8 ms·

There is something weird about government telling business a benefit is so important they have to provide it, but it's apparently not important enough for gover

There is something weird about government telling business a benefit is so important they have to provide it, but it's apparently not important enough for government to provide it.

junofan 4y ago
Didn’t the government create a marketplace where people can buy health insurance? If people don’t want to use it, why force it?
- stickfigure 4y ago
  Two problems - one is adverse selection, the other is that uninsured people still get care anyway (showing up at the ER) and somebody has to pay for it. Right now we do it by bankrupting every 20th person that walks through the door, which seems rather unfair.
  - a-user-you-like 4y ago
    It used to be, and should be again, that the hospital owner or physician would foot the bill if you couldn’t pay. Much more direct charity, a beautiful thing. Taxing everyone to hell to cover every health expense is immoral.
    - dividefuel 4y ago
      How is it more moral to force someone to provide care for free than it is to tax the populace to provide universal care?
      - a-user-you-like 4y ago
        I wish those advocating universal taxing for crappy care would take the moral high road and not rob his fellow citizen to pay for his bills. Instead, let his fellow citizen give freely in love. Universal healthcare is such a moral sham, and what we have now in the US is also pretty bad. There is a better way.
        Dylan16807 4y ago
        If you really mean donations, you are not going to get that many billions of dollars in donations. This specific "better way" does not exist. If you're trying to get enough hospitals to do this that people don't just go to a cheaper hospital, then almost all hospitals are going to have to raise their prices... and that's effectively the same as a tax. They're "robbing" every patient the same way.
        a-user-you-like 4y ago
        Of course I mean donations, either through your family, church, or beyond. Of course it’s possible, there’s even a network now called Samaritan’s that facilitates this. The hospital can turn of course offer to foot the bill, but can do so only after you’ve exhausted other options. But none of this is forced.
        Dylan16807 4y ago
        You won't get enough. People will go bankrupt, which makes everyone else pay but in a messier and overall worse way than taxes.
    - mixedCase 4y ago
      Not going to defend universal healthcare or healthcare taxes, seeing I'm currently getting fucked by that at this moment, but given the way you wrote that I feel that you need to be pointed out that this results in either: 1) More expensive healthcare, to cover for these cases directly in a fund or via third party insurance. 2) Healthcare scarcity. You can't draw blood from a stone. Healthcare investors/workers at large don't get in to become a charity so your "solution" comes with explicit downsides you should mention.
      - a-user-you-like 4y ago
        It only results in those if you keep the regulation levels high, which we have now. We need a multi-faceted approach which lets the market lower prices. Local control, local solutions. More efficiency, human touch, love. No solution is perfect, but that’s a world that’s more personal for those helping and being helped. It also is more economically efficient. I’m not saying this is the only solution, but one that starts with robbing your neighbor is the moral low route and we should and can do better.
    - Spoom 4y ago
      Force hospital to provide care for indigents -> hospital raises prices for everyone to cover -> same effect as a tax. I'd much rather just be up front about it.
      - a-user-you-like 4y ago
        Not forcing, the universal crap care option is forcing through robbing his neighbor.
    - abofh 4y ago
      Where do you think those dollars go? Hospitals aren't that great of an investment, but insurance companies are
  - clcaev 4y ago
    > uninsured people still get care anyway (showing up at the ER) This is somewhat of a myth; at least it is nuanced. The care in the ER is to stabilize the patient, not fix them. They provide acute care only. Even acute care can be quite limited. People are triaged based on how acute their case is. Many languish in an uncomfortable waiting room for hours till they crash or leave. This rationing is done by limiting the beds so that the ER is almost always over capacity. This is by design. Since ER are cost centers, when a hospital asks for a building permit from the municipality, the number of emergency room beds open to the public is the primary negotiation. It's the bottleneck that limits costs. Emergency beds equipped to handle trauma, e.g, gunshot wounds or car accidents, is even more limited. To avoid costs, many hospitals simply do not have a trauma center, unless the municipality agrees to have significant subsidy. People die in ambulances while they search for a hospital with an open trauma bed. This is a complex and heartbreaking topic.
