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Comment by quitit | Hacker News Reader

>People will say that this is necessary to remain competitive, but it just isn't.

In other countries there are private health funds that return all of their profits to their members by simply covering more types of care and lowering premiums, all while still giving their staff very good, very attractive pay. That is clearly a win:win setting without being a government-run entity.

A person doesn't need to earn 100M-200M in a decade of company service. That is an obscene amount of money, and merely opportunistic payment from a system where the foxes are guarding the hen house. Unfortunately the US health system has this pattern repeated through it from insurers, to hospitals and beyond - the money is being funnel to those which can minimise, not optimise, care.

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Within the US, could you have a cooperative-style insurance scheme that pays any excess to its members?

I believe these days most insurance companies farm out most of the risk to reinsurers anyway, so you could do it at a relatively small scale.

IIUC, UHC has a margin of 5.8% [1] with a denial rate of 32% [2]. I don't think you can offer insurance at the price that they do while having an honest denial rate.

You may argue that you shouldn't offer insurance for a rate that doesn't cover actual incidence and I would agree but it seems to be their business model.

[1]: https://www.unitedhealthgroup.com/content/dam/UHG/PDF/invest...

[2]: https://news.ycombinator.com/item?id=42359122

I have a family member that recently told me they’re on a US co-op plan. I need to explore this but it sounds like what you describe?

This article is about someone getting cutting edge care beyond medical literature from the one of the leading experts in the world. I've got to imagine most health funds would simply not be able to cover that type of care for an individual?

The article notes this particular healthcare fund made billions of dollars in profit for the year and one of the parties interviewed speculates that this individual's care would represent a few minutes of that.

The gastroenterologist is not the expensive part, either, the expensive part was the manufacturing process for the drug. It would be super cool to invest the billions of profit for this insurance company into developing more efficient ways to produce this category of drug. Alas,

Instead we are investing in finding the most underhanded ways possible to deny medical care for each patient, all the while pretending we are not making medical decisions for them.

Absolutely, the insurer could sacrifice some profitability to pay for this case, but eventually health care costs have to be rationed somewhere. I don't think any health care system can afford this level of treatment for as often as it is needed, and I don't think capping the profit in the industry solves that problem.

Also I would agree the insurer is absolutely making medical decisions with its own definition of medical necessity. But the Doctor is also making financial decisions when he recommends a drug that pays him significant consulting fees every year. There's warped incentives all over.

Not sure why this is being downvoted. Universal healthcare is great, but even if you're in Sweden they're not going to fly you over to Minnesota to get experimental treatment that costs $1M/year.

It's likely downvoted because it's irrelevant. Very few (if any) private plans in the US would cover it either.

Some plans, like the one in the article, obviously do.

This is the paradox of US healthcare: it's probably the most advanced in the world if you/your insurer can foot the bill, but that's an enormous if.

The problem is that the profit making side of the business is becoming dominant. There will always be room for experimental procedures even if the US saw regulation that limited the profit-making abilities of health insurers.

The situation at the moment is that routine, basic medicine is being denied, often algorithmically, along with "pharmabro" types buying up basic medications for the sole purpose of increasing its price. That's starkly different from the development of novel medications demanding high prices to reward R&D efforts.

You'd be flown to Stockholm. Or within EU I may expect.

Ha. No. The Perssons aren’t major donors to the Cleveland Clinic for no reason.

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