4 ms·

> Health insurance is a pretty terrible product. What's the alternative?

hermannj314 5y ago
Health insurance is a terrible product because it is usually not insurance at all. If you are an alcoholic with a history of OWI/DUIs and you have a pre-existing car accident and no job, no one expects you to get free car insurance paid for by the government that will fix your already damaged car and make sure you can drive again as a human right. In Healthcare, we assume that product should exist and we demand that it be called insurance for some reason. The alternative to health insurance is free Healthcare. It isn't insurance at all.
- duckmysick 5y ago
  I believe you're arguing semantics. If we're being strict about the definition of insurance, we should also be strict about "free healthcare". There's no such thing. Somebody has to pay for it. If it's the government, they do so using money collected from their citizens. You can call it premium, tax, payment - it doesn't matter. At its core it's a system of distributing risk - which is insurance. In my mind, the alternative to health insurance is paying market rates out of your pocket for everything. It's not a good idea and that's why most of the countries have universal health insurance coverage.
aspenmayer 5y ago
A single payer system? Or a hybrid system with Medicare for all with income limits, above which you must either get third party insurance or pay a small tax is how it was done in Australia last time I was there. It seemed to work well when I was there, and I did have need of it. I had to go to the ER when I was peeing blood after being kicked by a horse directly in the kidney. Fortunately there were no blood clots and it passed after a day or two, but they had to do tests to verify it all and also an MRI I believe. I never got a bill. I had more medical expenses from mandatory screening fees for visa applications there than from a potentially life threatening medical emergency. And it was included in my yearly taxes with no fees at the point of usage for anything I can remember offhand. Meds were cheap because the whole country’s Medicare board bargains with the pharmaceutical companies directly, and if your meds are too expensive, they will just go with a competitor and leave that vendor out of the Medicare coverage schedule. This is not unequivocally a good thing, but those meds are still available on the market, but you will pay more for them unless you have third party coverage. Generics are also available just like most places. Not sure if it’s changed since, as that was like 15 years ago.
- duckmysick 5y ago
  Right. Which is still called insurance. Medicare in Australia: https://www.health.gov.au/health-topics/medicare https://www.health.gov.au/health-topics/medicare > Medicare is Australia’s universal health insurance scheme. It guarantees all Australians (and some overseas visitors) access to a wide range of health and hospital services at low or no cost. Medicare in Canada: https://www.canada.ca/en/health-canada/services/canada-health-care-system.html https://www.canada.ca/en/health-canada/services/canada-healt... > Medicare is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket. Hope you're feeling better now. That kidney kick must have been hell of a painful one.
  - aspenmayer 5y ago
    I actually tried to keep working. I felt horrible pain, but my sympathy for the horse masked a fair bit of it til I got home an hour or so later. The pain was an intense dull ache. If I hadn’t peed blood, I probably would have just suffered through it, because I grew up poor in USA without health insurance of any kind, and was acculturated to not taking medicine or receiving medical treatment unless mandated by law or in actual emergencies. Once I saw blood in the toilet bowl, I was much less reticent to go to the ER immediately, to put it lightly. My folks were first responders in a very remote rural area when I was growing up; I knew that much blood in my urine was potentially life-threatening without immediate medical interventions if blood clots were to form. I still feel bad for the horse. It got spooked, and was entirely blameless, if a bit anxious. It was a windy day, and the tin roofs of the surrounding buildings set the horse off somehow. I had too much slack in the lead rope, the horse walked ahead just far enough away for me to be in the danger zone right behind. I saw a motion blur of horseflesh, reflexively covered my face, and took a rear hoof right below my ribs. I almost kept my grip on the rope, but some part of my mind decided to let the horse win this one, and I dropped it right as my legs gave out from the impact and the sudden pain. The horse ran, and trampled it’s own rope, broke the bit in its mouth. The poor thing’s tongue was cut top to bottom, and halfway across. I failed the horse in my careless handling and lack of empathy and situational awareness on that day. As these were racehorses, I’m glad that they received medical care and made a full recovery after missing some races. On balance, maybe the horse got off easy compared to how hard they run them on race days. That was the worst experience I had with a horse. The second worse was being lifted off the ground by my bicep by a mother horse when I calmly petted her daughter. And the younger horse was nearly as big as her, so not a baby by any means. Horses are to be respected. All animals ought to be; doubly so for those that can literally trample you to death.
bobsmooth 5y ago
In addition to the other comments, it should be pointed out that not everyone needs car insurance but everyone will require medical attention at some point.
- lmm 5y ago
  That's not true though? It's entirely possible to be healthy right up until the moment you die and never get into a situation that a doctor or hospital could help with.
  - bobsmooth 5y ago
    It's also possible to win the lottery but we shouldn't legislate around the tiny minority.
    - lmm 5y ago
      Most people drive too. So whatever distinction you're trying to draw between car insurance and medical insurance is bogus both in theory and in practice.
  - ineedasername 5y ago
    The baby "you" needed health insurance the moment it took it's first breath and let out a shriek of terror due to its suddenly change in circumstances. I know from experience: Until my wife gave birth, all the claims were for here. Once born, hospital bills were partitioned into those for my wife and those for my newborn.
    - lmm 5y ago
      Plenty of people are born at home and don't receive any particular medical treatment. Of course there are risks to that, but it's hardly unheard of.
      - ineedasername 5y ago
        I think you are stretching things beyond what is reasonable here. Claiming that healthcare is a choice on these grounds is not reasonable: most home deliveries are accompanied by a midwife who knows how to treat the mother and provide immediate care for the child. Absent that, you're looking at increase mortality rates for mother and child, and when death is the alternative the idea of "choice" in healthcare loses all sense in which it is an accessible option to people. It's the choice of a gun to your head. To go on: After birth it would also be considered child abuse to avoid taking a severely sick child to the doctor, which practically makes "choosing" to avoid healthcare illegal. For those who may never get sick? Healthcare is not a choice if it relies on extreme fortune to avoid it. People mostly end up needing doctors for things beyond their control. Relying on unassisted home birth followed by odds defying luck in never getting severely sick up and until the moment you die of a massive instantly fatal heart attack or something similar? That is not a choice. This makes it hard to determine if you are hairsplitting for the sake of it or genuinely arguing for healthcare as a choice people can make. If it's the later, you're making a spurious argument from the potential for statistical anomalies.

