3 ms·
The big problem with modern health “insurance” (as opposed to catastrophic major medical insurance, which is true insurance), is that it prevents the formation
by efitz 2y ago
The big problem with modern health “insurance” (as opposed to catastrophic major medical insurance, which is true insurance), is that it prevents the formation of of health care businesses that cater to different socioeconomic strata. I most other businesses, there are usually product offerings at different price points, eg Ford Fiesta vs Ford Raptor R, bespoke steakhouses vs Denny’s, Wal-Mart vs Nordstrom, etc.
There are some hard to discover offerings in healthcare but overall very little differentiation.
Why don’t we have multiple chains of monthly subscription diabetes centers, for instance? If it weren’t for insurance and over-regulation of every aspect of healthcare, we would see market flourishing in the US as there is an over abundance of chronic illness.
I sympathize with the PoV that we want someone else to pay because it’s expensive, but another way to solve that would be to remove all the regulatory capture and industry collusion and predatory middlemen (PBMs I’m talking to you) and let new delivery mechanisms evolve. Let supply adapt to demand.
- phil21 2y agoThe biggest problem with modern health "insurance" is that it's not insurance - it's a health care plan that presents a giant principal agent problem throughout the entire medical system starting with the patient and cascading from there. I'm old enough to remember a time you could break an arm, show up to your primary doctor's office that day without a pre-scheduled appointment, and walk out with a cast on plus pain meds all for less than a week's take-home pay for a blue collar employee. This was largely due in part for the reason you were the one paying the bill and there was almost no overhead. Plus the doctors who charged absurd fees simply lost patients to the competition down the street. Principal agent problems are rife in modern society, starting with medical care. They basically remove almost all pricing competition from the equation.
- insane_dreamer 2y agoThe cost to become a doctor is now so high in the US that you have a tremendous amount of debt and have to charge high to pay it off. It’s also why no one wants to become a GP.
- phil21 2y agoDoctors really are not that highly paid outside of speciality practices these days. As you note, GP is the last resort for most largely due to this reason. Many on HN make more than physicians these days. Doctor pay is not the problem in US healthcare and hasn’t really ever been.
- hammock 2y agoWhat laws in the last 20 or so years have made this situation better or worse?
- insane_dreamer 2y agoThat would be a huge mistake. In a deregulated market you will have more predatory middlemen not less. You would have everyone scrambling for the high end serving the top 25% population at high cost and no one wanting to serve the bottom 50% because they can’t afford it and there are lots of fixed costs (good luck hiring qualified doctors and nurses, equipment etc). We could go back to when a dentist was someone on a stool by the side of the road with a pair of pliers, because that’s the level of health care that poor would be able to afford. Health care has to be a universal right that a society provides for its citizens. We have no problem with subsiding the military and defense industry to the tune of $750B a year. I’d rather spend that on having a healthy and educated population. If only we had our priorities straight.