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So I happen to be in Costa Rica for the month. Just like every other 1st world country, it has managed to have universal health care that is better and cheaper

So I happen to be in Costa Rica for the month. Just like every other 1st world country, it has managed to have universal health care that is better and cheaper without private insurance. Even if you do get private insurance for quicker access, it’s still much cheaper than the US. I just spoke to someone who flew down here to save $30K on dental work. The problem isn’t the ACA, it’s the ass backwards American health care system. I was at a meetup of American ex-pats here and half of them said they established residency here to join CAJA - the health care system

nostrebored 8mo ago
ACA enshrined the worst parts of the American healthcare system for years to come. It is a politicized victory that is the best solution for no American citizens. Places I’ve been with fully privatized healthcare or single payer are both significantly better for consumers. Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come.
- lotsofpulp 8mo ago
  > Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come. Why do their stocks underperform so badly? https://imgur.com/S8bNSM2 https://imgur.com/S8bNSM2
  - rybosworld 8mo ago
    Why would a 3-year stock chart be indicative of underperformance?
    - lotsofpulp 8mo ago
      It is a 5 year chart, and the 10 year is not free on that website. You can find out similar results for longer periods here: https://dqydj.com/stock-return-calculator/ https://dqydj.com/stock-return-calculator/ https://dqydj.com/sp-500-return-calculator/ https://dqydj.com/sp-500-return-calculator/
- ipsento606 8mo ago
  > ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be
  - deleted 8mo ago
    [deleted]
  - CGMthrowaway 8mo ago
    We traded the cruelty of Exclusion for the cruelty of Extraction.
    - tptacek 8mo ago
      What does that mean?
      - deleted 8mo ago
        [deleted]
      - CGMthrowaway 8mo ago
        Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)
        raw_anon_1111 8mo ago
        You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.
- deleted 8mo ago
  [deleted]
SV_BubbleTime 8mo ago
Costa Rica is a beautiful country. But it is in no way “first world”. It has no military, and is effectively dependent of the US and in best cases neighboring countries. It has excellent weather and soil which account for its fruits exports… and outside of some niche industry, is mostly reliant on tourism which means importing money. I love that country and have been many times. But if it were god forbid wiped off the face of the earth, it would be sad and annoying at best. Costa Rica has “free healthcare” / healcare from taxes because it has 5 million people, about 1/2 of New Jersey. This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and lack the honor to not state it.
- raw_anon_1111 8mo ago
  Costa Rica purposefully got rid of its military so it could provide services. It didn’t feel a need to fund three unnecessary wars in two years. Guess which other country has universal healthcare - China. They are just slightly more populous than the US. > This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and lack the honor to not state it. China does have a military… Maybe you should take your own advice. Every other country in the world seems to have figured this out.
  - nradov 8mo ago
    Please stop spreading lies and propaganda. China does not have "universal healthcare" in any meaningful sense. They may claim to have it, but it's not something that poor people can actually access for expensive treatments. Patients have to pay out of pocket for most services.
    - raw_anon_1111 8mo ago
      So let’s talk about Canada, Great Britain, every country in the EU…
      - 8mo ago
hibikir 8mo ago
It's a difficult fix, because the real issue here isn't who pays, but how much it's paid, total. If the cost of care in the US was the same as the cost in, say, Spain, the vast majority of people would have little problem paying out of pocket, and having just high deductible insurance for really big ticket items. At the same time, it'd be easy to have the government pay for it all. The US system is just very expensive in general, so it's a problem regardless of who pays for it. Most of the costs are ultimately salaries to Americans, and money handed to American companies, so most savings would come from someone's livelihood. That's why we cannot reform: The party that actually cuts costs will build resentment for decades, and create a blip of unemployment. Nobody wants to do that, and therefore you aren't going to be a serious, relentless attempt at cutting costs. We've seen how the attempts that the ACA made were counteracted by consolidation at all levels. Serious cuts have to have no mother. Say, if we ever did have an AI that worked well enough at this, and outcompeted primary care physicians. Foreign pharmacies bypassing all controls and being able to hand you much discounted drugs the day after. Telemedicine and cheap travel put together to make surgery that didn't involve an ER visit just as easy and much cheaper than using the US system. Straight out disruption, because the incentives are such we sure aren't getting improvements in regulation.
- raw_anon_1111 8mo ago
  Would doctors need to make as much money if the cost of education wasn’t so high? Would they need to charge as much if they didn’t have go have a staff to chase down payments from patients and deal with insurance companies? Not to mention that because of Bush, the government is not allowed to negotiate drug prices.

nostrebored 8mo ago

ACA enshrined the worst parts of the American healthcare system for years to come. It is a politicized victory that is the best solution for no American citizens. Places I’ve been with fully privatized healthcare or single payer are both significantly better for consumers. Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come.