    - t-writescode 4y ago
      The uninsured people hold off on getting care for so long that by the time they can finally get care, it's ER time, converting a $20 visit and some antibiotics to a $100k case of amputation, or whatever.
    - candiddevmike 4y ago
      It's not complex, it's a great example of poor resource allocation. For how much we collectively spend on healthcare, there should be no perform finding it. The resources are going to the wrong place (profit, insurance, admin).
- nerdponx 4y ago
  Adverse selection and thus unaffordably expensive.
- t-writescode 4y ago
  Is that the same marketplace where health insurance starts at $500 / mo, when my job subsidizes my insurance down to $0 / mo (HSA) and like $10 to $100 a month for PPO? When you're already working the gig economy, I imagine $500 / mo is a lot more of your relative income than $100 or whatever for me.
- emkoemko 4y ago
  that's how you end up with 45,000 people in the US of A dying each year from lack of health care...COVID killed 380,000 Americans because they lacked health care, not sure why its such a bad idea to give everyone healthcare
  - gruez 4y ago
    >that's how you end up with 45,000 people in the US of A dying each year from lack of health care...COVID killed 380,000 Americans because they lacked health care What's the methodology for calculating the amount of people dying from "lack of health care"?
    - t-writescode 4y ago
      if I had to guess, easily treatable illnesses where the early warning signs were not taken care of - or even the medium warning signs weren't taken care of, when it was treatable, correlated with "why didn't you go to the hospital?" and "couldn't afford it" If I had to guess. I haven't looked, though, of course.
- MattGaiser 4y ago
  Because when they do need it, they will demand the government provide it anyway. It is like employment insurance. Self employed love to opt out, but come a major economic crisis, they demand they be allowed to participate.
- KennyBlanken 4y ago
  Wages for a huge swath of the country have not kept up with inflation over the last half a century, pressuring the 'lower class'. Many people have to choose between paying for something that primarily only matters in case of a bad event (health insurance), versus paying for things that if they don't pay for them, bad things happen with certainty, fairly quickly - loss of power, going hungry, not having gas for the car that they require because our public transit systems have been systematically disassembled (again over the last half a century), astronomical interest/late fees on loans and a credit score drop that can mean credit gets even more expensive, or is automatically revoked, or impacts one's ability to find employment in a kafka-esque hell where having too bad a credit rating means a fair number of companies won't employ you. When Wallyworld has staff who train employees in how to file for government benefits, maybe it's time to look at corporate tax share (in the 50's it used to be about 50%, now it's a few percent) and minimum wages.
- bjelkeman-again 4y ago
  Many people living in the gig economy have a lower income [1], and less stable income than the average. Add to that the US has the highest cost healthcare in the developed world [2], more than twice the cost per person compared to where I live, Sweden. With four years lower life expectancy [3]. There are clearly better ways to get healthcare for everyone. [1] https://www.cnbc.com/2018/08/28/about-half-of-californias-gig-economy-workers-struggling-with-poverty.html https://www.cnbc.com/2018/08/28/about-half-of-californias-gi... [2] The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person. https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.pbs.org/newshour/health/health-costs-how-the-us-... [3] https://ourworldindata.org/life-expectancy https://ourworldindata.org/life-expectancy
- spaetzleesser 4y ago
  In any other developed country there are some cost controls on health care. Without that universal health care will never work.
jnwatson 4y ago
It is a classic instance of “unfunded mandate”.
- abofh 4y ago
  So surely you've asked your employer to stop providing insurance so that you can obtain it on the open market?
  - stetrain 4y ago
    You’d need most large employers to stop group-buying insurance for an individual buying on the market to have a fair shot at pricing.
quadrifoliate 4y ago
