Public Fried Chicken (by Scott Banister) | Hacker News Reader

Public Fried Chicken (by Scott Banister)

dustincurtis.com

24 pointssachinag36 comments

A ridiculous portion of the pain of health care costs goes away if you use catastrophic insurance for catastrophes and cash for everything else.

Example: I am covered under national insurance for dentistry in Japan, but Japanese dentistry is a nightmare (in no small part due to the fact that it is covered by national insurance), so I get it done when I go back to the US to visit family. Since I have no American insurance, I pay cash. And its so easy. After spending literally 15 minutes explaining to my dentist's office that I would be paying cash (and was not unwilling to pay cash, a concept they found almost mystifying), it was simplicity it self. They told me it cost $225, I passed over the credit card, done. See you next year.

No need to send paper back and forth between a massive paper-munching machine at the insurance company and a department at the dentist devoted solely to moving paper through that machine. No complicated contracts or regulations. Full pricing transparency -- I know I consumed $225 worth of services, and if that number actually mattered to me I could shop it around fairly effectively.

Funny, the Canadians I know don't go across the border to the US for dental services. I think you're really commenting on the inefficiency of the japanese system more than anything else. No arguments from me on that, but other countries are much, much more efficient.

Anyway, I don't think the average person has the option of venue-shopping between two countries, one in which he has nationalised health insurance, according to preference.

Well, in theory this is how insurance is supposed to work, and is how it works in other fields. The general idea of insurance is risk management: I have a huge unpredictable risk which worries me, so I transform it into a small, predictable risk by purchasing insurance.

And, true to form, with other types of insurance I pay "routine" types of costs myself; for example, I have auto insurance, but I don't expect it to pay for a tank of gas or an oil change. I pay those myself, and have the insurance available for things like accidents, which are unpredictable and far too expensive for me to pay for all in one go.

And yet... health insurance tends overwhelmingly to pay for predictable routine treatments (yearly checkups, for example) while balking at paying for precisely the sorts of large unpredictable costs it's meant to help manage. How'd we end up with that system?

Well, first of all, many health insurance plans don't cover routine care (annual physicals, etc.).

Second of all, those plans that do cover routine care generally do so under the theory that, by paying a small amount of money for routine care, they're avoiding paying much more down the road when the cheap problems that would have been caught at a routine physical turn into big, expensive problems.

Increasingly, health insurance plans cover routine care under the banner of "wellness" (there's a reason why there are specialized procedure codes to identify them). Unfortunately, they often take the form of "sure, we'll cover that prostate screening, but if it turns out you actually have cancer, um, tough luck."

That's nice until you try to obtain catastrophic coverage and are declined despite a lack of any current or chronic medical condition. It also fails to account for things like the fact that an MRI costs $150 in Japan and $600 in a "cheap" clinic in the US.

Wow, it's obvious. Health care is exactly like every other commodity. Why didn't we think of that before?

http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

I just logged on to post the exact same paper.

To anyone who doesn't want to download the pdf linked above: it's Kenneth Arrow's economics paper "Uncertainty and the Welfare Economics of Medical Care." It launched the field of health-care economics. It demonstrates that health care is not like fried chicken. It was published in 1963.

Of course, there are counter-arguments to be made. But an argument comparing health care to fried chicken without taking Arrow's work into account is a worthless argument.

"If you have an FCP, they pay your bill for you. If you don’t, you eat free."

I've paid massive emergency-room bills. The author and publisher (apparently not the same person) are morons if they believe it.

I don't mean to endorse the ideas. I will be publishing an article arguing the opposite position as well.

But it is poorly written and a bad analogy.

I can't think of a situation where I needed fried chicken to prevent my child from dying.

Yeah, what's the opposite position, an even less coherent analogy?

What is the proposed benefit of publishing badly researched articles making weak arguments for both sides?

They will hound you for ER bills until you're bankrupt. I saw a significant other dragged through years of both ill-health and debt-collectors in that situation.

vertical and horizontal scrolling to read an article?

It's Dustin - I think the quality of his past articles allows him to try new shit on new articles.

The vertical scrolling is not likely to be deliberate. The horizontal most certainly is.

The vertical scrolling is definitely deliberate for the people running a resolution that requires it -- note that once you scroll down all the way to read the article, you don't need to vertically scroll again.

Is this the pro or anti article?

This is definitely anti government-run healthcare.

Well, then it's incoherent. Or at least I don't understand the point he is trying to make.

I think he is arguing that healthcare is just a commodity.

or that clinics should be combined with taco bells.

