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Private insurance in the US needs to be completely dismantled, and we need to go to a single payer system. Not a panacea, of course, but what we have is so brok

• krupan 2y ago
  Our "insurance" sucks because of all the government involvement. Putting government completely in control would solve some problems, but I personally would like to see how things go if we do the opposite and take government out of it completely.
  • curious_curios 2y ago
    I get the sentiment, but I can say without any hyperbole that would be a death sentence on the majority of people with chronic conditions.
    • krupan 2y ago
      When people say things like this I feel sad that we seem to have no idea what insurance really is, or that people are free to organize help for others and that many many good people would freely choose to do so.
      • sympil 2y ago
        … are free to organize help for others.. We have done so in the form of government. The whole promote the general welfare bit. The free rider problem is not an issue with publicly funded healthcare.
        • krupan 2y ago
          Government forcing us all to do something a certain way is not people freely organizing. Sorry to break it to you. Please see my other comment in this thread for more of my thoughts on that.
          • sympil 2y ago
            …people freely organizing… It is to the extent possible for 330 million people. There are no instances in world history in which people freely organizing as you put it adequately solved the issues of hunger, education, healthcare, etc. for civilizations with more than 5 million people. People, in the form of their elected officials, can freely decide to impose a publicly funded solution. You’d be free to refuse care in such a system, or to leave. All societies have rules that some people don’t like.
            • krupan 2y ago
              Thank you for that explanation, Comrade. In all seriousness, if those are the only choices then it's not people freely organizing. And this forced "free" organization is NOT the only way to solve these problems, and in fact it isn't really a solution to these problems at all.
              • sympil 2y ago
                Acknowledging what governments do makes me a communist? All societies impose rules on its citizens. Some socieities have imposed a publicly funded healthcare solution. Some of them have done so successfully. Leave the country if you don’t like living somewhere that imposes rules on you.
                • krupan 2y ago
                  If you can't tell the difference between which kinds of rules governments impose then I'm sorry I can't help you. I'm not going to leave this country because it still grants citizens the most freedom of any country. I'd like for that to continue to be the case.
          • 2y ago
      • cloverich 2y ago
        It's an obvious outcome though. Cheaper insurance can be had by excluding anyone with a chronic or serious condition. Healthy people will flock to it. Their rates will drop. The rates for the non-healthy will thus go up, and effectively be unaffordable for most; the same reason you cannot get home insurance in a fire prone area. It's not that it is expensive -- you literally cannot get it (unless Government backs it, e.g. same as our current insurance). The destitute in health will indeed get some charity. But unless people willingly donate to the same level they are paying for insurance today, it will be strictly less. Yes, "insurance" as such has lost its meaning. Its healthcare coverage. Everyone knows that, we just keep calling it "insurance".
        • krupan 2y ago
          Insurance is supposed to be for rare and expensive occurances. Fires (in most places), windstorms, car accidents, etc. It's essentially a bank account that a large number of people put money into and only a few people ever withdraw from. So yes, you are correct that it doesn't work to have fire insurance in fire prone areas, or to cover medical care for people that are chronically sick. It's not that insurance companies are evil, it just doesn't fit the insurance model. A different solution is needed. One that we could come up with if we had some freedom to experiment with. Health insurance today is really a collective bargaining organization. You join the UHC club and UHC negotiatates rates with medical providers on club members behalf. Except it doesn't even work very well in that model because it's not run like a club with members having any input really. You also can't easily leave one club if you are unhappy and join another club, and your employer and the government are paying more of the money into the club than you are.
          • cloverich 2y ago
            > A different solution is needed. One that we could come up with if we had some freedom to experiment with. I believe if you propose such a practical experiment HN would be happy to discuss, poke holes, etc. However, most people are fine to look at other countries that have already implemented universal health care well, at a fraction of US prices and say, lets do that. The average American on private insurance already pays more than what such a system would cost. Allowing a private option on top would resolve issues with anyone worried about reduced quality / lack of choice.
  • thedougd 2y ago
    In what specific way would you like to see the government stop intervening?
    • Uvix 2y ago
      Remove the requirement to spend 80% of premiums on care. Right now there's no incentive for providers to keep their costs low, which hurts people both with and without insurance.
