Comment by maxxxxx | Hacker News Reader

Comment by maxxxxx | Hacker News Reader

When I read these stories it always strikes me how arbitrary the system is. You can have insurance but you still may lose everything. There really is no way to do it right. It's a pure gamble.

We're willing to endure incredible pain to ensure that nobody gets a free ride.

Giving people a free ride can be a valid selfish act.

When I enjoy paying all my tax that covers social systems like healthcare and decent schools and welfare, it's not because I'm altruistic. It's because I believe it's the cheapest way to not get stabbed and robbed that also doesn't feel like a dystopian gated community.

Or put more absurdly: I want quality NPCs in my world. (not that they're mindless automatons, but that I want prosperity for all those people who make up the backdrop of my experience, even if they're not immediate friends, family, colleagues)

I think this is a compelling argument, but the advocates for more social services never seem to use it.

Completely agree here, except for the "quality NPCs" bit. Remember, "There, but for the grace of God, go I". It both enrages and saddens me that people will willingly suffer more pain trying to keep "free riders" out than save the bureaucratic labor and just let everyone in and "buy in bulk".

Other countries get better care for less per person, in some cases much less. Americans are irrationally, short-sightedly selfish and cheap when it comes to medical threats to our well-being. If only we could frame this as a national security issue...

" If only we could frame this as a national security issue... "

If you framed it that way you would just end up paying even more without better results. Just look at the high incarceration rates and the prison costs that follow.

I have to say the "Medicare for all" movement looks more and more attractive.

It's not that simple. The indigent get a free ride, people over a certain age get a free ride. It's the people who work for workplaces who offer no coverage who get screwed --the working poor.

Now, medicine for all is not a panacea either, but it may be better than what we have now.

I think one answer might be a two tiered system. One that is no strings attached[1] basic healthcare for all and a second tier for those who want 'premium' healthcare through their employer or other private means.

Reason is even in places with universal coverage, often times people will get private coverage for a multitude of reasons from quality of care, to wait times, to experience of staff (low incidence of malpractice), etc.

[1] Lest anyone be overenthusiastic, this often means your doctor has final say in options, treatment, etc. which is why a 'premium' private market thrives alongside the universal option.

"I think one answer might be a two tiered system. One that is no strings attached basic healthcare for all and a second tier for those who want 'premium' healthcare through their employer or other private means.

Reason is even in places with universal coverage, often times people will get private coverage for a multitude of reasons from quality of care, to wait times, to experience of staff, etc. "

Exactly. That's how it works in most of Europe.

"Insurance" can't solve the issue of sky-high healthcare costs. In fact, the closest thing to a quick solution (a real solution would require draining the swamp altogether, by reforming the entire healthcare sector essentially from the ground up) is its very opposite, namely price transparency, with the end-user paying directly for their health care. This doesn't mean doing away with insurance entirely, but it will have to be catastrophic insurance, the main purpose of which will be dealing with truly rare health conditions/medical emergencies, albeit with a sub-component of subsidizing cheap preventive care.

That sounds great except that people who account for the most spending are the least receptive to pricing pressures.

My dad had the misfortune to suffer from a serious stroke. He needs a lot of medical care, and frankly doesn’t have the ability to broker deals between various medical providers.

There are many many people in similar situations. Even in a world where scum companies didn’t charge usurious prices for drugs like epipens, denying someone care is a moral travesty that should be handled in a fair way.

"There are many many people in similar situations. Even in a world where scum companies didn’t charge usurious prices for drugs like epipens, denying someone care is a moral travesty that should be handled in a fair way. "

At least there should be a clear, well documented way for people to avoid these problems. Right now you can get insurance and do everything right but you still may get screwed.

It can, and it does in other countries. The U.S. is a huge outlier in the developed world in letting insurance companies run as for-profit entities with 20% administrative overhead. We pay ~18% of GDP for healthcare (1st in the world) and yet are nowhere near the top in terms of overall outcomes. In Japan, insurance companies have ~3% administrative overhead and run a non-profits. They pay 11% as a fraction of GDP, despite a huge relative proportion of elderly and an extremely high usage rate (no one goes to the doctor more than the Japanese)

Add to that overhead the huge billing departments most doctors have.

I'm not sure why you conclude insurance cannot solve healthcare. Private insurance, where there's a profit motive, may be inappropriate but insurance - as a concept of spreading risk over a large population - seems logical for a generally healthy population with occasional health issues.

The problem with healthcare is it's not a good like others which are insured. Even with price transparency the patient isn't qualified to decide what treatment to get at what price (your doctor is), and often the patient isn't at their best physically or mentally when treatment decisions need to be made.

Comparing the US healthcare cost to other countries is slightly misleading as much of the world free-rides off US pharma research.

If we want affordable insurance we should let people with chronic or debilitating diseases die rather than treat them with expensive medications/procedures that increase cost on us all. But when it's your loved one that's sick it's extremely hard to be this cavalier about the decision to not treat at any cost. I know I couldn't make that call.

"Comparing the US healthcare cost to other countries is slightly misleading as much of the world free-rides off US pharma research."

I want to see hard numbers on this. I strongly believe that this is just self-serving propaganda to justify ripping off people in the US.

Fair request on hard data. I don't have it and don't want to suggest this is a well-researched point on my part by simply Googling some random report.

I was going off comments from some post-doc friends who immigrated to the US because they said medical research funding here is much better than elsewhere.

(As an aside I think some replies to my comment misunderstood my point. I believe government insurance is highly appropriate for a good like healthcare. Just that it's not without it's downsides and being Canadian I've seen those first-hand).

much of the world free-rides off US pharma research

Hospitals do research now? The rest of the world gets free rides off US-made plaster casts for broken arms?

Because we have 40+ years of concrete first-hand evidence that it does not.

The line about US pharma research providing a free ride to other countries is exactly what the pharma lobby wants everyone to think. Meanwhile, they’ve enjoyed record profits leading to huge stock buyback programs and easily capture the majority of profits in the healthcare sector.

Pharma companies are ripping off Americans and we’re letting them.

I don't think there is a very significant difference between "catastrophic insurance" and my ACA plan which has a deductible of something like $5500/year.

And I don't think my monthly (individual) premium of around $400 is particularly unreasonable; I think that's what healthcare costs. Subsidies are a separate issue.

That’s maddening, because of course that’s just the kind of horrible, random outcome insurance and the modern social safety net was supposed to prevent. Are we going to have to go fully Victorian before the pendulum swings back?

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