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142 points helloworld | 9 comments | | HN request time: 1.643s | source | bottom
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Apocryphon ◴[] No.12307113[source]
So how can consumers respond to this corporate chicanery? In a capitalist system, the natural recourse is for citizens to turn to the private market for alternatives. Could this provide an incentive for Aetna's competitors to make it easier for Aetna's customers to switch to them?

One would assume that libertarians and free marketeers would cheer the concept of boycotts, as it is one of the mechanisms that citizens are empowered with in a laissez-faire society.

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rayiner ◴[] No.12307162[source]
What corporate chicanery? They took a loss on exchange plans last year. They have every right to pull out of the exchanges until the government makes them stay.

I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-subsidization, propping up money-losing individual plans with profits from group plans. And then they berate companies for pulling out of money-losing enterprises, as if providing healthcare for people who can't afford it is the job of private companies rather than the government.

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1. tptacek ◴[] No.12307484[source]
You're a supporter of single payer? Health care is something like a fifth of the whole US economy. You're comfortable with the USG setting prices for it?
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2. harryh ◴[] No.12307678[source]
I don't know about single payer, but health care is tricky. What do we do (as a society) about this guy: https://news.ycombinator.com/item?id=12307526

He has his gallbladder out and all of a sudden he's a super risky person to insure. How do we get him in a risk pool where his premiums won't be unaffordable?

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3. tptacek ◴[] No.12308102[source]
By shifting more of the group insurance market onto the individual market, perhaps mostly by eliminating current incentives for employer group coverage, to minimize the adverse selection problem.

Incidentally: two members of my immediate family have the same problem he does. No history of serious illness, no current health problems, probably healthier than the median in both cases for their age cohort, but uninsurable outside the exchanges due to bogus pre-existing condition rules.

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4. harryh ◴[] No.12308243{3}[source]
1) Can we make the individual mandate in the individual market strong enough to really eliminate (or at least minimize) the adverse selection problem?

I am unconvinced that we can. Perhaps though.

2) Are you really convinced that the pre-existing rules you encountered were bogus? Are insurance companies just dumb when it comes to this sort of thing? I tend to assume, absent other evidence, that insurance companies will be profit seeking so would only turn people down if they expected to (probabilistically) lose money on the deal. Perhaps they're just not smart enough to discern differences at this level though? I don't have much experience in this area.

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5. tptacek ◴[] No.12308272{4}[source]
I think penalties need to be sharply increased, but the problem isn't so much free riders as it is that statistically the most attractive segment of the market is overwhelmingly likely to be employed at a firm that offers group coverage.
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6. harryh ◴[] No.12308284{5}[source]
I certainly agree that employer provided health care coverage should be taxable income (I assume that's the mechanism by which you would shift people).

It's interesting to note that McCain proposed this as part of his campaign in 2004 and Obama pilloried him for it.

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7. tptacek ◴[] No.12309720{6}[source]
Yep. Clinton wanted to tax employer-provided health care too. McCain and Clinton were right about that --- but Baucus, and I guess by extension Obama, was right about the individual mandate.
8. Broken_Hippo ◴[] No.12309799{4}[source]
1.) It might be possible, but that would probably take time, a lot of work, and likely intervention with laws and money. I'm not all that hopeful that it could be done. Right now there are a lot of people with inadequate to no health coverage. They have issues and problems that are going to need taken care of, which means that the first 3-5 years are probably going to be more expensive than later on. Some are just things folks have been putting off - surgery for carpal tunnel, for example. A few folks will have much larger problems that they can't do much about without insurance. Maybe they don't take care of their diabetes well enough or should really be taking heart medicine or anti-depressants.

Basically, gotta get everyone caught up to the healthiest they can be, and afterwards there would be a lot better maintenance, which in return would mean that the companies have a chance of not needing to worry about the adverse selection.

It would probably also help to get rid of the networks and simplify the insurance end at the doctors offices to both reduce costs and get rid of some of the redunancies in addition to having some sort of care and coverage standards that spread across insurances, just so that people are able to get the care they need instead of going with not-quite-so-good-for-them alternatives because they happen to have a crappy prescription plan.

Other changes I would make would be to require all insurers to sell directly to consumers and decouple insurance from employment - much like most folks get their car insurance. In addition, I'd require insurers to use the exchanges if they want to be in the business and make it so that insurers have a national license instead of needing certified in each and every state they sell in. This would not only standardize coverage, but reduce overhead.

Unfortunately, this sort of thing requires planning on a rather large scale and fixing a lot of problems such as affordability of care. The current political climate hasn't been so keen on that sort of long-term planning nor cooporation, not to mention that the companies themselves might not be too keen on that last one either.

2.) I tend to think all pre-existing rules are bogus. Though they say they help with their risk, I'm skeptical. Most the plans I saw wanted folks to have continuous health care coverage to go around some of the rules (I've always gotten insurance through and employer when I lived in the US). Yet having coverage doesn't mean you take care of your condition. The opposite is also true. Obviously, some folks don't take care of x,y, or z because of lack of coverage as well. And things such as gall bladder surgery are more one-time events with few lasting needs after the surgery for most folks.

9. rayiner ◴[] No.12310555[source]
I think it's the least bad of a set of various bad solutions. Healthcare seems so essential that we can't let poor people go without it. And it seems like demand is totally inelastic. So maybe it's better to have no market than to have one where government is excessively entangled with insurance companies.

But I admit that I'm not super well educated on the issue.