      • viraptor 2y ago
        That would just cause more money going to the insurance company itself. What positive result comes out of that?
        • Uvix 2y ago
          Care before the deductible is met will be more affordable, because insurance companies will negotiate lower rates with providers.
          • viraptor 2y ago
            They can negotiate any price they want at any point. That means pre-deductible price can stay high, but afterwards the provider pay is low and the insurer profits are high. The accounting has enough slack in the way billing's done that it can be achieved in many ways. That change has no benefit at all for the insured (unless you assume the insurer cares about them...)
    • krupan 2y ago
      Here's just one idea. Currently the vast majority of us get healthcare through our employers because government heavily incentives that. Because of that, we really aren't the customers of health insurance companies, our employers are. That's ludicrous. It gives far too much power to our employers.
  • brokencode 2y ago
    In what ways does government involvement cause problems? And what actions do you think companies might take to benefit customers if not for government involvement?
    • krupan 2y ago
      Look, our society functions at all because most people are good people. Not everyone is good, so good people who are scared of bad people have given government power over all people. The problem is, power corrupts good people. Government gives power to insurance (and to other healthcare related companies, and really to a myriad of other players in other industries) primarily by: - introducing regulations that make competing with incumbents nearly impossible - giving tax breaks to favored corporations and behaviors Why does government do this? Again, because the good people in government have been corrupted by power. The people they give power to help them stay powerful by giving them campaign contributions and other favors. It's a vicious cycle. I'm not sure how to answer your last question, "what actions do you think companies might take to benefit customers if not for government involvement?" when every corporation does things to benefit it's customers. That's why any and every corporation exists, to benefit it's customers. Customers are anyone that benefits the company. Apple makes great products that benefit their customers without the government telling them to do it. In industries like healthcare in the U.S. right now, we are not the people who are primarily benefitting the corporations. The way things are bought and paid for right now I don't think we benefit health "insurance" companies at all!
      • brokencode 2y ago
        > “That's why any and every corporation exists, to benefit it's customers.” That is an incredibly optimistic belief you have about the purpose of corporations. In reality, corporations only have the responsibility to benefit their shareholders. Making sure your customers are happy and keep giving you business is certainly one route. And I think most companies at least start out this way. Though it’s funny you use Apple as an example, since they’ve been widely criticized in recent years due to the parasitic App Store practices enabled by their stranglehold over the smartphone industry. Government does get corrupted by money, but that money ultimately comes from rich corporations. Eliminating government involvement could just make corporations abuse their power in other ways.
  • fecal_henge 2y ago
    Look at all these 'big meddling government' nations doing so much worse than the US in healthcare statistics. https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_healthcare_spending.jpg https://en.m.wikipedia.org/wiki/File:Life_expectancy_vs_heal...
    • krupan 2y ago
      I agreed that going full government single-payer would improve some things. I just think we can do better by going a different route
• ericjmorey 2y ago
  Correct.
• BobaFloutist 2y ago
  I will never forgive Lieberman for killing the public option, which would at least have force private health insurance to compedte with the government.
  • bediger4000 2y ago
    Now, now! Some shell company, not at all connected to Lieberman, for a tidy sum shortly after that. Increased the GDP of Panama, or maybe Malta;
• changoplatanero 2y ago
  I'd like their to be a single payer for my healthcare but I'd like that single payer to be me and not the government and not an insurance company. Just like I am the single payer for all my food and my housing why can't we have a world where I pay for my healthcare too?
  • eximius 2y ago
    You can already do this. It's a bad idea because of the state of the rest of healthcare _due to the state of health insurance_, but nothing prevents you from self-insuring.
  • mock-possum 2y ago
    We shouldn’t even have to pay for essential services like healthcare. If it’s a matter of life or death, the state should be taking care of its citizens.
    • marbro 2y ago
      If you rely on the state to take care of you, you'll die. Only fools rely on the government. Smart people take care of themselves.
      • deleted 2y ago
        [deleted]
  • deleted 2y ago
    [deleted]
  • Denvercoder9 2y ago
    Because there is a non-zero chance that at some point you'll need a medical procedure that is, even at non-inflated cost price, more expensive than your net worth in order to survive; and society considers it unethical to let you die in that case. With the same reasoning you're not actually the single payer for your food, and food stamps exist.
