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And why federal governments make the best health insurance carriers. Brokers, medical billing staff, and other middlemen serve no purpose other than increasing

And why federal governments make the best health insurance carriers. Brokers, medical billing staff, and other middlemen serve no purpose other than increasing cost (in order for an inefficient, openly colluding private cabal to invest premiums, deny claims, and collect profit) because everybody needs access to medical treatment.

xupybd 4y ago
I live with free healthcare. The last three trips to the emergency department have been over eight hour waits. My father's cancer treatment was not covered so the last year of his life cost him everything. On the other side my child's healthcare is amazing and all free. We get instant access to great services.
- lostlogin 4y ago
  I have both, and the wait at the paid clinic is long, as is the wait at the free clinic. It’s not whether the cost is socialised or not that decides how long the wait will be. It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn.
  - TedDoesntTalk 4y ago
    > It’s not whether the cost is socialised or not that decides how long the wait will be If care is free, aren’t you more likely to go than if you had to pay even a minimal cost?
    - lostlogin 4y ago
      It more complicated than that unfortunately. New Zealand has an accident compensation system which pays for accidents (though there may be a small surcharge) but not most medical events. They split the hair finer that is sane. Swallow a foreign body? Medical problem. Swallow a foreign body as say ‘it feels scratched’? Accident. Insect bite? Medical. Mosquito bite? Accident (it’s a distant memory from when I billed these things but I’m fairly confident I’m right). It’s all to do with cause and effect, and each must be identified. The accident compensation scheme covers a portion of wages too. Medical problems cost, not US style but not free.
    - thewebcount 4y ago
      Are you? I kind of try to avoid going to doctors and particularly hospitals and ER/EDs as much as possible. Between people with contagious illnesses, and huge amounts of wasted time, I have very little incentive to use as much healthcare as possible.
    - relaxing 4y ago
      Yeah man I love spending my time in the hospital.
  - lelanthran 4y ago
    > It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn. By competing on ... what? Can't be price (because "free" wins). The only other option is competing on quality. Your statement doesn't sound correct.
    - Timon3 4y ago
      Competition isn't the only way for a private system to have influence on a non-private system. You understand that, right?
      - lelanthran 4y ago
        > Competition isn't the only way for a private system to have influence on a non-private system. You understand that, right? I already asked what the ways are; why are you replying saying there are ways? I literally asked "In what ways?" and you are replying "handwaving There Are Ways" ...
        Timon3 4y ago
        No, you did not. You specified that you're only looking at competition, and then replied to yourself that there isn't anything else. In case you really can't imagine alternatives: what if the private system spreads lies about the non-private system? What if they use their influence to change laws and regulations to prefer their system? What if they use their influence to make others with influence treat those using the non-private system worse? None of these are competition in the sense you're asking for, and yet they are a natural consequence of private incentives.
    - lostlogin 4y ago
      Staff, including very senior staff often work in both systems. They then hire staff from the public system into the private one. This runs down the public system. There are accusations that they don't work fast or efficiently in the public system, leading to inefficiency. Senior staff with roles or even ownership of private facilities arrange contracts for outsourcing of work to private facilities. I have worked in both systems and currently work in the private setting.
- fellowniusmonk 4y ago
  I think another component to the equation in wait times is also doctors per capita and GDP per capita. It's hard to compare apples to oranges but with high doctors per capita, low wait times for speciality services, long lived citizens and a far lower percentage of GDP spent on health, I wonder if there are any serious holes to poke in Italy's system when compared to the U.S. or if they simply just beat us on every metric. https://www.oecd-ilibrary.org//sites/242e3c8c-en/1/3/2/index.html?itemId=/content/publication/242e3c8c-en&_csp_=e90031be7ce6b03025f09a0c506286b0&itemIGO=oecd&itemContentType=book#figure-d1e471 https://www.oecd-ilibrary.org//sites/242e3c8c-en/1/3/2/index...
  - xupybd 4y ago
    Interestingly we do better on doctors per 1000 than the US. https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=NZ-US https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?location...
- ecommerceguy 4y ago
  I just had kidney stones, while extremely painful not very high on the er totem pole. Got in, got a bed, IV all within 10 minutes of walking in. There's at least 30 hospitals in my metro and hundreds of urgent cares. $1500 on my HSA plan, which btw right now is returning 4.6% in a money market. How awesome is that? Great deal. Worst pain ever.
- christophilus 4y ago
  I live with private healthcare. The last few trips to the ER have been 8 hour waits, too. This is an under capacity thing. I live in a place that has boomed, and the mismanaged hospital hasn’t remotely kept up. They fired a bunch of folks during COVID, then shocked pikachu found themselves understaffed. The point is, the entire thing is broken nearly everywhere you look. I don’t know what a better alternative is, but we sure need one.
  - chrisweekly 4y ago
    My visit to the Mass General ER in 2012 involved waiting 25 hours for a ready room.
  - sbaiddn 4y ago
    I live in the US. Every trip to the ER has had <5 min. waits. They're so fast, last time my kid had a fever I went there because the after hours pediatrician was a ten minute drive (10>5). So you millage may vary.
    - sbaiddn 4y ago
      I should add this is for my local ER. Although I've never had a long wait in the US (my wife has), my local ER is literally half empty every time I go there, and the triage area 100% empty.