Health insurance is a terrible product because it is usually not insurance at all. If you are an alcoholic with a history of OWI/DUIs and you have a pre-existing car accident and no job, no one expects you to get free car insurance paid for by the government that will fix your already damaged car and make sure you can drive again as a human right. In Healthcare, we assume that product should exist and we demand that it be called insurance for some reason. The alternative to health insurance is free Healthcare. It isn't insurance at all.

duckmysick 5y ago
I believe you're arguing semantics. If we're being strict about the definition of insurance, we should also be strict about "free healthcare". There's no such thing. Somebody has to pay for it. If it's the government, they do so using money collected from their citizens. You can call it premium, tax, payment - it doesn't matter. At its core it's a system of distributing risk - which is insurance. In my mind, the alternative to health insurance is paying market rates out of your pocket for everything. It's not a good idea and that's why most of the countries have universal health insurance coverage.

aspenmayer 5y ago

A single payer system? Or a hybrid system with Medicare for all with income limits, above which you must either get third party insurance or pay a small tax is how it was done in Australia last time I was there. It seemed to work well when I was there, and I did have need of it. I had to go to the ER when I was peeing blood after being kicked by a horse directly in the kidney. Fortunately there were no blood clots and it passed after a day or two, but they had to do tests to verify it all and also an MRI I believe. I never got a bill. I had more medical expenses from mandatory screening fees for visa applications there than from a potentially life threatening medical emergency. And it was included in my yearly taxes with no fees at the point of usage for anything I can remember offhand. Meds were cheap because the whole country’s Medicare board bargains with the pharmaceutical companies directly, and if your meds are too expensive, they will just go with a competitor and leave that vendor out of the Medicare coverage schedule. This is not unequivocally a good thing, but those meds are still available on the market, but you will pay more for them unless you have third party coverage. Generics are also available just like most places. Not sure if it’s changed since, as that was like 15 years ago.