Here's the thesis: Routine health care, like routine food purchases, should be paid for directly by the consumer rather than paid for through indirections like insurance/employment benefits/government.

That makes sense when you keep it inside the metaphor; however there is a large difference between providing a chicken dinner, and providing healthcare. The full costs would be prohibitive for nearly everyone if everyone only paid for what they use. Meaning the system might be unfair but it is arguably better than no system at all.

In a system where routine healthcare was paid for out of pocket, it would inevitably be more affordable. Right now, it's priced by a colluding insurers and providers, and the high costs of non-routine care are subsidized by overpriced routine care.

I think an important issue is that life isn't fair. Some people need nothing but routine checkups for 90 years. Some children need a million dollars of medical care before they're 10 years old. I don't think it's fair to say that if you happen to get a rare and costly-to-treat disease, you're just screwed. It makes much more sense to me to balance healthcare costs roughly equally across the whole population.

What keeps this system fair is that everyone really is recieving the same thing: the promise of good health care no matter what health issues they encounter. Health care systems work because most people pay for more than they "use." Whether it's the goverment or private companies that organize this system of most people paying a little more so some people can use a lot more makes no difference to me. I think it's the right system, so the question to me is just whether it works or not. Current U.S. health care is broken in a lot of ways, and I'm not sure it can fixed while it stays in the market. If the government can make a system where everyone pays roughly equally and everyone recieves all the care they need, then let them take it over. If they can't, then they should be working to find someone who can.

Or to come back to the analogy, some people need to eat 10 chickens a day and some people can live on a wing a week. If people pay out of pocket for their chicken, then some people will just starve to death. There is no avoiding it. No one can afford the amount of chicken that some people need.

As soon as you show me how a chicken dinner can usually cost $10, but can sometimes cost $75,000 instead, I'll allow that this is not an idiotic mischaracterization of the basic nature of health care.

If you drive your car through the KFC window due to tragic combination of chicken grease, fingers, and steering wheel, your chicken dinner may very well cost $75,000. It makes sense to insure against that risk. But you don't have to insure against the $10 chicken dinners to insure against that.

There's no such thing as free chicken.

The point that I agree with is that running healthcare through the gov't is going to mean we get 3rd tier care at 1st rate costs.

But at least we'll all be equally screwed.

What tier care are we getting now, at what rate costs? Sincerely curious as to your opinion.

Short version I would rate US as tier 1 care, at tier 1 pricing.

I dont know a simpler aggregate measure than life expectancy.

For the way that Americans live, the average life expectancy is nothing short of a medical miracle.

We don't rate at the top of the scale, but like everything, you have to take that in context - interesing argument here ->

http://freakonomics.blogs.nytimes.com/2009/12/10/why-does-th...

As for costs, it's not cheap, but it's not out of reach for average working people - especially when you're solution oriented as commentator above who notes catastrophic only as a solution.

My fundamental problem with this entire debate is that true national health care tugs heart strings yet there are clearly much more effecient proposals than what the gov't is proposing.

In my experience the US gov't - eg the largest employer in the world - has one interest, and that's expanding their business.

I guess for those who can get health care, I'd agree with you. For those who have no insurance (which is often the same thing as no access, at least to expensive care) and/or pre-existing conditions, I guess they have either zero care or infinite pricing.

I think the "average working person" is slowly disappearing, replaced by the person with one, two or three no-benefit low wage jobs.

I expected nothing but sausage out of the government, particularly since the administration and the Dems were so set on getting an agreement, any agreement. It was theoretically possible for the two parties to have an honest debate and work toward an agreement that's good for citizens and uses taxes and other money efficiently, but in practice that would be impossible since their primary concern seems to be not agreeing to whatever the other side says.

It seems so plausible that we could have a much more rational and accessible health care system, however because health care is so expensive it can only be meaningfully underwritten by either or both of the government or insurance companies. The government is dysfunctional, and the insurance company's primary objective is to ensure least access to health care while still convincing people that they're a good buy.

Feh.

More reason than ever to work hard, and do your best to inspire, mentor, and help anybody out there that shows signs of life as an entrepreneur - private industry CAN negotiate vs. insurance where individuals cannot.

If they had the public option, it would have been at least better than a bunch of private insurers across the country. A national plan would have a larger pool of people to spread the risk apart, lower cost as a result.

The downside would be that employees from the existing insurers would probably lose their jobs because their employers can't compete against the goliath, but some private ensurers would probably still exist.

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