7 ms·

Yeah I wish Obama care had simply been: 'employer provided healthcare is illegal in 2024'

Travis_Pastrami 3y ago
I don't see how that would be any better than what we have now. If employer provided healthcare was removed, that would leave us with a bunch of private healthcare companies. These private companies would drive up the cost even more. If an affordable or free healthcare option was offered on top of making employer provided healthcare illegal, then I completely am behind your idea.
- photonbeam 3y ago
  Its not a given that prices would increase Look at how these systems work in other countries
  - ekianjo 3y ago
    Sounds like you have no clue about whats happening in other countries
    - zer0tonin 3y ago
      Well let me enlighten you, as someone who doesn't live in america. I pay a bit less than 150 euros a months in health insurance in the Netherlands. It is not tied to my employer in any way. If I was poor I could ask for those payments to be subsidized by the state. If I am sick I can just get an appointment with my GP within the day and not pay a thing, they can refer me to specialists or blood tests if needed, which are also fast and free. The remaining healthcare costs for medications or dentistry are so low I don't even notice them. Hope this will shed some light to you about what's happening in other countries.
      - patrec 3y ago
        The problem with the above account is that the 150 euros you claim to pay per month for health "insurance" is transparently a fantasy number, and in reality you probably pay closer to an order of magnitude more into the Dutch health system.
        ben_w 3y ago
        According to wikipedia: > Funding for all short-term health care is 50% from employers, 45% from the insured person and 5% by the government. … > Premiums paid by the insured are, on average, €137 per month for basic health care - https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Only an order of magnitude if you're in base-2. That said, this doesn't quite track with the numbers for https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... and https://en.wikipedia.org/wiki/International_dollar https://en.wikipedia.org/wiki/International_dollar But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier.
        patrec 3y ago
        > Only an order of magnitude if you're in base-2. Nope. Look at how much the Netherlands actually spends on Healthcare, it's about 11.2% of GDP in 2021 [1]. Per capita GDP in 2021 was ~53k€. ((53k€*11.2%)/12) ≈ 495€ Only problem is, like most developed countries, close to a majority of people are net recipients (around 40%). Someone will have to pay their share too. Chances are, if you're posting on HN, that's you, as you'll be somewhere in the top 5% income bracket. I think if the OP does the math based on their actual numbers, they'd be more likely to find themselves in the ~1000€/month ballpark than the 150€/month they seem to think they are paying. > But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier. The Netherlands (11% of GDP) is not quite as extreme as the US (17%), but it's certainly nothing to write home about, especially as I don't get the impression that either health care expenditure as percentage of GDP or demographics are moving in a favorable direction. [1] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2021&locations=NL&start=2001 https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...
    - ffgjgf1 3y ago
      The Swiss healthcare system is privatized to a higher degree than the US one (no Medicare/aid equivalents) yet it seems to be doing mostly fine because of sensible regulation?
      - CaptainZapp 3y ago
