Comment by jseliger | Hacker News Reader

Comment by jseliger | Hacker News Reader

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It's very expensive being sick for any extended period of time; I had my first partial glossectomy surgery (removal of a piece of my tongue) in October 2022 (https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...), and there are at least three major components to being sick for a long time: health itself; financial viability; and managing the healthcare team.

I've been lucky with the generosity of friends and strangers regarding the second one due a successful Go Fund Me, but I've also gotten walloped with some gnarly bills, most notably for Signatera blood tests for cancer particles and for genetic testing of the tumor itself. United Healthcare considers those experimental and thus uncovered. But the genetic testing of the tumor is essential because it might lead to targeted treatments.

Legislation has supposedly limited surprise out-of-network bills, but, even with insurance, costs can be very high, and those combined with not being able to work effectively leads to problems.

I'd like to see insurers be sued for malpractice since they feel entitled to make medical decisions for people.

That will raise the price of insurance even more. Now you have to cover the cost of risk of suing your own insurance pool.

Alternatively, they could consider not having lone employees mass-denying procedures from a spreadsheet. Or at least stop using the AI that gets it wrong so often it's indistinguishable from intentional.

I think biggest problem is health insurance is now more like a weird HSA where insurer owns the money and operates as cartel. It might be cheaper for some to not even have it and just go to Mexico, maybe some minimal insurance only for emergency room.

Hard to call it insurance, when so much used for known chronic ongoing costs.

A friend of mine had gastric bypass revision surgery in Mexico because it was cheaper.

As opposed to a single 'doctor' mass denying 1000's of requests a day? That should be illegal.

Profit margins are like 4% on health insurance. Insurance companies introduce a lot of cost and waste, but there's no evidence to me these mass denials are anything but the market not bearing real insurance that covers things reasonably under current regulatory conditions.

Could it be the consumer is too poor to pay for a bloated system that covers what it does, plus the mass denials?

The whole system is fucked and the even more fucked part is mass denials may be a symptom of the madness of the inefficient rube Goldberg machine and not even a profit driver.

> Profit margins are like 4% on health insurance.

If I tell you my cost of a bottle of water is $96,000 and sell it to you for $100,000 in the middle of the desert, my profit margin is only 4%.

You would also get a nice visit from the IRS.

I'd rather pay taxes on $4000 than $0.40

I honestly thought the jig here was lying about the 96k. If the bottle actually costs 96k then I don't begrudge the 4% risk for hauling to the desert.

The jig here is that even though profit is a reasonably slim 4%, the water bottle is being sold at an outrageously high price.

IOW, medical insurance is both expensive and not very profitable because hospitals are charging tremendous sums (and implied that they are overcharging).

That doesn't explain the denials though. My point was that they're apparently doing mass denials and still barely breaking a profit. It suggests the consumer wouldn't be able to afford the insurance that doesn't, if it's not a small piece of the puzzle, otherwise they'd pay more for that.

The old Onion joke about a nation with a GoFundMe-based healthcare system rings true.

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