    - brewdad 4y ago
      You either live in a miracle land where no one ever gets sick yet ER capacity remains high just in case or your child was on the verge of death. The last time I visited an ER with my child it took 10 minutes just to check in. Then a 2 hour wait to be seen.
      - sbaiddn 4y ago
        Miracle land, and it's probably unsustainable. The hospital is large, but opened just over a year ago. My guess is that my neighbors haven't incorporated it into their routines. Also, where I live there are five (?) Hospitals with ER within a ten minute drive... in suburbia. There just can't be that many people getting deathly ill sick.
- yamtaddle 4y ago
  Last time I went to the ER with my dad it was about a 3-hour wait, and he really needed to get in. Saw a few people who looked like they definitely ought to get help, given the runaround and told it'd be hours and hours of waiting, until they left to try to find another ER with a shorter wait (in one case, the patient was delirious, sweating, and being guided around by a couple friends—I hope she got help somewhere), I assume because they looked like they couldn't pay and were probably uninsured (there was definitely a pattern to who got this treatment), so the staff were doing everything they could to discourage them. Some people who were there when we arrived, were still waiting when we got out, so they'd been there at least 4 hours. US, and he's insured, and it's supposedly a pretty-good hospital. I've been to the same ER within months of that, and it was empty and I was back in a room (well, cubby) within 15 minutes, with something just barely severe enough to merit an ER visit. Quick. Fucking expensive (think it was almost $3k by the time they were done sending bills, for 5 stitches and an x-ray—and that's with insurance), but quick. It was mostly just timing and luck. > My father's cancer treatment was not covered so the last year of his life cost him everything. Sucks that it happens to anyone, but the final year(s) of healthcare finding a way to soak up every cent, before the end, is basically the norm here in the US. Everyone's retirement savings is just money the healthcare industry's lettings us hold temporarily.
  - xupybd 4y ago
    I have never heard of anyone in my city getting in within 3 hours. That would be amazing.
- rqtwteye 4y ago
  Last time I was the ER in the US, I waited four hours with a pretty serious fever. Talked to a doctor for maybe 5 minutes and got sent home. Cost me only $500.
  - sdenton4 4y ago
    If only there were some automated system you could talk to to decide whether it's worth going to the ER in the first place...
    - brewdad 4y ago
      My urgent care facility, the only option between 5pm and 9am or on weekends, pretty much sends everyone to the ER as a precaution. If it’s serious enough, they’ll call ahead and get you into the triage system before you arrive.
    - xupybd 4y ago
      We have a free health line. It operates 24/7. You talk to an operator who puts you in a queue to talk to a triage nurse. They tell you if you need to go to the ER.
pessimizer 4y ago
Insuring massive populations isn't really insurance because of large numbers (there's no risk involved.) It's just an economic rent. It's a poker game where most of the players are cooperating.
- bhawks 4y ago
  Senior / elderly care can be enormously expensive. Especially towards end of life. I could agree with you if the population was all teen to 45 year olds but that is not realistic. The same dynamics play out with pension schemes. Declining birth rates play havoc with proposals that rely on a large, young employed base who's work supports a small, retired set of pensioners. My own perspective is that healthcare is extremely limited on the provider side. Professional organizations have been limiting the supply of doctors / doctor equivalents for decades. Not to minimize the work a family medicine or general practitioner puts in, but many important health services/early interventiona can be safely and reliably provided by a nurse practitioner or physicians assistant (what a horrible name) on a much larger and affordable scale then exists today.
  - throwawaytemp29 4y ago
    I always believed that nurse practitioners would be just about as good at primary care as a doctor. But fuck me my nurse practitioner is useless. Like tons of British Columbia residents I don’t have a family doctor, so thought this would work. But they are afraid to do anything. At least a doctor will be confidently wrong like chat gpt.
- dsfyu404ed 4y ago
  Insuring populations that are too small/niche/finite or over which you have too much information and ability to price discriminate (i.e. charge them exactly the cost of insuring them) isn't insurance either. It's a perverted cross between escrow and welfare in which the population basically pays their own way in the long run plus supports all the people who make their living by being "administrative overhead" along the way.
lazide 4y ago
Don’t bet on it. There is enough (potential) money and incentive here that almost any system will be perverted eventually. NHS is not known for speedy treatment, for instance. It’s about ongoing oversight and a willingness and ability to cut through bullshit to fix things. That’s in short supply here and everywhere else. The stories (first hand from relatives who use it) of blatant profiteering and abuse of the system in Medicare is mind boggling.
- ChrisMarshallNY 4y ago
  > NHS is not known for speedy treatment, for instance. From what I understand (I am not a UK citizen, but me mum's mum spoke Scouse. My mother, on the other hand, spoke The Queen's English), everyone loves to hate on the NHS, but no politician in their right mind will touch it. It's a "third rail."
  - lazide 4y ago
    Well, it’s the same here for the existing healthcare system in the US. Even basic reforms (obamacare) get met with insane opposition.
    - ChrisMarshallNY 4y ago
      The difference is who the opposition is from. In the UK, it's from the voters. In the US, it's from the Healthcare Industry.
      - lazide 4y ago
        Companies can’t vote.
        JPws_Prntr_Fngr 4y ago
        Why would they need to? Their lobbyists write the legislation and they finance the politicians who vote on it.
deleted 4y ago
[deleted]
paulddraper 4y ago
If you think government doesn't have those things, you don't know much about how it works. Most of Medicare is administered by middlemen and private companies.

