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This article makes a good case for the abolition of health insurance. If everybody had to pay for medical care, medical care would need to be affordable to sur

This article makes a good case for the abolition of health insurance. If everybody had to pay for medical care, medical care would need to be affordable to survive. It's hard for me to believe that a doctor couldn't afford medical care for her husband. She just couldn't get outside of the box and consider that the treatment was more important than the cost.

ceejayoz 3mo ago
> This article makes a good case for the abolition of health insurance. Yes. > If everybody had to pay for medical care, medical care would need to be affordable to survive. How would people with zero income afford it?
- readthenotes1 3mo ago
  The way they used to before medical insurance took over that industry: charity
  - ceejayoz 3mo ago
    So everyone had their healthcare needs addressed in the 1800s? Which charities have the funding to cover a $1M NICU stay?
    - foco_tubi 3mo ago
      The more interesting hypothetical is: would a NICU stay still cost $1M if the factors inflating that cost (namely, insurance subsidizing hospital revenue) were no longer in place?
      - ceejayoz 3mo ago
        I can assure you it wouldn't be $0, or anywhere near close to that. My kiddos were born the day before the third trimester and spent two months in the hospital. Staff it at minimum wage, cap the costs at just the stuff used, and you're still talking a lot of money.
        foco_tubi 3mo ago
        No one is making the claim that the cost of service would be $0. Quite obviously. What you can't be sure of is the real cost in terms of resources, and how that would be accounted and paid for. The price of your childrens' stay, to you personally, could be far less than what you originally paid personally if healthcare was not reliant on private subsidy. You would also likely be subsidizing the costs of other children staying in the hospital through public subsidy using your tax dollars. I reckon that last point is where a lot of people in the US get hung up.
        ceejayoz 3mo ago
        > No one is making the claim that the cost of service would be $0. Quite obviously. I am making the claim that the cost will be prohibitive to handle via charity, especially as a national healthcare strategy, as proposed upthread.
        foco_tubi 3mo ago
        Do you not agree that charity/philanthropy is already an essential part of the US healthcare strategy?
        ceejayoz 3mo ago
        US healthcare costs are $16k/person/year. I do not think charity makes up a particularly signficant portion of that cost, no.
        foco_tubi 3mo ago
        That's not the question I asked, but you're still heading down the road to being incorrect. The fact is that charitable giving, need-based aid, philanthropic donations, government assistance, and other forms of subsidy fund *roughly half of the sum total American healthcare costs.* That's trillions of dollars.
foco_tubi 3mo ago
> It's hard for me to believe that a doctor couldn't afford medical care for her husband Why's that? Between mortgage, repaying education debt, supporting children, recovering from a husband's failed business venture...what is hard to believe about having trouble paying for another expense, especially after you've been reassured that the expense would be at least partially recompensated and that turns out to not be the case?
- RiverStone 3mo ago
  At a high income level, you should have more buffer for life’s events if you’ve made good decisions in your life. Generally speaking. For example, that mortgage, did you stretch the very limit of your income or did you buy something reasonable? Nobody forced you to buy a house, you could also rent or commute longer. I lived in a crappy rental for five years and commuted and was able to fully pay off my student loans at the beginning of my career. As an example Education debt can be put on forbearance or deferment under many life circumstances. Given high income level, you also have many options available to you like personal loans.
  - foco_tubi 3mo ago
    Without assuming the specifics as you do, it’s possible and entirely believable that any buffer was wiped out by the husband’s business. Access to credit could also be affected. As long as we’re throwing anecdotes, access to forbearance and deferment is shaky at best. I’ve personally had inconsistent success across various income levels.
  - broadsidepicnic 3mo ago
    yeah well I make top 1% of income earners in my country, but yet I don't have any liquid(able) assets worth high five figures. House, if I'd sell it, would likely be worth less than I paid for it before pandemic. I couldn't really pay for lets say $200k treatment for next week. It might be the string that broke camel's back, a sinkhole I could never climb out of.
  - trymas 3mo ago
    This take makes my blood boil. They had the buffer! She’s top level medical doctor with top health insurance for her family, shelling out who knows how many thousands of dollars a month for it. Those payments must have covered them, but they were denied instead. American health insurance is a total scam. UPDATE: also a minor proof in the days of wealth accumulation to the top 0.00001%, that (seemingly) wealthy Californian doctors and entrepreneurs are much much closer to bankruptcy than many of us could think.
jmpman 3mo ago
An alternative approach would be health care for all - with the caveat that there is NO private pay option. The unfortunate situation is that that ultra wealthy have greater influence over the political process due to citizens united, and are also the ones who would benefit from lower funding towards public health care. With their ability to access premium treatment via a private option, their incentive is to use their political influence to lower public health care spending, without any negative impact on their own health.
- tliltocatl 3mo ago
  > with the caveat that there is NO private pay option I don't think there is a society in the world that ever had that successfully executed in practice. I live in Norway, and even if the public heath system is probably as good as it gets here, I often use private providers for non-urgent things simply because waiting time can be up to six month otherwise. And even if you somehow manage this on paper, you'll be very surprised on how markets work. They don't need legal recognition. They don't even need money. See: USSR. Health care was public and medics weren't even a particularly attractive profession because there were too much of them already. Still if you wanted to survive an appointment you'd better have a package of some deficit wares ready. What denies public healthcare money isn't "wealthy trying to cut public spending down". It's bureaucrats wanting their share of the pork barrel.
xtracto 3mo ago
I think for profit Health Insurance is a straight 100% scam. The only service where you pay a company for a service and when you need that service they spend as much money as possible to avoid giving you that service. But... I've come to realize that it is impossible to make people understand it or change it. So, I've been proposing a lesser change: In theory Insurance companies business model is to hedge against the risk of people getting sick ok? Well, let's make the bet fair and remove them the ability to decide who gets covered and who doesn't. In the case of the original article: Let a neutral third party panel of professionals be the ones that decide whether the Health Insurer has to cover or not the case. Otherwise, Insurers are behaving like Casinos that decide to pay or not to pay to people who win a game.

