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Kind of a silly take in my opinion. While it's may be true that the majority of money in a medical transaction (which is inflated) doesn't go to the insurer, it

by rozap 2y ago

Kind of a silly take in my opinion. While it's may be true that the majority of money in a medical transaction (which is inflated) doesn't go to the insurer, it goes to the provider, it doesn't change the fact that "insurers" absolutely add a layer of uncertainty to the process. In times of uncertainty (ie: getting sick) anything that adds uncertainty will rightfully be hated. In Canada, their system has a number of major shortcomings. But in college when my girlfriend got appendicitis, I just took her to the hospital without worry about in/out of network, and without worrying about if we'd get a claim rejected after the fact and have our small college student bank accounts drained. That is huge, and should not be underestimated. Here I do not have that luxury. Even though I have plenty of money saved up, it doesn't ever feel like enough. If one of us has a major illness, it can get wiped out due to a claim denial. And who makes the approve/deny choice? The author of that post does some bad thinking here by completely missing the source of the vitriol directed at insurers. While providers do charge out the ass, at least they are doing something useful, while in these times of great uncertainty and pain, insurers only rent seek, blood suck, and do not offer anything of value.

0xDEAFBEAD 2y ago
>it doesn't change the fact that "insurers" absolutely add a layer of uncertainty to the process. Not relative to the case of having no insurance. You're implicitly blaming insurers for the fact that the US doesn't have universal public healthcare. Don't hate the player, hate the game.
- acdha 2y ago
  Now, why doesn’t the United States have universal public healthcare? Because every time it’s been proposed since the 19th century there’s been stiff opposition from doctors, hospital owners, and private insurance companies. So while it’s true that they didn’t start the problem, it’s fair to blame all of them for the problems of a system they’ve poured enormous amounts of money into preserving.
  - fastball 2y ago
    The US doesn't have universal public healthcare because it is a country of 350M people and would probably be a disaster. Significantly smaller countries (UK/Canada) have major issues with their systems with a fraction of the population.
    - acdha 2y ago
      That’s just silly. What mechanism do you believe makes healthcare fall apart in a larger country but not, say, the larger EU? Similarly, these alleged major problems don’t seem to show up in stats where residents of those countries live longer and healthier lives at much lower cost, and medical bankruptcy is rare.
      - fastball 2y ago
        The EU is not one country. It is certainly not one healthcare system. But yes, I 100% agree with you. If the US wants to implement public healthcare, it should follow the EU's lead and implement it at the state level with very limited (if at all) top-down interference from the Federal government. Imo, the only thing that it makes sense to do at a nationwide level is negotiating drug prices. To answer your (flawed) question though, humans have demonstrated time and time again that they struggle to top-down manage large economical undertakings at scale. It seems that at a small scale, we have the capacity to do all sorts of things with all sorts of means of management. But past a certain point we start to get in our own way with internal strife, graft, poor abstractions and assumptions, etc. Some people think AI will help us figure this out, but I'm skeptical. So far the only consistent tool that helps us work against this is the invisible hand of a free market, which does enough to align incentives that the problems become tractable.
        acdha 2y ago
        > The EU is not one country. It is certainly not one healthcare system. That was my point: even if there is some hypothetical property of size where a national healthcare system would fall apart, which we have no reason to believe exists, letting each of the 50 states run their own should be similar to the European model where a larger population is covered by a variety of programs and that provides natural experiments for the efficacy of different approaches.
warner25 2y ago
I think most of what you said is on the mark, but the core problem is still what the providers are charging. I wouldn't worry so much about in/out-of-network or claim denials, and might not even worry about having insurance coverage at all, if: a 90-minute ER visit (even for a false alarm) didn't cost $10k; or if one night in the hospital (just for observation and a couple blood tests) didn't cost $50k; or if anything actually serious didn't cost hundreds of thousands or millions of dollars.
- deleted 2y ago
  [deleted]

by rozap 2y ago

0xDEAFBEAD 2y ago

>it doesn't change the fact that "insurers" absolutely add a layer of uncertainty to the process. Not relative to the case of having no insurance. You're implicitly blaming insurers for the fact that the US doesn't have universal public healthcare. Don't hate the player, hate the game.

acdha 2y ago
Now, why doesn’t the United States have universal public healthcare? Because every time it’s been proposed since the 19th century there’s been stiff opposition from doctors, hospital owners, and private insurance companies. So while it’s true that they didn’t start the problem, it’s fair to blame all of them for the problems of a system they’ve poured enormous amounts of money into preserving.
- fastball 2y ago
  The US doesn't have universal public healthcare because it is a country of 350M people and would probably be a disaster. Significantly smaller countries (UK/Canada) have major issues with their systems with a fraction of the population.
  - acdha 2y ago
    That’s just silly. What mechanism do you believe makes healthcare fall apart in a larger country but not, say, the larger EU? Similarly, these alleged major problems don’t seem to show up in stats where residents of those countries live longer and healthier lives at much lower cost, and medical bankruptcy is rare.
    - fastball 2y ago
      The EU is not one country. It is certainly not one healthcare system. But yes, I 100% agree with you. If the US wants to implement public healthcare, it should follow the EU's lead and implement it at the state level with very limited (if at all) top-down interference from the Federal government. Imo, the only thing that it makes sense to do at a nationwide level is negotiating drug prices. To answer your (flawed) question though, humans have demonstrated time and time again that they struggle to top-down manage large economical undertakings at scale. It seems that at a small scale, we have the capacity to do all sorts of things with all sorts of means of management. But past a certain point we start to get in our own way with internal strife, graft, poor abstractions and assumptions, etc. Some people think AI will help us figure this out, but I'm skeptical. So far the only consistent tool that helps us work against this is the invisible hand of a free market, which does enough to align incentives that the problems become tractable.
      - acdha 2y ago
        > The EU is not one country. It is certainly not one healthcare system. That was my point: even if there is some hypothetical property of size where a national healthcare system would fall apart, which we have no reason to believe exists, letting each of the 50 states run their own should be similar to the European model where a larger population is covered by a variety of programs and that provides natural experiments for the efficacy of different approaches.

warner25 2y ago

I think most of what you said is on the mark, but the core problem is still what the providers are charging. I wouldn't worry so much about in/out-of-network or claim denials, and might not even worry about having insurance coverage at all, if: a 90-minute ER visit (even for a false alarm) didn't cost $10k; or if one night in the hospital (just for observation and a couple blood tests) didn't cost $50k; or if anything actually serious didn't cost hundreds of thousands or millions of dollars.

deleted 2y ago
[deleted]