That doesn't make sense. For example, the government can tell construction companies that they have to provide their workers hard hats and proper safety equipment. This does not mean that the government should necessarily have to provide this safety equipment themselves (although it might be a good idea for other reasons). Governments regulate indirectly like this all the time, there's nothing "weird" about it.
- Bilal_io 4y ago
  Except that healthcare is needed outside of work, by the worker, their spouse and children. It's needed for the person with the job and the one without. For the rich and the poor. Bad analogy, healthcare is a human right that shouldn't be tied to a job.
  - Spooky23 4y ago
    You need to convince regular people who vote conservative to stop doing so. The socialist boogeyman scares people more than lack of healthcare.
    - pessimizer 4y ago
      You say this as if Democrats didn't attack socialized healthcare in every underhanded way they possibly could when Bernie was running in 2016 and 2020. Before 2016, socialized healthcare was overwhelmingly supported by Democratic voters, and even carried a small majority of Republican voters for a short time. The Democrats fixed that good. Will providing healthcare to everyone end racism?
      - Bilal_io 4y ago
        If I am not mistaken, there were still 70+ percent of all Americans that supported universal healthcare as of 2020.
        pessimizer 4y ago
shostack 4y ago
Because that requires enough votes for Democrats. There's a good chance we'd have this if we did.
- Bilal_io 4y ago
  The bitter truth is that not every Democrat supports universal healthcare.
  - heavyset_go 4y ago
    We saw this over a decade ago when blue dog Democrats did their best to prevent universal healthcare from being implemented, and we instead got the ACA.
nine_zeros 4y ago
The real answer is for government to make employer sponsored health insurance "optional". As in, employers no longer need to provide health insurance and for health insurance enrollment to be open 24/7, much like car insurance. This will cause a large population in America to shop around all the time, reducing prices pressures. Simultaneously, they need to reduce the regulatory burden on health insurance companies (but always accept pre-existing conditions). This way more health insurance startups can compete with the large legal entities that are health insurance companies. With these two in place, no employer will ever control healthcare for employees, insurance companies will need to learn to live in thin margins and medical providers don't need to bear the administrative burden of insurance, this, reduce cost or pay more to the providers and nurses. In this way, insurance companies that cannot compete on price will fail and that is healthy capitalism.
- abofh 4y ago
  What would be the point of a health insurance startup? It's just a risk pool. You get cancer, it costs (let's say) 3 million. He doesn't, risk, 1.5 million. Insurance companies exist to hedge risk - the federal government doesn't need to hedge, it can literally inflate the risk out of the market. Pay my doctor's well, they deserve it. I don't even remember who I bought insurance from - don't care if they get paid.
  - nine_zeros 4y ago
    > What would be the point of a health insurance startup? It's just a risk pool. You get cancer, it costs (let's say) 3 million. He doesn't, risk, 1.5 million. To start with, they would have lower costs of executive pay than entrenched players. A startup can disrupt with operational costs. Later they can negotiate better prices with providers, source cheaper drugs from around the world, use technology more efficiently. There is so much room to do something here, if the regulatory burden were low.
- pessimizer 4y ago
  > The real answer is for government to make employer sponsored health insurance "optional." The real answer is not to acknowledge employer sponsored health insurance at all, and to treat it (tax it) just like every other form of compensation. Its current treatment is a nearly 100 year old remnant of attacks against unions. If you stop the giveaway to employers, employee-provided health insurance would evaporate, and the government would be forced to take rational action on healthcare provision and costs. Health insurance is as much of a scam as casino gambling, and should be regulated out of existence.
programmarchy 4y ago
There’s something more weird about tying healthcare to employment. In fact, it’s largely an accident of history: > In 1943 the War Labor Board, which had one year earlier introduced wage and price controls, ruled that contributions to insurance and pension funds did not count as wages. In a war economy with labor shortages, employer contributions for employee health benefits became a means of maneuvering around wage controls. https://www.ncbi.nlm.nih.gov/books/NBK235989/ https://www.ncbi.nlm.nih.gov/books/NBK235989/

