and it's pretty interconnected. Big contributors: fee for service incentives, administration overhead, end of life care, inefficiencies due to fragmentation and licensing, insurance inefficiency (not the profit margin, but the tracking/coding level of detail), over subscription of expensive (e.g. capital heavy) procedures, pharmaceutical costs.
        vizzier 6y ago
        I'm reminded of https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost... when these discussions come up.
    - smogcutter 6y ago
      Part of the issue is that the insurance pool needs to include low risk individuals to work. If everyone under 30 says “I won’t shell out for private insurance, and if something catastrophic happens, fuck it, I’ll declare bankruptcy”, the system falls apart for everyone. Unpopular as it is, this is the logic behind the ACA mandate. It’s a terrible outcome, unless you’re rich enough not to care about insurance to begin with. You get coverage that’s unaffordable for higher risk people who need it, and uninsured “healthy” people one stroke of bad luck away from disaster.
  - JumpCrisscross 6y ago
    > which is an insane idea Swiss American here. It's not insane [1]. The state of healthcare in America is so poor, I would caution us from referring to anything as insane without empirical evidence. [1] https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
    - foolmeonce 6y ago
      If people are arguing over what I meant, this system is the one I was thinking of. The US already implemented tax penalties on no-coverage and could adapt them to be auto-enrollement in basic coverage at a high deductible. I have nothing against single payer, but I don't think it is worth fighting for the details of it in the US system when it can be emulated like it is in Switzerland. (But for pricing to be fair, the more important problem in to reverse the incentive for removing lower risk individuals into group plans and make sure everyone is considering the actual price of their insurance.)
- lotsofpulp 6y ago
  It already exists, visit healthcare.gov. Pretty slick website too.
  - munk-a 6y ago
    I agree - but the comment above was, AFAICT specifically advocating for removing both Large and Small Group insurance pools provided by employers from the equation. Folks currently get insurance from a variety of sources, Medicare, Medicaid, Military Tri-care, Fed/State/County Insurance, Self-funded plans - there's a lot of variety here. I believe the comment above was advocating for closing Small and Large Group coverage (and probably self-funded pools as well) in favor of those customers being dumped on the Individual market which does exist - and does definitely have it's own problems. Oh, and the Individual insurance market predates the ACA and healthcare.gov - it was much harder to navigate before the ACA due to the pre-condition exclusions but there were a variety of plans on offer to individuals.
    - lotsofpulp 6y ago
      >I believe the comment above was advocating for closing Small and Large Group coverage (and probably self-funded pools as well) in favor of those customers being dumped on the Individual market which does exist - and does definitely have it's own problems. The only problems I know of in the individual market are due to the fact that so many healthy lives are locked up in the government/small/large business group plans. If everyone, and I mean everyone was dumped onto the market, then there would be sufficient healthy lives to balance the whole situation. Basically, it would be the same as taxpayer funded healthcare, except you get to choose your insurance company. >Oh, and the Individual insurance market predates the ACA and healthcare.gov - it was much harder to navigate before the ACA due to the pre-condition exclusions but there were a variety of plans on offer to individuals. The individual market pre-ACA and the one that exists now are completely different. It's actually possible to compare different insurances in the one that exists post ACA due to standardization and certain stipulations for being ACA compliant.
      - ghaff 6y ago
- deleted 6y ago
  [deleted]
- deleted 6y ago
  [deleted]

cwkoss 6y ago

Medicare for all: individuals shouldn't be paying for healthcare personally.

refurb 6y ago
Medicare has premiums, deductibles, co-insurance and co-pays you realize?
- Spivak 6y ago
  So does my PPO plan, that’s not the point. The point is that my healthcare doesn’t become more expensive when I’m unemployed.
- toomuchtodo 6y ago
  It doesn’t have to, that’s simply a policy decision. Policy can and does change.
  - refurb 6y ago
    The why call it “Medicare for all” if it’s not Medicare? Is this like “defund the police” where we aren’t trying I actually defund them?
    - toomuchtodo 6y ago
      Marketing and branding. "Medicare" is what most are familiar with, even if there are some tweaks to make.
- midasuni 6y ago
  Yet the cost per head in the US of Medicare is higher than the UK’s health system. That’s kot cost per head covered. That’s dividing government health spending by the US population. The US pays enough in taxes to provide great healthcare to every citizen. It chooses not to.

whiddershins 6y ago

We already have unemployment insurance, it’s easy to imagine something like government assisted cobra for recent job loss. We already have Medicaid for people who are chronically poor. It’s possible to decouple healthcare from a specific employer without moving to single payer or similar. I often like to point to Germany to show there is are much more varied solutions that can be tried than people are likely to say. Conflating all these different ideas makes it harder to find an optimal solution, IMO.

mjevans 6y ago
It's possible... Single bidder though. A reverse dutch auction in each market region for qualified providers to offer services, and if the price in that market isn't desired then short term bring in the military docs, and longer term fund the education of more doctors with the provision that they resettle among the target areas needing coverage.
- imtringued 6y ago
  The problem with USA's private healthcare system is that it refuses to train enough doctors. You're supposed to overproduce doctors to drive prices down.