Comment by krupan | Hacker News Reader

Comment by krupan | Hacker News Reader

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Let's be careful to not look at one type of health care, emergency care, and generalize to all types of health care. Right now we all (Americans at least) don't really have insurance. We are part of pre-paid health clubs and we try to use the health club membership to pay for everything. For true time-sensitive emergencies we should all have traditional insurance, and yes, the services should probably be supplied, like fire fighting, by non-profit organizations.

Health care that is not time critical should not work like the fire department. In fact, emergency rooms, once they diagnose something as not being an emergency should be able to say, "sorry, this isn't the right place for this, go to a doctors office."

With non-emergency care we should all be able to get price quotes up front, we should be completely aware of our choices and the be able to shop around. We could maybe outsource that to health care clubs like Aetna and UHC if we choose to (knowing that we are getting less choice and that we'll have to deal with those bureaucracies as a trade-off), but there shouldn't be any tax breaks or employee incentives for using those health clubs.

I recently had surgery to have my vision corrected with no "insurance" (or health care club) involved and it was so nice. I shopped around, the doctors all competed for my business and treated me like royalty, there was absolutely no confusion over price, there were financing options available, the technology was cutting edge (or I could have chosen to go less cutting edge and paid less), it was incredibly refreshing. I'd love if most of my health care could be like that.

This works reasonably well for things like vision care because they're entirely opt-in. Patients who aren't satisfied with the prices they're being quoted can realistically choose to keep wearing glasses instead.

No one in their right mind is going to decide that the going rate for chemotherapy is a little steep right now so they're going to sit with the cancer for a year or two and see if the prices come down.

So think of it in terms of food then. We don't have "food insurance," yet food is a short-term need and it works pretty darn well as a free market.

A) We do have socialized food insurance. That's literally what EBT is.

B) I'm not going to wake up in the morning to discover that my expected annual food costs have suddenly increased by four or five orders of magnitude. There is no budget-conscious version of a lot of non-emergency, but still lifesaving, medical care.

A) we do not have universal single payer food. Some welfare for the poor yes.

B) that's because food is a free market

A) Right. We have universal single payer food insurance, also known as taxpayer funded welfare for the poor. We're in essence covered by, and paying premiums to, a mandatory State-run insurance policy such that if we ever can't afford the minimum necessary food to survive the State will (at least in theory) step in and buy it for us from the open market.

B) Let me rephrase. I'm not going to wake up one day to find that my required daily calorie intake has increased by multiple orders of magnitude. There are very few household budgets that could reasonably be expected to absorb such a shock, no matter how efficiently the market for those calories functions.

A) and it works like insurance in that most of us don't ever need it, but it's there just in case. Also, it does not regulate prices, providers, etc.

B) Again, yes, we need health insurance for rare surprises just like we get fire insurance, auto collision insurance, etc. in case of those rare occurrences. We do not need insurance for medical treatments that everyone gets. We just need to plan ahead financially for those, just like we do for food, clothing, housing, etc. Preparing ahead of time for known expenses is not insurance. If everyone's house burned down a few times each year fire insurance would not work, you would instead just factor that in to the cost of living.

As I understand it, we have a relatively small number of people with serious or chronic illnesses whose normal, predictable healthcare expenses will drastically and permanently outstrip their realistic ability to pay. The only way they will ever be able to receive treatment is on someone else's dime, one way or another. And because everyone involved knows they're going to cost more to treat than they can pay then no sane insurer will willingly cover them if they have a choice in the matter.

As far as I can tell the main difference between the socialized food insurance we already have and the socialized medical insurance I'd like us to have is that subsistence level food costs are uniformly low for everyone whereas subsistence level medical costs vary wildly from person to person.

Vision and dental are areas where the market is halfways working. If you get a planned surgery the hospital will still try to rip you off left and right. It's not only emergency.

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