There is something weird about government telling business a benefit is so important they have to provide it, but it's apparently not important enough for government to provide it.

junofan 4y ago

Didn’t the government create a marketplace where people can buy health insurance? If people don’t want to use it, why force it?

stickfigure 4y ago
Two problems - one is adverse selection, the other is that uninsured people still get care anyway (showing up at the ER) and somebody has to pay for it. Right now we do it by bankrupting every 20th person that walks through the door, which seems rather unfair.
- a-user-you-like 4y ago
  It used to be, and should be again, that the hospital owner or physician would foot the bill if you couldn’t pay. Much more direct charity, a beautiful thing. Taxing everyone to hell to cover every health expense is immoral.
  - dividefuel 4y ago
    How is it more moral to force someone to provide care for free than it is to tax the populace to provide universal care?
    - a-user-you-like 4y ago
      I wish those advocating universal taxing for crappy care would take the moral high road and not rob his fellow citizen to pay for his bills. Instead, let his fellow citizen give freely in love. Universal healthcare is such a moral sham, and what we have now in the US is also pretty bad. There is a better way.
      - Dylan16807 4y ago
        If you really mean donations, you are not going to get that many billions of dollars in donations. This specific "better way" does not exist. If you're trying to get enough hospitals to do this that people don't just go to a cheaper hospital, then almost all hospitals are going to have to raise their prices... and that's effectively the same as a tax. They're "robbing" every patient the same way.
        a-user-you-like 4y ago
        Of course I mean donations, either through your family, church, or beyond. Of course it’s possible, there’s even a network now called Samaritan’s that facilitates this. The hospital can turn of course offer to foot the bill, but can do so only after you’ve exhausted other options. But none of this is forced.
        Dylan16807 4y ago
        You won't get enough. People will go bankrupt, which makes everyone else pay but in a messier and overall worse way than taxes.
  - mixedCase 4y ago
    Not going to defend universal healthcare or healthcare taxes, seeing I'm currently getting fucked by that at this moment, but given the way you wrote that I feel that you need to be pointed out that this results in either: 1) More expensive healthcare, to cover for these cases directly in a fund or via third party insurance. 2) Healthcare scarcity. You can't draw blood from a stone. Healthcare investors/workers at large don't get in to become a charity so your "solution" comes with explicit downsides you should mention.
    - a-user-you-like 4y ago
      It only results in those if you keep the regulation levels high, which we have now. We need a multi-faceted approach which lets the market lower prices. Local control, local solutions. More efficiency, human touch, love. No solution is perfect, but that’s a world that’s more personal for those helping and being helped. It also is more economically efficient. I’m not saying this is the only solution, but one that starts with robbing your neighbor is the moral low route and we should and can do better.
  - Spoom 4y ago
    Force hospital to provide care for indigents -> hospital raises prices for everyone to cover -> same effect as a tax. I'd much rather just be up front about it.
    - a-user-you-like 4y ago
      Not forcing, the universal crap care option is forcing through robbing his neighbor.
  - abofh 4y ago
    Where do you think those dollars go? Hospitals aren't that great of an investment, but insurance companies are
- clcaev 4y ago
  > uninsured people still get care anyway (showing up at the ER) This is somewhat of a myth; at least it is nuanced. The care in the ER is to stabilize the patient, not fix them. They provide acute care only. Even acute care can be quite limited. People are triaged based on how acute their case is. Many languish in an uncomfortable waiting room for hours till they crash or leave. This rationing is done by limiting the beds so that the ER is almost always over capacity. This is by design. Since ER are cost centers, when a hospital asks for a building permit from the municipality, the number of emergency room beds open to the public is the primary negotiation. It's the bottleneck that limits costs. Emergency beds equipped to handle trauma, e.g, gunshot wounds or car accidents, is even more limited. To avoid costs, many hospitals simply do not have a trauma center, unless the municipality agrees to have significant subsidy. People die in ambulances while they search for a hospital with an open trauma bed. This is a complex and heartbreaking topic.
