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142 points helloworld | 23 comments | | HN request time: 0.282s | source | bottom
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seibelj ◴[] No.12306806[source]
Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?
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VonGuard ◴[] No.12306849[source]
There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is very much in the pocket of the health care industry. As such, the markets were a compromise measure enacted by congress to make it easier for people to choose health care. Before Obamacare, it was sort of a black box where only HR people could figure out pricing structures and health care providers didn't really compete in any way with each other.

Obamacare did do some good things that needed to be done, but essentially, everything about it was a bandaid intended to kick this shitty system down the road to the next person who had to deal with it. But hey, at least health care companies can't just turn you down because you have Diabetes or are too fat anymore.

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1. Frondo ◴[] No.12306935[source]
Obamacare has had one significant, lasting effect: culturally, the idea is now that everyone should have access to health care. That's the default. Bringing in a public option will be an easy, natural next step, if not for Clinton, then for whoever succeeds her.
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2. VonGuard ◴[] No.12307225[source]
If Clinton brings us single payer, I will worship at her altar forever. She used to promise this stuff in the 90's, but basically gave it all up when she actually went into politics and gained public office, later saying single payer will not work.

If she does get us single payer, she's the greatest trojan horse ever in American politics.

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3. nappy-doo ◴[] No.12307299[source]
> If she does get us single payer, she's the greatest trojan horse ever in American politics.

Arguably, that'd be Trump instead of Clinton.

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4. sweettea ◴[] No.12307336[source]
I believe statistics say that expanding Medicaid added 8 million covered folks, about 15% of uninsured Americans, and otherwise Obamacare has only gotten an additional few percent of uninsured Americans to become insured. I don't think the norm is that everyone should have access to health insurance any more than it was before due to Obamacare's negligible increases in coverage.

[http://www.heritage.org/research/reports/2014/10/obamacares-...]

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5. Frondo ◴[] No.12307526[source]
Oh, I'd agree completely that, as an implementation of universal health care, Obamacare falls far short. I always say, it's better than what preceded it, but that is a pretty low bar to achieve.

(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)

But while the implementation is pretty poor, the idea behind it is significant: everyone should have access to health care. Not just tied to a job, not just if you've got lots of money. It isn't working great, but that's the goal at least.

I know there are still lots of people who come back with opposition to that idea (even in these comments a few people are trotting out the whole "universal health care is slavery" junk), but whatever, there are people who oppose all kinds of things. Obama shifted the playing field of expectations, and good things will come as a result of that. That's all I'm trying to say.

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6. harryh ◴[] No.12307658{3}[source]
(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)

Probably you were denied personal health insurance not for BS reasons, but because the insurance companies knew they would (probabilistically) lose money insuring you. But now under Obamacare, if they participate on the exchanges, they are obligated to sell to you. So, shockingly, we see that most companies operating on the exchanges lose money doing so.

Your inability to get coverage before and the problems that Aetna is having today are very closely related.

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7. VonGuard ◴[] No.12307699{3}[source]
I think Trump is more of an infected pot of filth catapulted over the walls... Not sure he's hiding much.
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8. eecc ◴[] No.12308027{4}[source]
you're suggesting the guy should throw himself off a cliff?
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9. harryh ◴[] No.12308059{5}[source]
I'm not suggesting he do anything. In fact, I think his story is a great example of what makes the economics of health care so challenging.

I was merely pointing out a connection from his personal story to the general topic of conversation that a lot of people don't seem to realize.

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10. jessaustin ◴[] No.12308086{4}[source]
I'm torn. Sometimes I think Trump would be the most average President ever, and sometimes I think we have no idea at all what he would do. I'm quite sure it's unlikely he'll do anything that he's campaigned on. Wall-building is work.
11. lemmsjid ◴[] No.12308208{3}[source]
Same exact scenario here, except a kidney problem. It was a nightmare to get back into coverage and required ultimately working for a large company.

Since that happened I've always thought the lack of universal healthcare was a major cultural lever against entrepreneurship and small business ownership, because stable healthcare coverage is probably the number one draw of working a corporate job. It seems so culturally odd to me that employment and healthcare are so linked in the U.S.

Unfortunately I think some people don't understand how existentially frightening it is to get a bunch of rejection letters from insurance companies until it happens to them.

