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Comment by ars | Hacker News Reader

> that would leave us with a bunch of private healthcare companies.

It's already a bunch of private companies.

> These private companies would drive up the cost even more.

Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up.

Although we really should not ignore that insurance companies are not the drivers of higher costs, it's health care providers that do that.

It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. Dr.'s will have to take a pay cut, and there will have to be mass layoffs, there's no other way to reduce costs.

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> It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem.

Health insurance profits are capped only as a percentage of premiums collected, not a fixed dollar amount cap. The rule is you must pay out 80% of premiums collected, everything else is OH&P.

Turns out, if healthcare costs go up, then premiums go up. If premiums go up, then insurer profits go up.

Healthcare providers and health insurers have an aligned perverse incentive to have healthcare cost as much as possible, since that is what increases their profits.

This isn’t a hard relationship to uncover if you are familiar with the insurer profit cap portion of the ACA and also how money gets made.

> Healthcare providers and health insurers have an aligned perverse incentive to have healthcare cost as much as possible

OK, I can agree with that - but it doesn't change my point that cost reductions need to start with providers, NOT with insurance companies.

> It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem.

What a delightfully naive view.

Answer me two simple questions:

1) How are insurance companies profits capped?

2) How does increasing or decreasing costs affect thier allowable profits?

1: Obama care: 80/20 rule.

2: Costs change nothing. But increased health care expenses do allow them to earn more (the 20).

So if increasing healthcare expenses allow them to earn more profits, then why do you think having capped profits means that insurance companies are 'not the problem'?

Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.

> Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.

Yes, that is true. But it doesn't change the fact that prices will have to change at the healthcare providers. Dr.s will earn less, people will be fired as positions are eliminated. There's no other way to reduce prices.

Where do you think all that "incentivized" money is going? It's going to people in healthcare will either take a pay-cut or will lose their jobs.

perhaps we should sidestep the problem of profitability in healthcare entirely and create a non-profit healthcare system? which even the most free-market loving enthusiast should be in agreement with -- inelastic demand and all

They exist. It helps nothing.

The gigantic UPMC is a non profit. Actually a TON of hospitals are non profits - every religious founded hospital is a non profit (Maimonides Medical Center, or every Mercy Hospital (Wikipedia counts 33 of them)).

60% of hospitals are non-profit.

He said a healthcare system. Not a hospital. They are related, but not the same thing.

Non-profit insurance companies also exist. It still helps nothing.

Are you hoping for non-profit drug and equipment makers as well? How far do you need this "non-profit" thing to go before you acknowledge it doesn't help at all?

The NHS is non-profit. That's a healthcare system, not just a hospital or insurance company. I repeat that he said "system" and you continue to talk about things that are not a healthcare system.

I can acknowledge that it not just helps but that it is far more functional than the US system I've had to suffer through for many years. In addition to years of experience with the US and NHS, I also have many years of experience with Italian national healthcare which is also non-profit and better than the US system.

The US system is better for some diseases but only if you are rich. And an absolute failure if you aren't employed. Even if you can manage to stay employed with a serious illness you better have a healthy family member with a lot of energy who can fight the insurance company that really doesn't want the cost and burden of you and will make that clear in every action.

How far do you need this "for profit" thing to go before you acknowledge its very serious flaws and inadequacies?

The NHS is a combo of hospitals, doctors, and insurance.

This combo (system as you like to call it, although that leaves out a ton of stuff) also exists in the US as a non-profit. I said this already.

It doesn't help

What will help is doctors taking a paycut and mass layoffs.

The problems in the US are not on the payment side, they are on the service side: it's simply too expensive.

We need twice as many doctors, working half as many hours, for half as much pay.

That's what would fix the US.

NHS is not a combo of "hospitals, doctors, and insurance". It does not involve insurance at all. It is a comprehensive and integrated healthcare system that runs as a whole.

I'm writing this from the UK where I use the NHS. I've also used the US system extensively and the Italian healthcare system extensively.

You need to get basic facts right if you want to be a part of the debate.

If this is aimed at free-market living enthusiasts, I believe the response from them would be that the market is currently not stopping anyone from opening non-profit healthcare providers today.

> Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up.

This is backwards logic. Those few large corporations have the bargaining power to negotiate lower premiums. Individual consumers have zero bargaining power.

You wish it was backwards logic. In reality the insurance company just needs to convince a single person in a company to pick them. And they are very good at doing that.

On the other hand individual consumers have ALL the bargaining power - they can simply pick a different insurance company, and insurance companies have to work very very very hard to get customers. They would compete on price because that's by far the most important thing to a consumer.

A company on the other hand cares about other stuff, how integrated in the system, how easy can we import members, manage members, how much marketing material do they give? Do we have to educate our employees, or will the insurance company do that for us?

Just tons of other stuff that isn't price. Individuals: It's 99% price.

So, you spend every single day of your existence in the US being absolutely fucked by the private medical sector, and you think that for some reason having no collective bargaining ability will make you better off?

I have a bridge to sell you.

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