  - t-writescode 4y ago
    The uninsured people hold off on getting care for so long that by the time they can finally get care, it's ER time, converting a $20 visit and some antibiotics to a $100k case of amputation, or whatever.
  - candiddevmike 4y ago
    It's not complex, it's a great example of poor resource allocation. For how much we collectively spend on healthcare, there should be no perform finding it. The resources are going to the wrong place (profit, insurance, admin).
nerdponx 4y ago
Adverse selection and thus unaffordably expensive.
t-writescode 4y ago
Is that the same marketplace where health insurance starts at $500 / mo, when my job subsidizes my insurance down to $0 / mo (HSA) and like $10 to $100 a month for PPO? When you're already working the gig economy, I imagine $500 / mo is a lot more of your relative income than $100 or whatever for me.
emkoemko 4y ago
that's how you end up with 45,000 people in the US of A dying each year from lack of health care...COVID killed 380,000 Americans because they lacked health care, not sure why its such a bad idea to give everyone healthcare
- gruez 4y ago
  >that's how you end up with 45,000 people in the US of A dying each year from lack of health care...COVID killed 380,000 Americans because they lacked health care What's the methodology for calculating the amount of people dying from "lack of health care"?
  - t-writescode 4y ago
    if I had to guess, easily treatable illnesses where the early warning signs were not taken care of - or even the medium warning signs weren't taken care of, when it was treatable, correlated with "why didn't you go to the hospital?" and "couldn't afford it" If I had to guess. I haven't looked, though, of course.
MattGaiser 4y ago
Because when they do need it, they will demand the government provide it anyway. It is like employment insurance. Self employed love to opt out, but come a major economic crisis, they demand they be allowed to participate.
KennyBlanken 4y ago
Wages for a huge swath of the country have not kept up with inflation over the last half a century, pressuring the 'lower class'. Many people have to choose between paying for something that primarily only matters in case of a bad event (health insurance), versus paying for things that if they don't pay for them, bad things happen with certainty, fairly quickly - loss of power, going hungry, not having gas for the car that they require because our public transit systems have been systematically disassembled (again over the last half a century), astronomical interest/late fees on loans and a credit score drop that can mean credit gets even more expensive, or is automatically revoked, or impacts one's ability to find employment in a kafka-esque hell where having too bad a credit rating means a fair number of companies won't employ you. When Wallyworld has staff who train employees in how to file for government benefits, maybe it's time to look at corporate tax share (in the 50's it used to be about 50%, now it's a few percent) and minimum wages.
bjelkeman-again 4y ago
Many people living in the gig economy have a lower income [1], and less stable income than the average. Add to that the US has the highest cost healthcare in the developed world [2], more than twice the cost per person compared to where I live, Sweden. With four years lower life expectancy [3]. There are clearly better ways to get healthcare for everyone. [1] https://www.cnbc.com/2018/08/28/about-half-of-californias-gig-economy-workers-struggling-with-poverty.html https://www.cnbc.com/2018/08/28/about-half-of-californias-gi... [2] The U.S. spent $8,233 on health per person in 2010. Norway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person. https://www.pbs.org/newshour/health/health-costs-how-the-us-compares-with-other-countries https://www.pbs.org/newshour/health/health-costs-how-the-us-... [3] https://ourworldindata.org/life-expectancy https://ourworldindata.org/life-expectancy
spaetzleesser 4y ago
In any other developed country there are some cost controls on health care. Without that universal health care will never work.