ceejayoz 3mo ago

> This article makes a good case for the abolition of health insurance. Yes. > If everybody had to pay for medical care, medical care would need to be affordable to survive. How would people with zero income afford it?

readthenotes1 3mo ago
The way they used to before medical insurance took over that industry: charity
- ceejayoz 3mo ago
  So everyone had their healthcare needs addressed in the 1800s? Which charities have the funding to cover a $1M NICU stay?
  - foco_tubi 3mo ago
    The more interesting hypothetical is: would a NICU stay still cost $1M if the factors inflating that cost (namely, insurance subsidizing hospital revenue) were no longer in place?
    - ceejayoz 3mo ago
      I can assure you it wouldn't be $0, or anywhere near close to that. My kiddos were born the day before the third trimester and spent two months in the hospital. Staff it at minimum wage, cap the costs at just the stuff used, and you're still talking a lot of money.
      - foco_tubi 3mo ago
        No one is making the claim that the cost of service would be $0. Quite obviously. What you can't be sure of is the real cost in terms of resources, and how that would be accounted and paid for. The price of your childrens' stay, to you personally, could be far less than what you originally paid personally if healthcare was not reliant on private subsidy. You would also likely be subsidizing the costs of other children staying in the hospital through public subsidy using your tax dollars. I reckon that last point is where a lot of people in the US get hung up.
        ceejayoz 3mo ago
        > No one is making the claim that the cost of service would be $0. Quite obviously. I am making the claim that the cost will be prohibitive to handle via charity, especially as a national healthcare strategy, as proposed upthread.
        foco_tubi 3mo ago
        Do you not agree that charity/philanthropy is already an essential part of the US healthcare strategy?
        ceejayoz 3mo ago
        US healthcare costs are $16k/person/year. I do not think charity makes up a particularly signficant portion of that cost, no.
        foco_tubi 3mo ago
        That's not the question I asked, but you're still heading down the road to being incorrect. The fact is that charitable giving, need-based aid, philanthropic donations, government assistance, and other forms of subsidy fund *roughly half of the sum total American healthcare costs.* That's trillions of dollars.