12. seanp2k2 ◴[] No.12308259{6}[source]
When the marker they use to draw a dot on where they need to cut you during surgery costs $50, it's hard for me to believe that the problem with health care is insurance companies not making enough money. Why does all this stuff cost so much in the first place? Medical equipment prices seem so far separated from reality that it's seriously laughable, and it'd be funny if it wasn't everyone who had to find a way to afford this junk. Go look at some prices for medical equipment (where you can even find prices) and see if those prices seem reasonable to you for the equipment.

Let's find a way to fix that? This doesn't even touch how some hospitals / networks must buy from a specific vendor, or how vendors sell packages which include things the buyer doesn't need (at the same exorbitant prices).

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13. Broken_Hippo ◴[] No.12308491{4}[source]
Well, not really. I had my gall bladder out about '08. I couldn't eat properly before it got out. It wasn't emergency, but the pain put me in the emergency room more than once. I didn't have gallstones, it quit working. It has been years since I got it out. I still have a few problems eating greasy foods (especially meat), but now generally avoid those and am mostly vegetarian. No other complications, and I have not required any sort of care for that surgery outside of that. Neither has my brother, who got his out about 5 years ago. Neither has my mother, who got hers out in 1978.

This type of thing isn't so much a pre-existing condition as much as they are "I had a health issue that was more severe than a simple infection". It isn't the same as "I have diabetes" or "I have chronic issues with x", which can cause expenses.

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14. harryh ◴[] No.12308509{5}[source]
See #2 here: https://news.ycombinator.com/item?id=12308243

I'm actually quite curious about this.

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15. Frondo ◴[] No.12308834{6}[source]
About being rejected from buying my own health insurance, based on a surgery I'd had, I think that the question of whether it's "smart" or "dumb" for insurers to do so is irrelevant.

Especially in a modern society, that decision-making process is no more relevant than asking whether it's OK to dump toxic waste into the river, because the fines could be cheaper than processing such waste safely.

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16. harryh ◴[] No.12308872{7}[source]
Private companies refusing to sell insurance to someone where they will lose money on the transaction is not at all like dumping toxic waste into a river.

If insurance companies can't make money (or at least break even) for a certain population then they are't a viable means of making sure care is payed for, and we need to develop alternate policies to make things work.

So it's actually very very relevant to understand the decision-making process of insurance companies in these situations.

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17. AnimalMuppet ◴[] No.12308921{8}[source]
True, but Frondo also has a point. If insurance companies can cherry-pick individuals and refuse to sell to specific individuals where the insurance company is more likely to lose money, that's... not good. It kind of defeats the point of insurance, in fact.

If Obamacare-as-a-block is business they don't want, they shouldn't have to take it. If it's a subset of individuals, I'm less sympathetic.

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18. harryh ◴[] No.12308957{9}[source]
Indeed. Obamacare-as-a-block was specifically designed to try to eliminate this cherry picking of individuals. But it's turning out that the solution might not be adequate because insurance companies are choosing to just abandon the whole block. That's what I meant with my "closely related" comment above.

And if the Obamacare exchanges don't work, that's no good either!

As I said elsewhere, the economics of health care are very challenging.

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19. Frondo ◴[] No.12309209{10}[source]
This is a discussion the rest of the western world has had and solved in various ways over the last fifty years. The economics of health care isn't a new mystery the world has never before seen, for us to unravel here, it's a matter of policy where we're just lagging behind the rest of the west.

That's why I find these questions irrelevant.

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20. ◴[] No.12309264{11}[source]
21. wtbob ◴[] No.12309830{7}[source]
> When the marker they use to draw a dot on where they need to cut you during surgery costs $50, it's hard for me to believe that the problem with health care is insurance companies not making enough money.

The insurance companies are the ones paying for that $50 dot. Well, after their discounts it's probably a $10 dot.

It was either Time or Newsweek a few years back which had an excellent long-form article on where health-care spending goes. As I recall, it's not the insurance companies: it's the hospitals, physicians, nurses, other staff and an army of hangers-on and middlemen.

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22. infinite_beam ◴[] No.12309984{8}[source]
Bitter Pill: Why Medical Bills Are Killing Us By Steven Brill Time Magazine Feb. 20, 2013. http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,Medical...
23. danielweber ◴[] No.12313221[source]
I have low-income friends who have no more access to health care now than they did 8 years ago. They either wade through Medicaid paperwork, or have huge deductible plans, or just have no insurance at all. (I don't know what they are doing about the penalty.)