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I, Health Insurer
- jonaldomo 13y agoI couldn't agree more with the statement: 'Insurance is fraught with paradoxes.'
- humanrebar 13y agoI was going to write a reasoned rebuttal to this post, but by the time I got to the bottom, it read like so much astroturf.
- pbreit 13y agoPlease do rebut. Based on the AstroTurf comment, hard to think you will be convincing at all.
- humanrebar 13y agoA quick example is the obvious contradiction in the following quotes from the blog: > With healthcare, the free market has clearly failed. > Does this even qualify as a “free market”? I don’t think so. Later the post pulls out some talking points about Mitt Romney and some conservative think tanks, which are definitely relevant if you are trying to score political points instead of discussing healthcare policy. The closing section that glosses over the big problems with centralized planning systems (broken promises with no legal recourse, implementation issues caused by politics interfering with sound decision making) and finishes with enthusiastic exclamation points: > Now this is what a free market looks like! > Wow! > This is a time to be proud. It seems like political cheerleading to me, but maybe I'm missing something. To summarize this piece, it seems like this guy felt guilty for working at an insurance company, but now he feels better because the he politically supports the ACA, which he feels is going pretty well. Is there an apolitical thesis for this blog post that I'm missing? Why was it written if not to express a political position? EDIT: The Romney and think tank thing is clearly an association fallacy. I don't want to get into pointless political bickering, which is why I was hesitant to comment in the first place. I brought up that part of the article because it only serves this sort of tangent instead of furthering the (IMO much more interesting) discussion of healthcare costs, policy, and incentives.
- rm445 13y agoAll opinions are political in some sense. However the author is a very well-known writer in the field of computer programming - as opposed to a political figure or someone of an unknown provenance. If you wish to dismiss his writing as fake grass roots rather than genuine, the burden of proof is on you.
- humanrebar 13y agoAh. I'm not familiar with the author. It may not be astroturf, but it reads like it. That's a rather unfortunate direction the author took, then. It finishes in a political argument, far from the interesting personal narrative about working in insurance that it initially seemed to be.
- sanderjd 13y agoYou may enjoy a book he wrote called CODE[0], which is one of my absolute favorites, but I doubt it will convince you to share his political opinions. 0: http://www.amazon.com/Code-Language-Computer-Hardware-Software/dp/0735611319 http://www.amazon.com/Code-Language-Computer-Hardware-Softwa...
- jbooth 13y agoIt was a breakdown of various ways the incredibly distorted healthcare market fails. The word 'free' is so politically overloaded that using it in multiple ways isn't a contradiction, although you could call it sloppy if you wanted. The post does make reference to politics, but it also has cogent argument about why market conditions lead to a downward spiral of gametheory when it comes to insurance and something you only have one of, like your body. So that's the thesis. I think he feels better because, as a free-lancer, he finally has the ability to shop for providers, instead of being locked into one because he's terrified about what 'pre-existing conditions' have come into existence since the last time he shopped.
- MisterBastahrd 13y agoYes, because when discussing the history of healthcare in this country, Mitt Romney and conservative think tanks had nothing to do with the direction of policy. You can't rebut anything he's said, but you're obviously upset that he said it anyway.
- bradleyjg 13y agoI understand astroturf to mean an organized group that purports to be grassroots (i.e. driven by broad membership) but is instead organized, funded, and run by a coterie paid by some outside entity. It's hard to see how a post by an individual relating his own opinions and experiences can possibly fit that term. It seems like a category error. Did you have some other definition in mind?
- pbreit 13y agoSingle-payer is inappropriate for the USA. Many other countries have made non-single-payer systems work well. Otherwise, a refreshing article. Our current system is the most free-market in the developed world and near the bottom in most categories (most expensive with worst outcomes).
- aaronbrethorst 13y ago> Single-payer is inappropriate for the USA. Citation needed.
- pbreit 13y agoCitation for an opinion? But see above.
- sirkneeland 13y agoWell the most efficiently functioning welfare states are ones that serve small and homogeneous populations. The United States is neither small nor homogeneous (and it is incredibly geographically dispersed for extra kicks). The largest country in Europe (Germany) has a population that is less than 1/3 the that of the United States, and more homogeneous than every US state (let alone all of them combined) with the possible exception of Vermont. And I bet even within Europe you would find the best and most efficient healthcare, education and other public services come from the smaller countries. Finland and Norway likely to better than Germany and France. Given how many of us deal with challenges of "scaling up" tech, processes and organizations as part of our jobs, I'm surprised more people don't really seem to consider the practical limitations of scale for projects of government.
- bryanlarsen 13y agoCanada is larger, more geographically dispersed and less homogeneous than the United States, and yet manages to have a functioning single-payer medical system.