foco_tubi 3mo ago

> It's hard for me to believe that a doctor couldn't afford medical care for her husband Why's that? Between mortgage, repaying education debt, supporting children, recovering from a husband's failed business venture...what is hard to believe about having trouble paying for another expense, especially after you've been reassured that the expense would be at least partially recompensated and that turns out to not be the case?

RiverStone 3mo ago
At a high income level, you should have more buffer for life’s events if you’ve made good decisions in your life. Generally speaking. For example, that mortgage, did you stretch the very limit of your income or did you buy something reasonable? Nobody forced you to buy a house, you could also rent or commute longer. I lived in a crappy rental for five years and commuted and was able to fully pay off my student loans at the beginning of my career. As an example Education debt can be put on forbearance or deferment under many life circumstances. Given high income level, you also have many options available to you like personal loans.
- foco_tubi 3mo ago
  Without assuming the specifics as you do, it’s possible and entirely believable that any buffer was wiped out by the husband’s business. Access to credit could also be affected. As long as we’re throwing anecdotes, access to forbearance and deferment is shaky at best. I’ve personally had inconsistent success across various income levels.
- broadsidepicnic 3mo ago
  yeah well I make top 1% of income earners in my country, but yet I don't have any liquid(able) assets worth high five figures. House, if I'd sell it, would likely be worth less than I paid for it before pandemic. I couldn't really pay for lets say $200k treatment for next week. It might be the string that broke camel's back, a sinkhole I could never climb out of.
- trymas 3mo ago
  This take makes my blood boil. They had the buffer! She’s top level medical doctor with top health insurance for her family, shelling out who knows how many thousands of dollars a month for it. Those payments must have covered them, but they were denied instead. American health insurance is a total scam. UPDATE: also a minor proof in the days of wealth accumulation to the top 0.00001%, that (seemingly) wealthy Californian doctors and entrepreneurs are much much closer to bankruptcy than many of us could think.

jmpman 3mo ago

An alternative approach would be health care for all - with the caveat that there is NO private pay option. The unfortunate situation is that that ultra wealthy have greater influence over the political process due to citizens united, and are also the ones who would benefit from lower funding towards public health care. With their ability to access premium treatment via a private option, their incentive is to use their political influence to lower public health care spending, without any negative impact on their own health.

tliltocatl 3mo ago
> with the caveat that there is NO private pay option I don't think there is a society in the world that ever had that successfully executed in practice. I live in Norway, and even if the public heath system is probably as good as it gets here, I often use private providers for non-urgent things simply because waiting time can be up to six month otherwise. And even if you somehow manage this on paper, you'll be very surprised on how markets work. They don't need legal recognition. They don't even need money. See: USSR. Health care was public and medics weren't even a particularly attractive profession because there were too much of them already. Still if you wanted to survive an appointment you'd better have a package of some deficit wares ready. What denies public healthcare money isn't "wealthy trying to cut public spending down". It's bureaucrats wanting their share of the pork barrel.

xtracto 3mo ago

I think for profit Health Insurance is a straight 100% scam. The only service where you pay a company for a service and when you need that service they spend as much money as possible to avoid giving you that service. But... I've come to realize that it is impossible to make people understand it or change it. So, I've been proposing a lesser change: In theory Insurance companies business model is to hedge against the risk of people getting sick ok? Well, let's make the bet fair and remove them the ability to decide who gets covered and who doesn't. In the case of the original article: Let a neutral third party panel of professionals be the ones that decide whether the Health Insurer has to cover or not the case. Otherwise, Insurers are behaving like Casinos that decide to pay or not to pay to people who win a game.