duckmysick 5y ago
Right. Which is still called insurance. Medicare in Australia: https://www.health.gov.au/health-topics/medicare https://www.health.gov.au/health-topics/medicare > Medicare is Australia’s universal health insurance scheme. It guarantees all Australians (and some overseas visitors) access to a wide range of health and hospital services at low or no cost. Medicare in Canada: https://www.canada.ca/en/health-canada/services/canada-health-care-system.html https://www.canada.ca/en/health-canada/services/canada-healt... > Medicare is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket. Hope you're feeling better now. That kidney kick must have been hell of a painful one.
- aspenmayer 5y ago
  I actually tried to keep working. I felt horrible pain, but my sympathy for the horse masked a fair bit of it til I got home an hour or so later. The pain was an intense dull ache. If I hadn’t peed blood, I probably would have just suffered through it, because I grew up poor in USA without health insurance of any kind, and was acculturated to not taking medicine or receiving medical treatment unless mandated by law or in actual emergencies. Once I saw blood in the toilet bowl, I was much less reticent to go to the ER immediately, to put it lightly. My folks were first responders in a very remote rural area when I was growing up; I knew that much blood in my urine was potentially life-threatening without immediate medical interventions if blood clots were to form. I still feel bad for the horse. It got spooked, and was entirely blameless, if a bit anxious. It was a windy day, and the tin roofs of the surrounding buildings set the horse off somehow. I had too much slack in the lead rope, the horse walked ahead just far enough away for me to be in the danger zone right behind. I saw a motion blur of horseflesh, reflexively covered my face, and took a rear hoof right below my ribs. I almost kept my grip on the rope, but some part of my mind decided to let the horse win this one, and I dropped it right as my legs gave out from the impact and the sudden pain. The horse ran, and trampled it’s own rope, broke the bit in its mouth. The poor thing’s tongue was cut top to bottom, and halfway across. I failed the horse in my careless handling and lack of empathy and situational awareness on that day. As these were racehorses, I’m glad that they received medical care and made a full recovery after missing some races. On balance, maybe the horse got off easy compared to how hard they run them on race days. That was the worst experience I had with a horse. The second worse was being lifted off the ground by my bicep by a mother horse when I calmly petted her daughter. And the younger horse was nearly as big as her, so not a baby by any means. Horses are to be respected. All animals ought to be; doubly so for those that can literally trample you to death.

bobsmooth 5y ago

In addition to the other comments, it should be pointed out that not everyone needs car insurance but everyone will require medical attention at some point.

lmm 5y ago
That's not true though? It's entirely possible to be healthy right up until the moment you die and never get into a situation that a doctor or hospital could help with.
- bobsmooth 5y ago
  It's also possible to win the lottery but we shouldn't legislate around the tiny minority.
  - lmm 5y ago
    Most people drive too. So whatever distinction you're trying to draw between car insurance and medical insurance is bogus both in theory and in practice.
- ineedasername 5y ago
  The baby "you" needed health insurance the moment it took it's first breath and let out a shriek of terror due to its suddenly change in circumstances. I know from experience: Until my wife gave birth, all the claims were for here. Once born, hospital bills were partitioned into those for my wife and those for my newborn.
  - lmm 5y ago
    Plenty of people are born at home and don't receive any particular medical treatment. Of course there are risks to that, but it's hardly unheard of.
    - ineedasername 5y ago
      I think you are stretching things beyond what is reasonable here. Claiming that healthcare is a choice on these grounds is not reasonable: most home deliveries are accompanied by a midwife who knows how to treat the mother and provide immediate care for the child. Absent that, you're looking at increase mortality rates for mother and child, and when death is the alternative the idea of "choice" in healthcare loses all sense in which it is an accessible option to people. It's the choice of a gun to your head. To go on: After birth it would also be considered child abuse to avoid taking a severely sick child to the doctor, which practically makes "choosing" to avoid healthcare illegal. For those who may never get sick? Healthcare is not a choice if it relies on extreme fortune to avoid it. People mostly end up needing doctors for things beyond their control. Relying on unassisted home birth followed by odds defying luck in never getting severely sick up and until the moment you die of a massive instantly fatal heart attack or something similar? That is not a choice. This makes it hard to determine if you are hairsplitting for the sake of it or genuinely arguing for healthcare as a choice people can make. If it's the later, you're making a spurious argument from the potential for statistical anomalies.