jnwatson 4y ago

It is a classic instance of “unfunded mandate”.

abofh 4y ago
So surely you've asked your employer to stop providing insurance so that you can obtain it on the open market?
- stetrain 4y ago
  You’d need most large employers to stop group-buying insurance for an individual buying on the market to have a fair shot at pricing.

quadrifoliate 4y ago

That doesn't make sense. For example, the government can tell construction companies that they have to provide their workers hard hats and proper safety equipment. This does not mean that the government should necessarily have to provide this safety equipment themselves (although it might be a good idea for other reasons). Governments regulate indirectly like this all the time, there's nothing "weird" about it.

Bilal_io 4y ago
Except that healthcare is needed outside of work, by the worker, their spouse and children. It's needed for the person with the job and the one without. For the rich and the poor. Bad analogy, healthcare is a human right that shouldn't be tied to a job.
- Spooky23 4y ago
  You need to convince regular people who vote conservative to stop doing so. The socialist boogeyman scares people more than lack of healthcare.
  - pessimizer 4y ago
    You say this as if Democrats didn't attack socialized healthcare in every underhanded way they possibly could when Bernie was running in 2016 and 2020. Before 2016, socialized healthcare was overwhelmingly supported by Democratic voters, and even carried a small majority of Republican voters for a short time. The Democrats fixed that good. Will providing healthcare to everyone end racism?
    - Bilal_io 4y ago
      If I am not mistaken, there were still 70+ percent of all Americans that supported universal healthcare as of 2020.
      - pessimizer 4y ago

shostack 4y ago

Because that requires enough votes for Democrats. There's a good chance we'd have this if we did.

Bilal_io 4y ago
The bitter truth is that not every Democrat supports universal healthcare.
- heavyset_go 4y ago
  We saw this over a decade ago when blue dog Democrats did their best to prevent universal healthcare from being implemented, and we instead got the ACA.

nine_zeros 4y ago

The real answer is for government to make employer sponsored health insurance "optional". As in, employers no longer need to provide health insurance and for health insurance enrollment to be open 24/7, much like car insurance. This will cause a large population in America to shop around all the time, reducing prices pressures. Simultaneously, they need to reduce the regulatory burden on health insurance companies (but always accept pre-existing conditions). This way more health insurance startups can compete with the large legal entities that are health insurance companies. With these two in place, no employer will ever control healthcare for employees, insurance companies will need to learn to live in thin margins and medical providers don't need to bear the administrative burden of insurance, this, reduce cost or pay more to the providers and nurses. In this way, insurance companies that cannot compete on price will fail and that is healthy capitalism.

abofh 4y ago
What would be the point of a health insurance startup? It's just a risk pool. You get cancer, it costs (let's say) 3 million. He doesn't, risk, 1.5 million. Insurance companies exist to hedge risk - the federal government doesn't need to hedge, it can literally inflate the risk out of the market. Pay my doctor's well, they deserve it. I don't even remember who I bought insurance from - don't care if they get paid.
- nine_zeros 4y ago
  > What would be the point of a health insurance startup? It's just a risk pool. You get cancer, it costs (let's say) 3 million. He doesn't, risk, 1.5 million. To start with, they would have lower costs of executive pay than entrenched players. A startup can disrupt with operational costs. Later they can negotiate better prices with providers, source cheaper drugs from around the world, use technology more efficiently. There is so much room to do something here, if the regulatory burden were low.
pessimizer 4y ago
> The real answer is for government to make employer sponsored health insurance "optional." The real answer is not to acknowledge employer sponsored health insurance at all, and to treat it (tax it) just like every other form of compensation. Its current treatment is a nearly 100 year old remnant of attacks against unions. If you stop the giveaway to employers, employee-provided health insurance would evaporate, and the government would be forced to take rational action on healthcare provision and costs. Health insurance is as much of a scam as casino gambling, and should be regulated out of existence.

programmarchy 4y ago

There’s something more weird about tying healthcare to employment. In fact, it’s largely an accident of history: > In 1943 the War Labor Board, which had one year earlier introduced wage and price controls, ruled that contributions to insurance and pension funds did not count as wages. In a war economy with labor shortages, employer contributions for employee health benefits became a means of maneuvering around wage controls. https://www.ncbi.nlm.nih.gov/books/NBK235989/ https://www.ncbi.nlm.nih.gov/books/NBK235989/