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Comment by throwawaygh | Hacker News Reader

> It blew my mind at how candid he was about the fact that his business exists due to regulatory mandates.

This is extraordinarily well understood in the insurance industry. They don't think of it as odd or a dirty secret, at all.

It's more surprising that he was so open about the naked corruption/nepotism in the origin story. Apparently there's a sector of society for whom that is also normal and acceptable.

> I feel like I’m self insuring when it comes to car and healthcare at least.

This is not at all the case for car insurance! You may be self-insuring the cost of your car, but are you also self-insuring against a lawsuit for damage to the other guy's car?

It's definitely more true than not for healthcare, though. Health insurance is a pretty terrible product.

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Agreed; but I don't see it as necessarily nefarious (only probably nefarious:)

In a lot of places, most people only wear seatbelt, wear a helmet, don't drink and drive, etc due to laws/regulations (and in others, they'll strongly actively fight these initiatives). We are really really REALLY bad, on average, assessing personal risks. Regulation, in part at least, is us as a society taking look at overall percentages and saying "well let's not do that".

There's a likely apocryphal story about sysadmin who was fired after event he estimated had less than 10% chance of happening, happened. Most of us assume that <50% means it won't happen, >50% means it will happen. With most events that insurance covers, most of us are aaaaawful at understanding it can ever happen to us... and we most definitely over-estimate the gracefulness, self-awareness and ownership we'll exhibit if it does help us.

> It's more surprising that he was so open about the naked corruption/nepotism in the origin story. Apparently there's a sector of society for whom that is also normal and acceptable.

I distinctly remember this from the interview as well! He simply drops it in there that he married into the family, that it’s a family run company, that the family owns some significant portion of it… “family family family”… it was an odd interview.

> but are you also self-insuring against a lawsuit for damage to the other guy's car?

I guess their insurance company is going to come after me/my insurance company to pay up… yeah without insurance I’d simply hope I could reason things out with whoever.

I’ve actually had to do that in the past. After a minor collision I asked the other driver whether we could settle things directly, and how much he’d feel was fair for me to pay to fix damage to his motorcycle. He named a figure and we drove to an ATM and I paid him that, we still exchanged info in case anything else came up but nothing did. Yes it was scary, but I think it was more efficient and less hassle in the end. This occurred in Los Angeles.

> Health insurance is a pretty terrible product.

What's the alternative?

Health insurance is a terrible product because it is usually not insurance at all.

If you are an alcoholic with a history of OWI/DUIs and you have a pre-existing car accident and no job, no one expects you to get free car insurance paid for by the government that will fix your already damaged car and make sure you can drive again as a human right.

In Healthcare, we assume that product should exist and we demand that it be called insurance for some reason.

The alternative to health insurance is free Healthcare. It isn't insurance at all.

I believe you're arguing semantics. If we're being strict about the definition of insurance, we should also be strict about "free healthcare". There's no such thing. Somebody has to pay for it. If it's the government, they do so using money collected from their citizens. You can call it premium, tax, payment - it doesn't matter. At its core it's a system of distributing risk - which is insurance.

In my mind, the alternative to health insurance is paying market rates out of your pocket for everything. It's not a good idea and that's why most of the countries have universal health insurance coverage.

A single payer system?

Or a hybrid system with Medicare for all with income limits, above which you must either get third party insurance or pay a small tax is how it was done in Australia last time I was there. It seemed to work well when I was there, and I did have need of it. I had to go to the ER when I was peeing blood after being kicked by a horse directly in the kidney. Fortunately there were no blood clots and it passed after a day or two, but they had to do tests to verify it all and also an MRI I believe. I never got a bill.

I had more medical expenses from mandatory screening fees for visa applications there than from a potentially life threatening medical emergency. And it was included in my yearly taxes with no fees at the point of usage for anything I can remember offhand.

Meds were cheap because the whole country’s Medicare board bargains with the pharmaceutical companies directly, and if your meds are too expensive, they will just go with a competitor and leave that vendor out of the Medicare coverage schedule. This is not unequivocally a good thing, but those meds are still available on the market, but you will pay more for them unless you have third party coverage. Generics are also available just like most places.

Not sure if it’s changed since, as that was like 15 years ago.

Right. Which is still called insurance.

Medicare in Australia: https://www.health.gov.au/health-topics/medicare

> Medicare is Australia’s universal health insurance scheme. It guarantees all Australians (and some overseas visitors) access to a wide range of health and hospital services at low or no cost.

Medicare in Canada: https://www.canada.ca/en/health-canada/services/canada-healt...

> Medicare is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket.

Hope you're feeling better now. That kidney kick must have been hell of a painful one.

I actually tried to keep working. I felt horrible pain, but my sympathy for the horse masked a fair bit of it til I got home an hour or so later. The pain was an intense dull ache. If I hadn’t peed blood, I probably would have just suffered through it, because I grew up poor in USA without health insurance of any kind, and was acculturated to not taking medicine or receiving medical treatment unless mandated by law or in actual emergencies. Once I saw blood in the toilet bowl, I was much less reticent to go to the ER immediately, to put it lightly. My folks were first responders in a very remote rural area when I was growing up; I knew that much blood in my urine was potentially life-threatening without immediate medical interventions if blood clots were to form.

I still feel bad for the horse. It got spooked, and was entirely blameless, if a bit anxious. It was a windy day, and the tin roofs of the surrounding buildings set the horse off somehow. I had too much slack in the lead rope, the horse walked ahead just far enough away for me to be in the danger zone right behind. I saw a motion blur of horseflesh, reflexively covered my face, and took a rear hoof right below my ribs. I almost kept my grip on the rope, but some part of my mind decided to let the horse win this one, and I dropped it right as my legs gave out from the impact and the sudden pain. The horse ran, and trampled it’s own rope, broke the bit in its mouth. The poor thing’s tongue was cut top to bottom, and halfway across.

I failed the horse in my careless handling and lack of empathy and situational awareness on that day. As these were racehorses, I’m glad that they received medical care and made a full recovery after missing some races. On balance, maybe the horse got off easy compared to how hard they run them on race days.

That was the worst experience I had with a horse. The second worse was being lifted off the ground by my bicep by a mother horse when I calmly petted her daughter. And the younger horse was nearly as big as her, so not a baby by any means.

Horses are to be respected. All animals ought to be; doubly so for those that can literally trample you to death.

In addition to the other comments, it should be pointed out that not everyone needs car insurance but everyone will require medical attention at some point.

That's not true though? It's entirely possible to be healthy right up until the moment you die and never get into a situation that a doctor or hospital could help with.

It's also possible to win the lottery but we shouldn't legislate around the tiny minority.

Most people drive too. So whatever distinction you're trying to draw between car insurance and medical insurance is bogus both in theory and in practice.

The baby "you" needed health insurance the moment it took it's first breath and let out a shriek of terror due to its suddenly change in circumstances. I know from experience: Until my wife gave birth, all the claims were for here. Once born, hospital bills were partitioned into those for my wife and those for my newborn.

Plenty of people are born at home and don't receive any particular medical treatment. Of course there are risks to that, but it's hardly unheard of.

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