- 13y ago
- parennoob 13y agoEven after you are fully insured, say with an 80-20 policy, healthcare costs in the US can be high enough to bankrupt someone, as many people in this recent thread reported (http://www.reddit.com/r/pics/comments/1tugnm/i_never_truly_understood_how_much_healthcare_in/ http://www.reddit.com/r/pics/comments/1tugnm/i_never_truly_u...) This scared me like anything when I first saw it. Any steps that the HN crowd can suggest to pre-empt such costs (I know that there might be very little you can do, but figured every little helps.)
- humanrebar 13y agoThere have always been disasters, disease, and death. No financial instrument will 100% protect everyone from those things. Any scheme (market- or bureaucracy-based) that guarantees to cover everybody from healthcare costs is a fool's errand because people will spend themselves poor, lie, cheat, and steal to stay alive. That being said, the best things to do are the obvious things. Take care of yourself (no smoking habits, no binge drinking). Tell your doctor about your family medical history so you can keep an eye out for hereditary diseases. Live below your means. Have an emergency fund -- a huge one if you're especially concerned. But besides all that, bankruptcy exists for this sort of situation. Sometimes life sucks and there should be a way to hit a reset button and move on.
- pravda 13y ago>Any scheme (market- or bureaucracy-based) that guarantees to cover everybody from healthcare costs is a fool's errand because people will spend themselves poor, lie, cheat, and steal to stay alive. I hear talk of far-off countries, where no one goes bankrupt from medical expenses.
- jkrems 13y agoNah, that's just fairytales.
- humanrebar 13y agoTo rephrase, giving everyone a blank check to pay for healthcare will never work. Many countries that provide universal healthcare either have budget problems or financial situations not true of the U.S. (small size, proportionally large oil reserves). Even then, at the end of the day, someone still says no to some costs.
- WalterBright 13y agoRegarding health care being a failure of the free market, I recommend this (rather long) article for some perspective: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/?single_page=true http://www.theatlantic.com/magazine/archive/2009/09/how-amer...
- humanrebar 13y agoOne of the biggest disappointments for me about the ACA was that it didn't address one of the most obvious problems with the American healthcare system -- the significant discount for employer-provided healthcare.
- IbJacked 13y agoIs employer-provided healthcare discounted, or merely subsidized by the employer (or both)? The plan through my employer seemed inexpensive, but they were paying a significant portion of the premium.
- bradleyjg 13y agoIt depends on exactly what you mean by discounted, but in a very real way the answer is both. First there's the obvious, and quite significant, tax benefits to employer provided healthcare over private purchased healthcare. In the former case, neither the employer nor the employee pay payroll taxes on their contributions and the employee portion is also exempted from income tax (the employer also doesn't pay income tax on its contribution, but it wouldn't for cash salary either). Second, more subtly, the group market faces much more favorable underwriting than the individual market. Even if non-employer group health insurance were allowed (which it isn't anymore under ACA) such groups are always subject to self-selection bias and thus are unlikely to be underwritten as as favorably. However, this point is somewhat tricky because there are both cross-subsidies and gross economic surpluses, which can be hard to untangle.
- jacobn 13y agoIt's tax deductible for the company to offer employees health care, but individual plans bought by individuals on the exchanges are not. So it's effectively subsidized in one case but not the other.
- sehugg 13y agoOne of the actuaries where I worked wrote a paper or gave a talk somewhere that I found very thought-provoking. In the future, he said, healthcare costs might rise to be as high as 50% or even 90% of GDP, and there would be nothing intrinsically wrong with that. It would simply reflect our evolving priorities of valuing good health more than anything else in our lives. If this is a real person giving a real talk that was taken seriously by other professionals, then that is terrifying (it's already ~20% GDP and climbing).
- ojbyrne 13y agoWhy necessarily? If GDP grew overnight by 10x, and 90% of that went to health care, and as a result (hypothetically) we lived to an average life span of 300, would that not be a positive result?
- lostlogin 13y agoGiven how I feel today, 1/1/14, there is no way I could cope with that many New Years.
- humanrebar 13y agoBecause then the entire country would essentially be working to stay alive and healthy instead of towards loftier goals.
- anonymoushn 13y agoHow much of the increased spending do we expect to be higher prices for the same care, and how much of it do we expect to be new types of care? Thus far there has been a lot of the former.
- toomuchtodo 13y agoPerhaps we should look on delivering healthcare more efficiently. Automate what you can, drive down the remaining human costs.
- gmac 13y ago
- ap22213 13y agoSo many health care posts and rebuttals these days. Surely a highly important issue for us collectively. But, also so political, and as a side-effect so prone to defensive stances. As hackers, perhaps a good approach to these types of arguments, would be to throw out far-out ideas, if even just to push the collective pointer one way or another. So here's my far out idea: Maybe, instead of a single payer system, the gov't should pay each family a penalty fee (scaled exponentially) for each each family member that precedes the average, current life expectancy target (or even acquires a terminal illness). This will shift focus to the very sick or those at risk of being very sick. And, it would thereby eliminate any particular diseases or genetic limitations that push down the life expectancy. Of course, the unintended consequences would be that some family members would start killing off other family members for benefit. But, this would just highlight psychopaths, and thus be a win-win long run.