xupybd 4y ago

I live with free healthcare. The last three trips to the emergency department have been over eight hour waits. My father's cancer treatment was not covered so the last year of his life cost him everything. On the other side my child's healthcare is amazing and all free. We get instant access to great services.

lostlogin 4y ago
I have both, and the wait at the paid clinic is long, as is the wait at the free clinic. It’s not whether the cost is socialised or not that decides how long the wait will be. It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn.
- TedDoesntTalk 4y ago
  > It’s not whether the cost is socialised or not that decides how long the wait will be If care is free, aren’t you more likely to go than if you had to pay even a minimal cost?
  - lostlogin 4y ago
    It more complicated than that unfortunately. New Zealand has an accident compensation system which pays for accidents (though there may be a small surcharge) but not most medical events. They split the hair finer that is sane. Swallow a foreign body? Medical problem. Swallow a foreign body as say ‘it feels scratched’? Accident. Insect bite? Medical. Mosquito bite? Accident (it’s a distant memory from when I billed these things but I’m fairly confident I’m right). It’s all to do with cause and effect, and each must be identified. The accident compensation scheme covers a portion of wages too. Medical problems cost, not US style but not free.
  - thewebcount 4y ago
    Are you? I kind of try to avoid going to doctors and particularly hospitals and ER/EDs as much as possible. Between people with contagious illnesses, and huge amounts of wasted time, I have very little incentive to use as much healthcare as possible.
  - relaxing 4y ago
    Yeah man I love spending my time in the hospital.
- lelanthran 4y ago
  > It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn. By competing on ... what? Can't be price (because "free" wins). The only other option is competing on quality. Your statement doesn't sound correct.
  - Timon3 4y ago
    Competition isn't the only way for a private system to have influence on a non-private system. You understand that, right?
    - lelanthran 4y ago
      > Competition isn't the only way for a private system to have influence on a non-private system. You understand that, right? I already asked what the ways are; why are you replying saying there are ways? I literally asked "In what ways?" and you are replying "handwaving There Are Ways" ...
      - Timon3 4y ago
        No, you did not. You specified that you're only looking at competition, and then replied to yourself that there isn't anything else. In case you really can't imagine alternatives: what if the private system spreads lies about the non-private system? What if they use their influence to change laws and regulations to prefer their system? What if they use their influence to make others with influence treat those using the non-private system worse? None of these are competition in the sense you're asking for, and yet they are a natural consequence of private incentives.
  - lostlogin 4y ago
    Staff, including very senior staff often work in both systems. They then hire staff from the public system into the private one. This runs down the public system. There are accusations that they don't work fast or efficiently in the public system, leading to inefficiency. Senior staff with roles or even ownership of private facilities arrange contracts for outsourcing of work to private facilities. I have worked in both systems and currently work in the private setting.
fellowniusmonk 4y ago
I think another component to the equation in wait times is also doctors per capita and GDP per capita. It's hard to compare apples to oranges but with high doctors per capita, low wait times for speciality services, long lived citizens and a far lower percentage of GDP spent on health, I wonder if there are any serious holes to poke in Italy's system when compared to the U.S. or if they simply just beat us on every metric. https://www.oecd-ilibrary.org//sites/242e3c8c-en/1/3/2/index.html?itemId=/content/publication/242e3c8c-en&_csp_=e90031be7ce6b03025f09a0c506286b0&itemIGO=oecd&itemContentType=book#figure-d1e471 https://www.oecd-ilibrary.org//sites/242e3c8c-en/1/3/2/index...
- xupybd 4y ago
  Interestingly we do better on doctors per 1000 than the US. https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=NZ-US https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?location...