        While generally true it needs to be noted that health insurance is very expensive in Switzerland. I'm not complaining since, first, this is a political decision and second, the level of service is outstanding. For example: psychotherapy is paid for or, if your doc orders an MRI you get an appointment after tomorrow. There's also no such shit as in network health providers (exceptions apply for some insurance models) or pre-existing conditions for the basic health plan (which is still pretty good and comprehensive). While I do think that it's an overall good system it is expensive (and subsidized for people who can't afford it). Also, health insurance is mandatory.
      - roydivision 3y ago
        - It is mandatory to have health insurance, if you don't chose one the state will chose one for you - On the whole it's very expensive, although this is somewhat offset by the high standard of living - The insurance companies are legally forced to provide a lowest tier plan
    - FireBeyond 3y ago
      As someone born in the UK, grew up in Australia and now in the US, who knows of paying a seven thousand dollar copay after my “platinum” insurance for “elective” surgery to remove a kidney stone that was too big to pass, versus a nine day stay for gout in Australia that resulted in a $38 out of pocket because I wanted premium TV channels in my room.
- ars 3y ago
  > that would leave us with a bunch of private healthcare companies. It's already a bunch of private companies. > These private companies would drive up the cost even more. Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up. Although we really should not ignore that insurance companies are not the drivers of higher costs, it's health care providers that do that. It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. Dr.'s will have to take a pay cut, and there will have to be mass layoffs, there's no other way to reduce costs.
  - unusualmonkey 3y ago
    > It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. What a delightfully naive view. Answer me two simple questions: 1) How are insurance companies profits capped? 2) How does increasing or decreasing costs affect thier allowable profits?
    - ars 3y ago
      1: Obama care: 80/20 rule. 2: Costs change nothing. But increased health care expenses do allow them to earn more (the 20).
      - unusualmonkey 3y ago
        So if increasing healthcare expenses allow them to earn more profits, then why do you think having capped profits means that insurance companies are 'not the problem'? Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.
        ars 3y ago
        > Insurance companies are incentivised, under law, to have the highest healthcare expenses possible. Yes, that is true. But it doesn't change the fact that prices will have to change at the healthcare providers. Dr.s will earn less, people will be fired as positions are eliminated. There's no other way to reduce prices. Where do you think all that "incentivized" money is going? It's going to people in healthcare will either take a pay-cut or will lose their jobs.
saboot 3y ago
That wasn't possible, having Lieberman's vote was required, and he said no to anything like that
- 88913527 3y ago
  Plus, health care spending is like >10% of GDP. You don't rewrite the rules like that with upsetting a great deal of corporate interests. An appreciable number of people benefit from all the inefficiency in delivering health care.
  - autoexec 3y ago
    > An appreciable number of people benefit from all the inefficiency in delivering health care. Not anything close the the number of people who suffer from the all the inefficiency in delivering health care, but guess which has more money to bribe lawmakers with
eastbound 3y ago
Meanwhile, France made mutuelle (half of the healthcare) mandatorily paid by employers. When you leave, you can keep it for a time, but it’s essentially paid by the employer…