- wehadfun 13y agonot related to the article, but I love the simplicity of the site. No Facebook plugins, twitter BS, huge images, ... Even the comment section didn't have a any crap. beautiful.
- gcb0 13y agoeveryone with half a brain can see the system is awful at healing people... But everyone attributes it to incompetence while forgetting that the US, besides nazi Germany, was the only country to have eugenics into law.
- twoodfin 13y agoIt's important to note that New York is one of the states from which ACA looks better than most: New York's announcement this week that insurance premiums would drop 50% next year for individuals buying their own coverage in new online marketplaces made good talking points for proponents of the Affordable Care Act, but consumers in most states are unlikely to see similar savings. That's because only a handful have New York's rules, which — like the federal law — bar insurers from rejecting people with health problems. Unlike the federal law, however, New York does not require consumers to purchase coverage, so over time, mainly older, sicker people, have purchased coverage. That drove up prices and discouraged younger, healthier people from buying policies, as did a requirement that insurers charge the same rates regardless of age or health status. As a result, premium prices listed for individuals often top $1,000 a month for some New Yorkers buying their own coverage, making the state's rates among most expensive in the nation. http://www.usatoday.com/story/news/politics/2013/07/20/kaiser-new-york-insurance-premiums/2570873/ http://www.usatoday.com/story/news/politics/2013/07/20/kaise... And the old New York model of a lousy risk pool with unaffordable premiums is where ACA is potentially headed if the individual mandate "tax" isn't given much teeth.
- bradleyjg 13y agoI've followed NY insurance premiums in the individual and small business market carefully for the last several years, and it is very hard for me to see how anyone came up with the 50% drop statistic. The linked article doesn't really help unfortunately. The only thing I can think of is that they are comparing apples to oranges. The standardized plans available in the exchange are somewhat different from almost all plans that were available last year in the private market. In particular, and surprising to many not paying close attention, none of the exchange plans downstate have any out-of-network coverage at all. Not even the usual and customary rate reimbursement. So while it's true that you could easily have paid $1000/month or more for an individual health care plan last year (and remember NY has even stricter community ratings than ACA, everyone pays the same) it isn't true that the same plan is $500/month on the exchange.
- humanrebar 13y agoI'm not an expert, but I hear that ACA platinum plans cover 90% of costs, which is a lower coverage level than some pre-ACA plans.
- ed_blackburn 13y agoI am UK citizen and see the NHS (universal, nationalised, funded from taxation) morphing to accommodate more market led enterprise. I often wonder how other nations health systems work. The American system is often ridiculed anedotally in the UK as an unfair example.
- a3n 13y ago> With healthcare, the free market has clearly failed. The United States now has the highest per capita healthcare costs in the world, but not a commensurate level of health, ... Because you aren't buying health. You're buying health insurance. It may come with free assumptions, but those are generally worthless, and they are not health either. If you want a thing, you should buy that thing. Health insurance is not health, and absolutely everyone who buys health insurance gets exactly what they pay for: insurance. Whether that indirectly results in health depends on the individual policy.
- jjoonathan 13y ago> Health insurance is not health, and absolutely everyone who buys health insurance gets exactly what they pay for: insurance. Part of his point is that people often pay for health "insurance" and don't receive the insurance they thought they were paying for (their "insurance" provider drops them the moment they get sick). You can blame people for not being able to understand the plans they are buying (dozens of pages of dense, industry-specific terminology) but you might as well blame the sky for being blue. One of the things the ACA does is make it easy to compare plans so that insurance companies actually have to compete against one another. > If you want a thing, you should buy that thing. There are two problems health insurance solves that make direct purchase of health care a complete non-starter. * 1: Most people have insufficient cappitalization to accept the heavily skewed risk profile. * 2: If you purchase emergency care at the point of provision, you are either forced to accept the terms "offered" by an effective monopoly (if you are conscious) or you are forced to pay whatever the "care" provider wants after the fact (if you are not conscious).
- a3n 13y ago> You can blame people for not being able to understand the plans they are buying Hmm, didn't mean to sound like I'm blaming people. I'm mostly just raging impotently at the fact that for most people the only meaningful way to get at health care is through health insurance, whose motivation is to not give it to you, good and hard. Given the costs and accessibility of modern medicine, I recognize that it would also be difficult for most people to pay directly. I would prefer, though, that we did that through a single payer (government) arrangement, the same way we pay for national defense. (The difference being, of course, that national defense is required by the Constitution, and health is not.)
- dllthomas 13y ago"If a misstatement is discovered, the policy would be declared null and void, and any premiums paid would be refunded." ... not in my experience.