ecommerceguy 4y ago
I just had kidney stones, while extremely painful not very high on the er totem pole. Got in, got a bed, IV all within 10 minutes of walking in. There's at least 30 hospitals in my metro and hundreds of urgent cares. $1500 on my HSA plan, which btw right now is returning 4.6% in a money market. How awesome is that? Great deal. Worst pain ever.
christophilus 4y ago
I live with private healthcare. The last few trips to the ER have been 8 hour waits, too. This is an under capacity thing. I live in a place that has boomed, and the mismanaged hospital hasn’t remotely kept up. They fired a bunch of folks during COVID, then shocked pikachu found themselves understaffed. The point is, the entire thing is broken nearly everywhere you look. I don’t know what a better alternative is, but we sure need one.
- chrisweekly 4y ago
  My visit to the Mass General ER in 2012 involved waiting 25 hours for a ready room.
- sbaiddn 4y ago
  I live in the US. Every trip to the ER has had <5 min. waits. They're so fast, last time my kid had a fever I went there because the after hours pediatrician was a ten minute drive (10>5). So you millage may vary.
  - sbaiddn 4y ago
    I should add this is for my local ER. Although I've never had a long wait in the US (my wife has), my local ER is literally half empty every time I go there, and the triage area 100% empty.
  - brewdad 4y ago
    You either live in a miracle land where no one ever gets sick yet ER capacity remains high just in case or your child was on the verge of death. The last time I visited an ER with my child it took 10 minutes just to check in. Then a 2 hour wait to be seen.
    - sbaiddn 4y ago
      Miracle land, and it's probably unsustainable. The hospital is large, but opened just over a year ago. My guess is that my neighbors haven't incorporated it into their routines. Also, where I live there are five (?) Hospitals with ER within a ten minute drive... in suburbia. There just can't be that many people getting deathly ill sick.
yamtaddle 4y ago
Last time I went to the ER with my dad it was about a 3-hour wait, and he really needed to get in. Saw a few people who looked like they definitely ought to get help, given the runaround and told it'd be hours and hours of waiting, until they left to try to find another ER with a shorter wait (in one case, the patient was delirious, sweating, and being guided around by a couple friends—I hope she got help somewhere), I assume because they looked like they couldn't pay and were probably uninsured (there was definitely a pattern to who got this treatment), so the staff were doing everything they could to discourage them. Some people who were there when we arrived, were still waiting when we got out, so they'd been there at least 4 hours. US, and he's insured, and it's supposedly a pretty-good hospital. I've been to the same ER within months of that, and it was empty and I was back in a room (well, cubby) within 15 minutes, with something just barely severe enough to merit an ER visit. Quick. Fucking expensive (think it was almost $3k by the time they were done sending bills, for 5 stitches and an x-ray—and that's with insurance), but quick. It was mostly just timing and luck. > My father's cancer treatment was not covered so the last year of his life cost him everything. Sucks that it happens to anyone, but the final year(s) of healthcare finding a way to soak up every cent, before the end, is basically the norm here in the US. Everyone's retirement savings is just money the healthcare industry's lettings us hold temporarily.
- xupybd 4y ago
  I have never heard of anyone in my city getting in within 3 hours. That would be amazing.
rqtwteye 4y ago
Last time I was the ER in the US, I waited four hours with a pretty serious fever. Talked to a doctor for maybe 5 minutes and got sent home. Cost me only $500.
- sdenton4 4y ago
  If only there were some automated system you could talk to to decide whether it's worth going to the ER in the first place...
  - brewdad 4y ago
    My urgent care facility, the only option between 5pm and 9am or on weekends, pretty much sends everyone to the ER as a precaution. If it’s serious enough, they’ll call ahead and get you into the triage system before you arrive.
  - xupybd 4y ago
    We have a free health line. It operates 24/7. You talk to an operator who puts you in a queue to talk to a triage nurse. They tell you if you need to go to the ER.

