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Comment by flyingfences | Hacker News Reader

That's what insurance is supposed to be: coverage for the catastrophic cases. This use of insurance for ordinary, everyday medical care is ridiculous. I have insurance on my car in case of a catastrophic collision; can you imagine if I had to deal with them for every oil change and brake job?

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I make the same argument and people don't get it. We are so brainwashed about the whole health insurance thing in America. Get rid of insurance middleman in EVERYTHING and see how prices drop.

Until it comes to dental work and hearing aids. Then people wish the insurance middleman was there.

Not me, I pay cash for my dental work. The only way insurance would help me is if there was a catastrophic event.

Because it's not valid. Ignoring routine and preventive care makes those catastrophic cases almost inevitable.

I don't understand your argument. Even on insurance, a lot of Americans routinely ignore preventive care because of the hassles, overhead and out of pocket costs even after insurance. Unless you are lucky to have great insurance by your employer. The point is that insurance should NOT be involved in preventive care. It should be a direct free market cash exchange b/w just 2 parties. Patient and doctor. That's it. NO premiums, no copays, no coinsurance, no claim paperwork, no calling insurance companies to figure out the charges etc etc and most importantly, no dependency on having a job to be able to afford going to a doctor even for preventive care.

You will see a lot of people using the (expensive) ER to treat their health issues. The reason they are there in the first place is that they couldn't pay for preventative care, so naturally they can't pay for the ER either. As a society when someone who can't pay ends up in the ER we have two options: treat them anyways, or turn them away.

Yes but that is due to our current expensive healthcare system where out of pocket costs are just some insane arbritrary number. Most hospitals cannot even tell you a "cash" price until you really push. My whole point is that it is all so expensive BECAUSE of insurance. If insurance was not involved in preventive care for example, all hospitals and doctors would have to compete on cash price and that would lower the out of pocket costs significantly. I bet less people will need to got ER because now they don't need to pay $10,000 for a doctor visit.

Even if a check up were $20 what I've described above would happen.

And then even fewer people would use it.

BTW, there's no out of pocket cost for preventive care for those with insurance in the US. There hasn't been since the Affordable Care Act became effective.

No one is saying to ignore routine and preventable care. We’re just observing that you can’t use insurance to lower the cost of it, in aggregate.

yes, and if routine procedures cost money, then people won't do them until they are emergencies. Why? Many people feel that they "shouldn't" "have to" spend money on those things.

The problem is that your catastrophic costs are likely to be massively higher if your problems are not caught by routine checkups and standard screenings. But if we make people pay the full costs for routine checkups and standard screenings, they won't bother getting them. So it is in the interest of your insurance company to make sure you get those checkups and screenings.

By contrast your odds of a catastrophic collision have more to do with drivers and driving collisions than they do with whether you got an oil change recently. If they were insuring your cost of major repairs and buying a new car, then they would have an incentive to get involved with routine maintenance as well.

I have good insurance from my employer but I haven't been to a doctor in at least 10 years. I don't think it's a given that people get routine care just because insurance covers it, or would avoid it if they had to pay (a predictable, modest amount) for it out-of-pocket.

It is not a given. But there is a correlation. And the correlation is enough for insurance companies to statistically benefit from their attempts to encourage people to do it.

There is a middle ground (this is how most dental care in Germany works): Regular cleanings are not covered by your insurance, giving an incentive for price competition. However, if you need major dental work your insurance might not cover it if you skipped the regular cleaning.

> But if we make people pay the full costs for routine checkups and standard screenings, they won't bother getting them.

Alas, those checkups and screenings still cost the same, regardless of who is paying for them. So when you decouple payment from benefit, you create adverse incentives.

I fully agree that at least in principle it seems wrong to have insurance for routine care, when most insurance only covers catastrophe.

I think the two practical problems with this view are (a) what's routine to you might be catastrophic (or at least seriously detrimental) to someone else, and (b) missing routine care often leads to catastrophic outcomes.

> what's routine to you might be catastrophic (or at least seriously detrimental) to someone else,

Whether a cost is insurable is not subjective. The gp observed that insurance only works to manage risk. Insurance against a risk of 100% certainty costs more than managing the risk itself. Insurance that covers doctor’s visits takes a certain expense and runs it through a system designed for uncertain expenses, thereby adding essentially parasitic loss.

> missing routine care often leads to catastrophic outcomes.

As a sibling comment observed, this is already something that insurance companies deal with. Failure to obtain regular and preventative care makes one more likely to need intervention, which means the cost of insuring the patient is more. Therefore people who are actually paying for catastrophic insurance can save money by going to checkups. This would decrease costs, rather than cause them to baloon like insuring high probability events.

Auto insurance does give discounts for things like taking a defensive driving course. Some will give discounts for installing a tracker on your car to show that you don't speed.

So it's not entirely out of the question that they could give discounts for properly maintaining your vehicle, if that were a major cause of accidents and it could be tracked.

Such a service does, in fact, exist for cars. https://www.nadaguides.com/cars/articles/pros-and-cons-pre-p...

And yet pretty much all of the developed world manages to do this much cheaper than the US whether or not there are insurers involved. This is not an insurance problem in the US.

It's a healthcare regulations being used as corporate welfare problem.

You’re completely missing chronic conditions, which as a whole are very common and expensive.

They’re also not insurable, by the definition of insurance.

What are you talking about? You’re suggesting things like diabetes isn’t covered by health insurance? That’s just not true. In fact, making sure “pre-existing conditions” are covered is a signature act by Obama to keep most people insured.

You’re using a very narrow definition of insurance that doesn’t cover health insurance in the US.

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