  • PMunch 2y ago
• conception 2y ago
  I haven’t seen any measure where the US is the best concerning healthcare. I usually see it in the teens for outcomes and generally other measures are worse. It’s just bad.
• siliconc0w 2y ago
  The costs just get worse as our understanding of disease prevention and chronic illness grows. The costs of neglecting early intervention are ultimately borne by society through programs like Medicare, as individuals age with significantly poorer health than they would have if they had received earlier treatment. It's much cheaper to repair a roof that has a small leak than it is to clean out and rebuild a house rotted with mold.
• dude187 2y ago
  "Single payer" really just means "no choice, and no competition". I wouldn't really expect things to get better under such a system, and worse it would put a much larger percentage of our freedom on the chopping block. Just look at the all the stuff they pulled over COVID. It would usher in a terrible era where everything you do is free for someone else to say no to, because "we all pay for that". I give it 10 years under such a system until we have a similar supreme Court ruling to the one we got for interstate trade. Except this time blowing out their scope of power to anything and everything, with no more limits
  • relaxing 2y ago
    > a terrible era where everything you do is free for someone else to say no to, because "we all pay for that". Yes I greatly prefer the current era, where everything you do is expensive and someone else can still say no.
    • dude187 2y ago
      It's not the same as the current setup, as it would provide justification for control over every aspect of your life. Like skydiving? Too bad, it costs us in heath care dollars, so we have to ban it. Competitive sports? Can't justify the cost. Oh and of COURSE you can't have free choice in your diet and libations. People make unhealthy choices and it costs all of us, so your choices will be made for you. It won't go all the way there day one, probably won't go there fully in the end, but the effect will be real. Just look at how every aspect of our freedom was restricted over COVID, with the justification that your choices "impact other people". It will put overly cautious or even just overly controlling public health individuals as having control they never should be allowed to have
  • tzs 2y ago
    Medicare has been providing single payer healthcare to Americans 65 and older for nearly 60 years without running into the pitfalls you are worried about. Why do you think a single payer system for younger people would not be able to also avoid those issues?
• tomp 2y ago
  I could hardly disagree more. The by far best system I've witnessed was the Swiss healthcare system, which is NOT a single-payer system. Some features: (1) health insurance is obligatory for all residents (2) must be private, cannot be purchased/sponsored by company (3) minimum coverage is specified by law (4) health insurers are private companies, often (mostly? always?) non-profit (5) they cannot reject applicants, and can only discriminate (by price) on: (a) age, (b) residence (i.e. more expensive city/area => more expensive health insurance) (6) all procedures are paid - 10% copay is mandatory (up to a certain yearly amount) (7) health insurers make extra money on better health insurance ("private coverage") offering better service, more experienced doctors, private hospital rooms, extra coverage (e.g. for mental health, abroad etc.) etc. - those can discriminate on much more features, including existing health conditions sex (e.g. for young women it's more expensive, because of pregnancy)
  • sympil 2y ago
    Let’s rephrase things a bit then: U.S. health insurance angencies and the system they operate under need to be dismantled.
  • relaxing 2y ago
    Single payer schemes don’t usually forbid private insurance either. I don’t see the advantage here.
  • culi 2y ago
    In 2016, Switzerland’s healthcare expenditure, as a percentage of GDP, was the highest in Europe. The country spent 12.3% of its GDP on healthcare. Swiss hospitals also accumulated losses amounting to CHF1 billion ($1.13 billion) in 2023. Most hospital costs are covered by the gov't though whereas in the US hospitals are private corporations.
• callc 2y ago
  I had to look up what “single player payer system” means since I thought it meant something like “each individual pays for themselves”, the opposite of a social safety net. I was completely wrong. Single payer means there is a single (gov) entity paying health care for everyone. 1000% this is what we need. Everyone needs to care about their health. When we need healthcare it’s so often for things out of our control, like cancer. Putting the burden on the individual is cruel. Capitalism as applied to human health is fundamentally inhumane (literally, profit valued over human life). I’d be interested to heard arguments otherwise. Of course, a universal healthcare system should take notes from capitalist markets to be efficient, but have the primary goal of maximizing human well-being
  • marbro 2y ago
    Caner isn't out of your control, it's usually caused by being fat and eating bad food. It's sometimes caused by genetics but that's a minority of cancers.