pessimizer 4y ago

Insuring massive populations isn't really insurance because of large numbers (there's no risk involved.) It's just an economic rent. It's a poker game where most of the players are cooperating.

bhawks 4y ago
Senior / elderly care can be enormously expensive. Especially towards end of life. I could agree with you if the population was all teen to 45 year olds but that is not realistic. The same dynamics play out with pension schemes. Declining birth rates play havoc with proposals that rely on a large, young employed base who's work supports a small, retired set of pensioners. My own perspective is that healthcare is extremely limited on the provider side. Professional organizations have been limiting the supply of doctors / doctor equivalents for decades. Not to minimize the work a family medicine or general practitioner puts in, but many important health services/early interventiona can be safely and reliably provided by a nurse practitioner or physicians assistant (what a horrible name) on a much larger and affordable scale then exists today.
- throwawaytemp29 4y ago
  I always believed that nurse practitioners would be just about as good at primary care as a doctor. But fuck me my nurse practitioner is useless. Like tons of British Columbia residents I don’t have a family doctor, so thought this would work. But they are afraid to do anything. At least a doctor will be confidently wrong like chat gpt.
dsfyu404ed 4y ago
Insuring populations that are too small/niche/finite or over which you have too much information and ability to price discriminate (i.e. charge them exactly the cost of insuring them) isn't insurance either. It's a perverted cross between escrow and welfare in which the population basically pays their own way in the long run plus supports all the people who make their living by being "administrative overhead" along the way.

lazide 4y ago

Don’t bet on it. There is enough (potential) money and incentive here that almost any system will be perverted eventually. NHS is not known for speedy treatment, for instance. It’s about ongoing oversight and a willingness and ability to cut through bullshit to fix things. That’s in short supply here and everywhere else. The stories (first hand from relatives who use it) of blatant profiteering and abuse of the system in Medicare is mind boggling.

ChrisMarshallNY 4y ago
> NHS is not known for speedy treatment, for instance. From what I understand (I am not a UK citizen, but me mum's mum spoke Scouse. My mother, on the other hand, spoke The Queen's English), everyone loves to hate on the NHS, but no politician in their right mind will touch it. It's a "third rail."
- lazide 4y ago
  Well, it’s the same here for the existing healthcare system in the US. Even basic reforms (obamacare) get met with insane opposition.
  - ChrisMarshallNY 4y ago
    The difference is who the opposition is from. In the UK, it's from the voters. In the US, it's from the Healthcare Industry.
    - lazide 4y ago
      Companies can’t vote.
      - JPws_Prntr_Fngr 4y ago
        Why would they need to? Their lobbyists write the legislation and they finance the politicians who vote on it.

deleted 4y ago

[deleted]

paulddraper 4y ago

If you think government doesn't have those things, you don't know much about how it works. Most of Medicare is administered by middlemen and private companies.