Comment by gustavus | Hacker News Reader

Comment by gustavus | Hacker News Reader

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Counterpoint against that. Because optometry isn't considered part of the "healthcare" umbrella when I went to get LASIK it was the easiest medical transaction that I've ever done. They explained what they would do, said this was the price, then said they could offer a discount and when I was still considering they said they could give me another discount. I got the upfront price paid for it got my surgery and went on my way. This wasn't some shady Nick Riveria place either it was one of the premier LASIK facilities in the world.

By contrast trying to do something as simple as buying a new medical device for my wife has been a Kafkaesque nightmare with random charges, wrong billing codes, switching companies, fighting insurance, demonstrating need, etc, etc for something I am willing to purchase. The device is also marked up several thousand percent to boot.

Part of the problem with the healthcare discussion is that we need to clarify what we mean by healthcare. When I hear people complain about healthcare they either are complaining about medicine, or hospital stays with crazy and confusing billing processes, and these 2 problems are completely different than each other and require a whole different set of discussions apporaches and solutions, but everyone just talks about "healthcare" with no nuance and it obscures any possible forward progress.

As a final question for pondering how much healthcare does everyone deserve? I think we'd agree it probably isn't reasonable to say a 96 year old woman should get a multimillion dollar experimental cancer treatment that will extend her life by 6 months before dying, on the other hand simply having access to Ibeprofun and Antibiotics means you have access to better medical care than anyone else at any point in history longer than 40 or 50 years ago?

Your nuanced plan of paying for things yourself completely falls apart once you or a loved one contracts stage II or higher cancer, suffers life threatening injuries from a car crash or any of a panopoly of unfortunate situations that would completely exceed your ability to self insure.

I am also not impressed with all of these just asking questions it's so complicated asides; there are dozens of existence proofs that demonstrate a diverse set of approaches that more or less solve this problem at the nation level. But that would require a bit of curiosity about how the rest of the world works, I suppose.

The problem with health care/insurance in the US is not because of unanswered economic theories (or lack of half baked econ 101 approaches), rather it's because of hard ideological commitments to maximize rent extraction based on historical contingencies.

Ever wonder why US corporations generally provide health insurance? World War II something something.

Optometrists do not do lasik. You met a private cash only ophthalmologist.

Optometrists don’t do LASIK though, only medical doctors. So you just saw an optometrist that works outside the insurance sphere since most medical insurance doesn’t cover LASIK. I do take your point though that when it’s a competitive environment away from insurance claims yes the service magically improves dramatically and the BS goes away.

Right, when most people complain about health care, they aren't complaining about quality of care when they get it. They're complaining about not being able to afford it.

Or, it being too confusing. That's a problem with health insurance, and not with money.

That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.

To your last point, rationing low availability health care is nothing new. Alcoholics can't get liver transplants for example. There's a whole field of bioethics that can surely answer some of those questions.

Oh I think most people who complain are upset by the attitude of medical workers and overall hubris inherent in the profession. It’s very correlated with wealth of the patient. Wealthy people can afford well paid happy doctors and nurses, nor stressed out overworked cynical disgruntled cogs in the hmo machine. Ymmv

> That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.

Why would we expect the incentives inherent in putting health care under the monopolistic control of those who seek political power to be any more favorable than those manifest in the current situation of apparent oligopolistic control by both profit-seekers and political-power-seekers?

Where would this solution leave those who just want to obtain services directly from service providers, without any political or financial middlemen either taking a cut, usurping their agency, or homogenizing the market?

> they aren't complaining about quality of care when they get it.

This isn't true. Plenty complaints about long waits for appointments, rushed appointments, not getting proper medicine. My wife recently couldn't get a specific potentially more effective medicine covered (it was in the end) because the insurance company wanted the dr to give her something cheaper.

Most people would still prefer going through all that bureaucracy than paying $10k out of pocket though. Your slight convenience doesn’t make it a good idea. You can still go to a private hospital in the US and feel free to pay out of pocket.

LASIK hasn't cost that much in decades.

Realistically, the price is at or around most people's insurance deductibles.

It's interesting your argument boils down to:

"Health insurance in my country is so obtuse and convoluted I would rather not put my basic medical needs in there, and rather just pay out of pocket for it separately."

Strange approach.

Not that strange at all, when you consider that one of the primary reasons it's become so obtuse and convoluted is precisely due to the inherent complications of paying for routine services through the model of a risk pool.

The common conception of health care has moved beyond just remedying severe illness or injury, but rules and incentives are still calcified around treating it that way.

I have no idea why - and I'm someone who has worked in the health insurance industry - it was ever allowed to be called insurance in the first place. It has only ever resembled insurance in the vaguest possible way (HDHPs are probably the closest thing to actual insurance now).

Insurers like to take all the benefits of the insurance model, and as few of the downsides as possible.

I mean, look at the model of "first you have to meet your deductible, then you have a co-pay which is your 'contribution' to your health care, but also you have to pay coinsurance which is the your portion of your costs after the deductible".

It's a partial amortization scheme for healthcare with a little "benefit of group negotiation" thrown in (when it doesn't actually cost "you" more to go through insurance than out of pocket... "you" because some people, like Martin Shkreli, make money pushing the illusion that somehow insurance companies are magical money fairies who pay providers with something other than the premiums you and I pay, either directly or through an employer...).

I mean, I would lean towards just having a better healthcare system if it were me, but yeah. You do you.

The way to have a better healthcare system would be to use insurance for its intended purpose of dealing with catastrophic contingencies, and restore a direct-pay market for routine services.

Every developed country in the world disagrees with your idea.

Why wouldn't you just do what works very well elsewhere?

Well, apart from not being a fan of the cargo-cult mentality you're applying here, I don't agree with the premise that solution you're implicitly advocating does work very well everywhere else.

The insurance model is broken because of political intervention in the first place. I'm not about to give political institutions de facto monopoly power over the most personal and private aspects of my life just to mitigate a public problem that they created to begin with. I want to cut out the middlemen entirely, not just shift dependence to a different, often less trustworthy, set of middlemen.

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