Comment by brightball | Hacker News Reader

Comment by brightball | Hacker News Reader

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In the US, the problem is too much regulation but that regulation comes from different levels like insurance companies, medicare, medicaid, etc.

I know somebody who owns a therapy business. Medicaid rates have not increased in 15 years and increasingly make it harder and harder to do your job. The level of stress and pressure it creates is intense.

What do you think is going to happen when private equity comes around and offers an exit?

I can't speak for the pressures on doctors as confidently, but I can assume there are similar issues.

So what you end up with is regulatory pressure that is forcing the market to a certain position, which makes private equity seem like the only realistic escape. In a true free market, this wouldn't happen or it would be significantly more expensive for the PE firms to make acquisitions. The businesses would either fail quickly or become successful enough to increase their rates and thus the compensation for their employees and owners, which removes incentives to sell.

I was at a sporting event earlier this year where I overheard an exec from an insurance company (I was a guest of somebody with pricey tickets). He was complaining about how a hospital was forcing them to increase rates after being willing to drop them as an insurance provider, because the insurance company would lose all business in the area of the hospital wasn't on board. It's a microcosm of the stuff happening behind the scenes.

> In the US, the problem is too much regulation but that regulation comes from different levels like insurance companies, medicare, medicaid, etc.

If only there were a single payer. ;-)

Seriously, there should be single-payer health care. Also, there's the fundamental question of whether you view health care as a political right or as a personal privilege. The free market is very good at serving the privileged, not so great at serving everyone universally, equally. If you're ok with millions of people having little or no health care, that's definitely what you'll get with a totally free market for health care.

The problem is not single payer health care, it's that the single payer that does exist (both medicare and medicaid are single payer) has decided not to increase the amount of money available, not even inflation adjustments, for 15 years.

How good would you feel about your job, even if well-paid initially, after 15 years of no raise. Not even inflation or cost-of-living adjustments.

And would you sell if someone came and offered you money for your customers, knowing they'd get screwed sooner or later?

> it's that the single payer that does exist (both medicare and medicaid are single payer) has decided not to increase the amount of money available

Excuse my ignorance as a non-American, but I don't understand how Medicare and Medicaid can be called "single-payer", even if we bunch both of them together for the sake of the argument. Are certain healthcare providers restricted so as to only accept Medicare and/or Medicaid patients, and cannot by law accept those who are privately insured or would like to pay out of pocket? That is the only context in which I can imagine Medicare/Medicaid being called "single payer".

Single-payer as in the government pays. We have Medicare, Medicaid, and veterans all covered by the government. If a provider wants to serve those markets (old, poor, vets) they have to accept the rates offered by the government.

> Single-payer as in the government pays.

Those aren't the same things.

The government paying for services in a private market is not single payer.

Single payer in the US simply means the patient doesn't front any money. The doctor/hospital/... just gets the money for medical services rendered directly from insurance (and insurance collects things like a deductible from the patient, not the doctor. Essentially, insurance guarantees payment to the medical provider and deals with all patient financial matters). Medicare and medicaid are single payer.

Things aren't called the same thing everywhere. For example, "single payer" is called "third payer" in Northwest Europe.

Expensive (e.g. expat) insurance tends to be single payer/third payer even though it is 100% private insurance. You just go to a doctor, they help, other than your insurance card, no questions asked.

> Single payer in the US simply means the patient doesn't front any money.

No, that's not what it means.

> The doctor/hospital/... just gets the money for medical services rendered directly from insurance (and insurance collects things like a deductible from the patient, not the doctor. Essentially, insurance guarantees payment to the medical provider and deals with all patient financial matters).

You seem to be describing medical insurance in general, not single payer health care.

> Medicare and medicaid are single payer.

No, they're not. "Medicare for All" would be single payer. https://en.wikipedia.org/wiki/Single-payer_healthcare

Uh, that’s pretty much the definition of single-payer, at least as commonly used.

From Wikipedia: Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer").

The difference here being the US has a fractured system, with several government systems (but from the same government). Medicare for All would be try single payer.

I linked to that very Wikipedia article and said Medicare for All would be single payer in another comment half an hour before yours: https://news.ycombinator.com/item?id=36751975

Large purchasers dictate pricing or discounts on suppliers everywhere. Walmart is famous for it. I can certainly understand the frustration, but the flipside is most people on Medicaid couldn't afford market-rate services anyway. Since we don't have a single-payer health care system in the US, unless your friend is legally required to accept Medicaid, I'm not sure this a regulation issue.

I also agree with you.

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