4 ms·

Agreed. In my mind that is the second biggest problem the system has. The first is the lack of an open market accepting only direct payments. Oddly, neither on

Agreed. In my mind that is the second biggest problem the system has. The first is the lack of an open market accepting only direct payments. Oddly, neither one of those was fixed in with the recent reforms.

DiabloD3 11y ago
The Republicans (representing the insurance companies, essentially lobbying on their behalf as opposed to merely being lobbied to) were the largest proponents against such changes, as it would cost the Republicans tens or hundreds of millions of dollars out of their private investment accounts.
- dantheman 11y ago
  The ACA was passed with zero republican votes - so it's hard to say their love for insurance companies is the reason it is the way it is.
- caseysoftware 11y ago
  The insurance companies lobbied heavily in favor of the ACA as written. After all, millions of people would now be required to buy their product and if the person couldn't afford it, the government would cover some portion of the gap. The real bill - total liabilities - will be paid later by the next CEO/management but the current people got their bonuses.
- PKop 11y ago
  Do you have a source for this? The ACA itself a huge boon to the insurance companies is it not? And conservatives opposed this bill strongly, for one reason because it adds layers of bureaucracy between doctors and patients that inflate and hide costs to the consumer. Also it mandates purchase of insurance (surely a benefit to insurance companies) which they strongly opposed. My point is simply, one could easily argue that the Democrats would be the largest opponents of such changes because of the very nature of the affordable care act, and as a libertarian / conservative myself I'm absolutely for policy that increases direct payment, price transparency and a more open market in health insurance. I'd be interested to see who opposed this.
waps 11y ago
Health care is famous for being one of the primary examples where the structure of the "market" makes competition impossible. Firstly, when you need healthcare, there is likely to be little warning, and it's a "care NOW or death" situation. Corporations feel that's exactly the time to ask for a million bucks for the "service" and people naturally feel like not paying for it. I side with people. The counterargument is essentially malthusian[1] : if we do that, eventually the whole economy will be healthcare (because evolution means the cases of the sick will become more and more expensive until the system fails). The huge problem with malthusian arguments is simple. Since their invention in 1798, not a single person has died due to a malthusian cause. No state has been devastated because of the effect described. The malthusian argument itself, however, can be argued to have killed more than 100 million people in the 20th century, and was used as justification for dozens of massacres, genocides and wars. I doubt it was ever the "real reason", but ... So malthusianism, which is the main reason we can't just decide to guarantee healthcare for everybody, is a theoretical argument that (so far) has proven entirely wrong. Everytime we moved in the direction of a malthusian catastrophy we compensated effectively without disaster. But the theory itself has been used as the justification for a number of catastrophies. It is the poster child for the idea of "the cure is worse than the disease". And you hear people advocating it directly too : privatising healthcare is much more expensive than just curing everybody (to the extent modern medicine can do so). [1] https://en.wikipedia.org/wiki/Malthusianism https://en.wikipedia.org/wiki/Malthusianism
richmarr 11y ago
Without meaning to kick the political hornets-nest... the real problem is trying to fund healthcare through insurance at all. It creates moral hazard, conflicting incentives and information asymmetry, which combine to make it an extremely inefficient market. A efficiency comparison; Medicare alone (which only covers the elderly and disabled) costs the US more per capita than the NHS costs the UK to cover the entire population. I'm not claiming that state-funded medicine is the perfect solution, and it has its downsides, but without those toxic incentives caused by insurance it generates much better health outcomes per dollar.

DiabloD3 11y ago

The Republicans (representing the insurance companies, essentially lobbying on their behalf as opposed to merely being lobbied to) were the largest proponents against such changes, as it would cost the Republicans tens or hundreds of millions of dollars out of their private investment accounts.

dantheman 11y ago
The ACA was passed with zero republican votes - so it's hard to say their love for insurance companies is the reason it is the way it is.
caseysoftware 11y ago
The insurance companies lobbied heavily in favor of the ACA as written. After all, millions of people would now be required to buy their product and if the person couldn't afford it, the government would cover some portion of the gap. The real bill - total liabilities - will be paid later by the next CEO/management but the current people got their bonuses.
PKop 11y ago
Do you have a source for this? The ACA itself a huge boon to the insurance companies is it not? And conservatives opposed this bill strongly, for one reason because it adds layers of bureaucracy between doctors and patients that inflate and hide costs to the consumer. Also it mandates purchase of insurance (surely a benefit to insurance companies) which they strongly opposed. My point is simply, one could easily argue that the Democrats would be the largest opponents of such changes because of the very nature of the affordable care act, and as a libertarian / conservative myself I'm absolutely for policy that increases direct payment, price transparency and a more open market in health insurance. I'd be interested to see who opposed this.

waps 11y ago

Health care is famous for being one of the primary examples where the structure of the "market" makes competition impossible. Firstly, when you need healthcare, there is likely to be little warning, and it's a "care NOW or death" situation. Corporations feel that's exactly the time to ask for a million bucks for the "service" and people naturally feel like not paying for it. I side with people. The counterargument is essentially malthusian[1] : if we do that, eventually the whole economy will be healthcare (because evolution means the cases of the sick will become more and more expensive until the system fails). The huge problem with malthusian arguments is simple. Since their invention in 1798, not a single person has died due to a malthusian cause. No state has been devastated because of the effect described. The malthusian argument itself, however, can be argued to have killed more than 100 million people in the 20th century, and was used as justification for dozens of massacres, genocides and wars. I doubt it was ever the "real reason", but ... So malthusianism, which is the main reason we can't just decide to guarantee healthcare for everybody, is a theoretical argument that (so far) has proven entirely wrong. Everytime we moved in the direction of a malthusian catastrophy we compensated effectively without disaster. But the theory itself has been used as the justification for a number of catastrophies. It is the poster child for the idea of "the cure is worse than the disease". And you hear people advocating it directly too : privatising healthcare is much more expensive than just curing everybody (to the extent modern medicine can do so). [1] https://en.wikipedia.org/wiki/Malthusianism https://en.wikipedia.org/wiki/Malthusianism

richmarr 11y ago

Without meaning to kick the political hornets-nest... the real problem is trying to fund healthcare through insurance at all. It creates moral hazard, conflicting incentives and information asymmetry, which combine to make it an extremely inefficient market. A efficiency comparison; Medicare alone (which only covers the elderly and disabled) costs the US more per capita than the NHS costs the UK to cover the entire population. I'm not claiming that state-funded medicine is the perfect solution, and it has its downsides, but without those toxic incentives caused by insurance it generates much better health outcomes per dollar.