5 ms·

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.
      - jandrewrogers 6y ago
        That isn’t insurance. You don’t need low-risk people in the pool for insurance to work. Insurance premiums are technically derived from individual risk, not the risk of an arbitrary pool. Pooling is only done to reduce the tail risk of the underwriter, it doesn’t materially change individual premiums. You do need low-risk people in the pool if you want low-risk people to subsidize the insurance premiums of high-risk people. That is not insurance, that is just socializing the premiums of high-risk individuals. These distinctions matter when discussing policy. Socializing medical costs may be the appropriate policy choice but lets not smuggle it in by abusing a term of art like “insurance” which means something very different.
        imtringued 6y ago
        If you only get insurance once it is too late it is not insurance either. Insurers have a financial incentive to avoid paying for expensive care. If early or preventative care is cheaper they will administer it while you are "healthy".
        smogcutter 6y ago
        That is how your employer provided plan works, however. They negotiate a rate for the whole group, not an individual medical workup and premium for each individual. If you want to move away from that to “just pay me the equivalent comp directly and I’ll get my own insurance”, rates are going to get ugly.
        rbanffy 6y ago
    - jimbokun 6y ago
      Was hoping a Republican Congress and President would at least attempt health care market reforms, but that didn’t happen. Would be happy with a government run plan, too, just want our government to make some attempt to address the problem, whether from the left or the right.
      - rbanffy 6y ago
        A competitive market reduces costs and profits. Why would the Republicans do that?
    - imtringued 6y ago
      I don't know the details so I appreciate your comment. You cannot have privatized healthcare while simultaneously restricting the supply of medical professionals. That's not a free market. It's welfare for specific individuals.
    - rbanffy 6y ago
      If you use a market to reduce cost of healthcare, it'll reduce cost for easy to treat conditions by extracting maximum profit from more difficult or rare conditions. Healthcare being a fundamental right, this fails by not ensuring people with rare conditions get it.
  - 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]

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.
    - jandrewrogers 6y ago
      That isn’t insurance. You don’t need low-risk people in the pool for insurance to work. Insurance premiums are technically derived from individual risk, not the risk of an arbitrary pool. Pooling is only done to reduce the tail risk of the underwriter, it doesn’t materially change individual premiums. You do need low-risk people in the pool if you want low-risk people to subsidize the insurance premiums of high-risk people. That is not insurance, that is just socializing the premiums of high-risk individuals. These distinctions matter when discussing policy. Socializing medical costs may be the appropriate policy choice but lets not smuggle it in by abusing a term of art like “insurance” which means something very different.
      - imtringued 6y ago
        If you only get insurance once it is too late it is not insurance either. Insurers have a financial incentive to avoid paying for expensive care. If early or preventative care is cheaper they will administer it while you are "healthy".
      - smogcutter 6y ago
        That is how your employer provided plan works, however. They negotiate a rate for the whole group, not an individual medical workup and premium for each individual. If you want to move away from that to “just pay me the equivalent comp directly and I’ll get my own insurance”, rates are going to get ugly.
      - rbanffy 6y ago
  - jimbokun 6y ago
    Was hoping a Republican Congress and President would at least attempt health care market reforms, but that didn’t happen. Would be happy with a government run plan, too, just want our government to make some attempt to address the problem, whether from the left or the right.
    - rbanffy 6y ago
      A competitive market reduces costs and profits. Why would the Republicans do that?
  - imtringued 6y ago
    I don't know the details so I appreciate your comment. You cannot have privatized healthcare while simultaneously restricting the supply of medical professionals. That's not a free market. It's welfare for specific individuals.
  - rbanffy 6y ago
    If you use a market to reduce cost of healthcare, it'll reduce cost for easy to treat conditions by extracting maximum profit from more difficult or rare conditions. Healthcare being a fundamental right, this fails by not ensuring people with rare conditions get it.
- 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
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