I don't see how that would be any better than what we have now. If employer provided healthcare was removed, that would leave us with a bunch of private healthcare companies. These private companies would drive up the cost even more. If an affordable or free healthcare option was offered on top of making employer provided healthcare illegal, then I completely am behind your idea.

photonbeam 3y ago
Its not a given that prices would increase Look at how these systems work in other countries
- ekianjo 3y ago
  Sounds like you have no clue about whats happening in other countries
  - zer0tonin 3y ago
    Well let me enlighten you, as someone who doesn't live in america. I pay a bit less than 150 euros a months in health insurance in the Netherlands. It is not tied to my employer in any way. If I was poor I could ask for those payments to be subsidized by the state. If I am sick I can just get an appointment with my GP within the day and not pay a thing, they can refer me to specialists or blood tests if needed, which are also fast and free. The remaining healthcare costs for medications or dentistry are so low I don't even notice them. Hope this will shed some light to you about what's happening in other countries.
    - patrec 3y ago
      The problem with the above account is that the 150 euros you claim to pay per month for health "insurance" is transparently a fantasy number, and in reality you probably pay closer to an order of magnitude more into the Dutch health system.
      - ben_w 3y ago
        According to wikipedia: > Funding for all short-term health care is 50% from employers, 45% from the insured person and 5% by the government. … > Premiums paid by the insured are, on average, €137 per month for basic health care - https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands Only an order of magnitude if you're in base-2. That said, this doesn't quite track with the numbers for https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... and https://en.wikipedia.org/wiki/International_dollar https://en.wikipedia.org/wiki/International_dollar But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier.
        patrec 3y ago
        > Only an order of magnitude if you're in base-2. Nope. Look at how much the Netherlands actually spends on Healthcare, it's about 11.2% of GDP in 2021 [1]. Per capita GDP in 2021 was ~53k€. ((53k€*11.2%)/12) ≈ 495€ Only problem is, like most developed countries, close to a majority of people are net recipients (around 40%). Someone will have to pay their share too. Chances are, if you're posting on HN, that's you, as you'll be somewhere in the top 5% income bracket. I think if the OP does the math based on their actual numbers, they'd be more likely to find themselves in the ~1000€/month ballpark than the 150€/month they seem to think they are paying. > But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier. The Netherlands (11% of GDP) is not quite as extreme as the US (17%), but it's certainly nothing to write home about, especially as I don't get the impression that either health care expenditure as percentage of GDP or demographics are moving in a favorable direction. [1] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2021&locations=NL&start=2001 https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...
  - ffgjgf1 3y ago
    The Swiss healthcare system is privatized to a higher degree than the US one (no Medicare/aid equivalents) yet it seems to be doing mostly fine because of sensible regulation?
    - CaptainZapp 3y ago
      While generally true it needs to be noted that health insurance is very expensive in Switzerland. I'm not complaining since, first, this is a political decision and second, the level of service is outstanding. For example: psychotherapy is paid for or, if your doc orders an MRI you get an appointment after tomorrow. There's also no such shit as in network health providers (exceptions apply for some insurance models) or pre-existing conditions for the basic health plan (which is still pretty good and comprehensive). While I do think that it's an overall good system it is expensive (and subsidized for people who can't afford it). Also, health insurance is mandatory.
    - roydivision 3y ago
      - It is mandatory to have health insurance, if you don't chose one the state will chose one for you - On the whole it's very expensive, although this is somewhat offset by the high standard of living - The insurance companies are legally forced to provide a lowest tier plan
  - FireBeyond 3y ago
    As someone born in the UK, grew up in Australia and now in the US, who knows of paying a seven thousand dollar copay after my “platinum” insurance for “elective” surgery to remove a kidney stone that was too big to pass, versus a nine day stay for gout in Australia that resulted in a $38 out of pocket because I wanted premium TV channels in my room.
ars 3y ago
> that would leave us with a bunch of private healthcare companies. It's already a bunch of private companies. > These private companies would drive up the cost even more. Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up. Although we really should not ignore that insurance companies are not the drivers of higher costs, it's health care providers that do that. It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. Dr.'s will have to take a pay cut, and there will have to be mass layoffs, there's no other way to reduce costs.
- unusualmonkey 3y ago
  > It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. What a delightfully naive view. Answer me two simple questions: 1) How are insurance companies profits capped? 2) How does increasing or decreasing costs affect thier allowable profits?
  - ars 3y ago
    1: Obama care: 80/20 rule. 2: Costs change nothing. But increased health care expenses do allow them to earn more (the 20).
    - unusualmonkey 3y ago
      So if increasing healthcare expenses allow them to earn more profits, then why do you think having capped profits means that insurance companies are 'not the problem'? Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.
      - ars 3y ago
        > Insurance companies are incentivised, under law, to have the highest healthcare expenses possible. Yes, that is true. But it doesn't change the fact that prices will have to change at the healthcare providers. Dr.s will earn less, people will be fired as positions are eliminated. There's no other way to reduce prices. Where do you think all that "incentivized" money is going? It's going to people in healthcare will either take a pay-cut or will lose their jobs.

saboot 3y ago

That wasn't possible, having Lieberman's vote was required, and he said no to anything like that

88913527 3y ago
Plus, health care spending is like >10% of GDP. You don't rewrite the rules like that with upsetting a great deal of corporate interests. An appreciable number of people benefit from all the inefficiency in delivering health care.
- autoexec 3y ago
  > An appreciable number of people benefit from all the inefficiency in delivering health care. Not anything close the the number of people who suffer from the all the inefficiency in delivering health care, but guess which has more money to bribe lawmakers with

eastbound 3y ago

Meanwhile, France made mutuelle (half of the healthcare) mandatorily paid by employers. When you leave, you can keep it for a time, but it’s essentially paid by the employer…