4 ms·

Which bits cost 100k? The $75 ibproufen? The $47 towel? The $19,563 bed charge? Oh, the $32,925 imaging that NFL players get instantly? Insurance in America is

by gishh 10mo ago

Which bits cost 100k? The $75 ibproufen? The $47 towel? The $19,563 bed charge? Oh, the $32,925 imaging that NFL players get instantly? Insurance in America is a fucking joke.

CommenterPerson 10mo ago
The charges you mention are likely all from hospitals. How about Pluvicto for advanced prostate cancer at $42,500 per monthly dose? All the players are in on it. The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.
- tptacek 10mo ago
  Currently insured Americans would likely be worse off under any plausible M4A plan.
  - GeoAtreides 10mo ago
    Show your work, please
  - hellotomyrars 10mo ago
    Based on what? Why even leave this comment if you’re just going to say “would likely be worse off” without giving literally any evidence or even suggestion of why. Insurance is a pool. The bigger your pool the more you spread the risk/load. It’s brain dead simple. Medical care is a human right, beyond that. Nothing about our system makes any sense and it is built to pad so many pockets in entirely opaque ways between you and the care you actually receive. Cut out several layers of middlemen and the costs go down. God forbid you have an accident and you end up at the wrong hospital when the one down the road is in-network but the one they took you to is out-of-network and you wake up owing thousands of dollars. I had pretty good marketplace insurance this year but the plan I’m on now isn’t even offered anymore and if I got the next closest offered plan I’d be paying 6X as much for the premiums with higher copays on top. I’ll be switching to my union offered plan instead which is much better than the new marketplace plan but still worse than the marketplace insurance I had before.
    - tptacek 10mo ago
      I think it's telling that people are shocked at the assertion I just made, which is not complicated or outlandish or hard to understand and is in fact backed up by referendum and attempted implementation results for state-level programs. I think two big things are happening that fog people's understanding of this issue: First, there's a widespread belief that M4A is popular, based on public opinion polling. The problem is that you can make almost anything popular in public opinion polling, and a lot of public opinion polling is deliberately run by interest groups to generate narratives about popularity. It's true: the "M4A" that poll respondents support would be enormously popular: it's proposed as abstraction with no clear tradeoffs. When you confront voters with the prospect of increased taxes and the loss of their current insurance policies, the wheels come off the wagon. The second big factor is that the demographics of people with employer-provided coverage --- the majority of all non-Medicare covered people in the US --- are not what you'd expect. As soon as you stipulate employer coverage, the cohort you're describing excludes basically all fixed-income and Medicaid-eligible households. The median household income of a family with employer-provided health insurance is closer to $120k than it is to $50k. For those households, M4A is not a very compelling deal: * There is a very clear trend in the data for them to already be satisfied with their existing health care. * The visible component of their insurance spending (their out-of-pocket, excluding employer side payments) is usually quite small compared to total spending. * M4A would mechanically eliminate the availability of existing plans (unless you came up with a truly weird and distortionate system of tax incentives to keep Anthem and United and Aetna policies going). Best case: costs that are hidden from those households today become visible, and you hope people are chill about that (in sort of the same way we hoped that people would be chill about inflation given wage increases outpacing it --- see how that went). Worst case, a lot of these households would lose their existing, favored insurance plans and pay more. Useful here to note that broad taxes on the middle and especially upper-middle class are how Europe funds generous social service packages; you can't get there by taxing the bejeezus out of billionaires. You should do that anyways, just because it's a good idea, but there aren't enough of them to pay the absolutely gobsmacking cost of a single-payer health system in one of the wealthiest large countries in the world. I'll cop to this: what I wrote last night, about "currently insured" people, was way too vague. I should have said "households with employer-provided health coverage" (again: that's most non-Medicare households). I plead strep throat; you're going to have to give me a break on clarity today.

by gishh 10mo ago

Which bits cost 100k? The $75 ibproufen? The $47 towel? The $19,563 bed charge? Oh, the $32,925 imaging that NFL players get instantly? Insurance in America is a fucking joke.

CommenterPerson 10mo ago

The charges you mention are likely all from hospitals. How about Pluvicto for advanced prostate cancer at $42,500 per monthly dose? All the players are in on it. The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.

tptacek 10mo ago
Currently insured Americans would likely be worse off under any plausible M4A plan.
- GeoAtreides 10mo ago
  Show your work, please
- hellotomyrars 10mo ago
  Based on what? Why even leave this comment if you’re just going to say “would likely be worse off” without giving literally any evidence or even suggestion of why. Insurance is a pool. The bigger your pool the more you spread the risk/load. It’s brain dead simple. Medical care is a human right, beyond that. Nothing about our system makes any sense and it is built to pad so many pockets in entirely opaque ways between you and the care you actually receive. Cut out several layers of middlemen and the costs go down. God forbid you have an accident and you end up at the wrong hospital when the one down the road is in-network but the one they took you to is out-of-network and you wake up owing thousands of dollars. I had pretty good marketplace insurance this year but the plan I’m on now isn’t even offered anymore and if I got the next closest offered plan I’d be paying 6X as much for the premiums with higher copays on top. I’ll be switching to my union offered plan instead which is much better than the new marketplace plan but still worse than the marketplace insurance I had before.
  - tptacek 10mo ago
    I think it's telling that people are shocked at the assertion I just made, which is not complicated or outlandish or hard to understand and is in fact backed up by referendum and attempted implementation results for state-level programs. I think two big things are happening that fog people's understanding of this issue: First, there's a widespread belief that M4A is popular, based on public opinion polling. The problem is that you can make almost anything popular in public opinion polling, and a lot of public opinion polling is deliberately run by interest groups to generate narratives about popularity. It's true: the "M4A" that poll respondents support would be enormously popular: it's proposed as abstraction with no clear tradeoffs. When you confront voters with the prospect of increased taxes and the loss of their current insurance policies, the wheels come off the wagon. The second big factor is that the demographics of people with employer-provided coverage --- the majority of all non-Medicare covered people in the US --- are not what you'd expect. As soon as you stipulate employer coverage, the cohort you're describing excludes basically all fixed-income and Medicaid-eligible households. The median household income of a family with employer-provided health insurance is closer to $120k than it is to $50k. For those households, M4A is not a very compelling deal: * There is a very clear trend in the data for them to already be satisfied with their existing health care. * The visible component of their insurance spending (their out-of-pocket, excluding employer side payments) is usually quite small compared to total spending. * M4A would mechanically eliminate the availability of existing plans (unless you came up with a truly weird and distortionate system of tax incentives to keep Anthem and United and Aetna policies going). Best case: costs that are hidden from those households today become visible, and you hope people are chill about that (in sort of the same way we hoped that people would be chill about inflation given wage increases outpacing it --- see how that went). Worst case, a lot of these households would lose their existing, favored insurance plans and pay more. Useful here to note that broad taxes on the middle and especially upper-middle class are how Europe funds generous social service packages; you can't get there by taxing the bejeezus out of billionaires. You should do that anyways, just because it's a good idea, but there aren't enough of them to pay the absolutely gobsmacking cost of a single-payer health system in one of the wealthiest large countries in the world. I'll cop to this: what I wrote last night, about "currently insured" people, was way too vague. I should have said "households with employer-provided health coverage" (again: that's most non-Medicare households). I plead strep throat; you're going to have to give me a break on clarity today.