    • deleted 2y ago
      [deleted]
    • technol0gic 2y ago
      hard false there, but thanks anyways
• dingnuts 2y ago
  I'm of the opinion that either a real free market or single payer would be better than what we currently have. The main thing everyone should agree on is that the employer healthcare mandate that ties health access to W-2 employment is responsible for this situation and should be revoked. What comes next matters less; every system has its drawbacks but ours is the worst. It has all the drawbacks and none of the benefits of everyone else's systems
  • marbro 2y ago
    If your employer or the government pays for your healthcare, you'll be unhealthy. If you pay, you'll be healthy.
    • dns_snek 2y ago
      Are you really claiming that the US is healthier than most of Europe?
      • krupan 2y ago
        That's not at all what was said
        • dns_snek 2y ago
          No? It's a very simple logical deduction. We know what types of systems these countries have and we know their health outcomes. They're the opposite of what they claimed in no uncertain terms.
          • krupan 2y ago
            Parent said that if your employer pays for your healthcare (which is pretty much the system in the US) or your government pays (which is the system in several other countries) you'll be less healthy than if you pay yourself. That's not what you seem to have understood from the parent comment
• zoul 2y ago
  What class is US healthcare best in? It’s probably among the best in quality you can get as a rich individual, but as a system it’s deeply flawed in many factors. US doesn’t even make it into the list of best 50 countries by life expectancy or maternal mortality ratio. Which is batshit crazy for such a rich country.
  • marbro 2y ago
    What is the life expectancy and maternal mortality ratio for lean white people in New York and Massachusetts? I'll bet that it's better than most European countries.
    • bdangubic 2y ago
      you should do some googling instead of betting losing bets :)
    • FireBeyond 2y ago
      Yeah, you will lose that bet and it won’t even be close.
• mystraline 2y ago
  So true. However we basically have 1 solution, and its not legal. And naturally, its the solution in this article. To be completely fair, just from the people who I know who have terminal uncovered diseases, I'm surprised more "direct action" hasn't been done. Desperate people with no good options can and do take the terrible options.
• gmueckl 2y ago
  A single payer system is politically impossible :/. But there are ways to get the system without overturning it completely. But they all come down to cutting or eliminating insurance profits in some way, I think. For example, prohibjt insurances from making profits at all - earnings must go into savings, future rates need to go down when savings are getting built up beyond a safety buffer. Another idea: a government mandated catalog of services that have to be covered, including fixed costs (maybe plus a small effort scaling factor based on provable additional needs for a patient). If a doctor claims medical necessity, the insurance is automatically required to pay that fixed amount - no rejection possible. If the claim is fraudulent, they can sue the doctor later.
• figassis 2y ago
  Maybe send DOGE after them to end all sweetheart deals with the regulator?
  • snailmailstare 2y ago
    Costs will go up to compensate the cost of leasing a Tesla for each executive. (Bringing new meaning to fringe benefit.)
• whazor 2y ago
  In Netherlands we have a free market for health insurance, however there are regulations and pretty much all essential care is included. Also the insurance company is not allowed to reject any person. Furthermore, every person is required to get health insurance. So healthy people pay for the old.
  • bdangubic 2y ago
    every person is required to get health insurance. this kind of “communism” will never work in the US of A long-term :)
    • yolovoe 2y ago
      Medicare, social security. We already have this in the US. We pay for the old, to receive the same benefits when we’re old.
    • pragmatic 2y ago
      It's already required. It's a question on your tax form.
      • jrs235 2y ago
        Correct. There just currently isn't a penalty if you don't have it.
    • fragmede 2y ago
      Is this the same US of A that is going around asking (brown) people for their papers, please?
• sershe 2y ago
  Why? US healthcare costs have nearly nothing to do with insurance and everything with doctor and hospital payments. I think the best way to improve US healthcare is to off all the righteous idiots. Just kidding! The 2nd best way is outlaw health insurance of any kind except maybe genuinely catastrophic, like lump sum cancer insurance or emergency room coveragr. Don't provide any public option. Once everything is out of pocket the outrageous provider prices will be forced to come down either economically or politically (my preferred option is easy immigration and the recognition of medical degrees from OECD countries)