lotsofpulp 8mo ago
> Insurance companies have raised prices to restore profit, were briefly a mandatory expense, and will exist for years to come. Why do their stocks underperform so badly? https://imgur.com/S8bNSM2 https://imgur.com/S8bNSM2
- rybosworld 8mo ago
  Why would a 3-year stock chart be indicative of underperformance?
  - lotsofpulp 8mo ago
    It is a 5 year chart, and the 10 year is not free on that website. You can find out similar results for longer periods here: https://dqydj.com/stock-return-calculator/ https://dqydj.com/stock-return-calculator/ https://dqydj.com/sp-500-return-calculator/ https://dqydj.com/sp-500-return-calculator/
ipsento606 8mo ago
> ACA enshrined the worst parts of the American healthcare system for years to come before the ACA, insurers could deny coverage for pre-existing conditions people have forgotten how bad things used to be
- deleted 8mo ago
  [deleted]
- CGMthrowaway 8mo ago
  We traded the cruelty of Exclusion for the cruelty of Extraction.
  - tptacek 8mo ago
    What does that mean?
    - deleted 8mo ago
      [deleted]
    - CGMthrowaway 8mo ago
      Before ACA, insurance had a more traditional "insurancey" role by excluding pre-existing conditions (aka managing moral hazard) in order to make money via premiums. In the "guaranteed issue" world post-ACA, insurance companies have pivoted instead to extracting as much money as they can from an increasingly vertically integrated ecosystem (PBMs etc)
      - raw_anon_1111 8mo ago
        You have the two mixed up. Insurance companies - even for group insurance like through your company where they always had to accept everyone - required you to have “continuing coverage” and not have gaps or you had waiting periods. The ACA also was written to enforce that through mandates and subsidies - a carrot and stick approach. The moral hazard was caused once there weren’t any mandates because of lawsuits by Republicans and the insurance companies still had to accept everyone.
deleted 8mo ago
[deleted]

SV_BubbleTime 8mo ago

Costa Rica is a beautiful country. But it is in no way “first world”. It has no military, and is effectively dependent of the US and in best cases neighboring countries. It has excellent weather and soil which account for its fruits exports… and outside of some niche industry, is mostly reliant on tourism which means importing money. I love that country and have been many times. But if it were god forbid wiped off the face of the earth, it would be sad and annoying at best. Costa Rica has “free healthcare” / healcare from taxes because it has 5 million people, about 1/2 of New Jersey. This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and lack the honor to not state it.

raw_anon_1111 8mo ago
Costa Rica purposefully got rid of its military so it could provide services. It didn’t feel a need to fund three unnecessary wars in two years. Guess which other country has universal healthcare - China. They are just slightly more populous than the US. > This isn’t some mechanism that the US just refuses to use. It’s a matter of scale. You either don’t know and should remain silent on the topic, or do know it and lack the honor to not state it. China does have a military… Maybe you should take your own advice. Every other country in the world seems to have figured this out.
- nradov 8mo ago
  Please stop spreading lies and propaganda. China does not have "universal healthcare" in any meaningful sense. They may claim to have it, but it's not something that poor people can actually access for expensive treatments. Patients have to pay out of pocket for most services.
  - raw_anon_1111 8mo ago
    So let’s talk about Canada, Great Britain, every country in the EU…
    - 8mo ago

hibikir 8mo ago

It's a difficult fix, because the real issue here isn't who pays, but how much it's paid, total. If the cost of care in the US was the same as the cost in, say, Spain, the vast majority of people would have little problem paying out of pocket, and having just high deductible insurance for really big ticket items. At the same time, it'd be easy to have the government pay for it all. The US system is just very expensive in general, so it's a problem regardless of who pays for it. Most of the costs are ultimately salaries to Americans, and money handed to American companies, so most savings would come from someone's livelihood. That's why we cannot reform: The party that actually cuts costs will build resentment for decades, and create a blip of unemployment. Nobody wants to do that, and therefore you aren't going to be a serious, relentless attempt at cutting costs. We've seen how the attempts that the ACA made were counteracted by consolidation at all levels. Serious cuts have to have no mother. Say, if we ever did have an AI that worked well enough at this, and outcompeted primary care physicians. Foreign pharmacies bypassing all controls and being able to hand you much discounted drugs the day after. Telemedicine and cheap travel put together to make surgery that didn't involve an ER visit just as easy and much cheaper than using the US system. Straight out disruption, because the incentives are such we sure aren't getting improvements in regulation.

raw_anon_1111 8mo ago
Would doctors need to make as much money if the cost of education wasn’t so high? Would they need to charge as much if they didn’t have go have a staff to chase down payments from patients and deal with insurance companies? Not to mention that because of Bush, the government is not allowed to negotiate drug prices.