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Comment by LetsGetTechnicl | Hacker News Reader

> Refusing to pay for medical care is hardly murder.

This is crazy. Maybe it's not "murder" in the traditional sense but you are making a choice on whether someone gets life-saving care, or lives in immense pain for the rest of their lives until they commit suicide. Again, this kind of normalized violence is justified when it's a business making choices to increase profits. We are so disconnected from our humanity that rounding errors in an Excel sheet mean actual lives are being ended, but that's okay.

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Countries with universal health care still have to make these decisions.

They budget differently, but they won't use unlimited resources on every situation.

> you are making a choice on whether someone gets life-saving care, or lives in immense pain

Is the care life-saving or pain-preventing?

There is an additional option: the person pays for it. Or someone else pays for it. Since the 1980s U.S. emergency rooms have been required to provide life-saving care regardless of whether someone can pay.

> normalized violence

It is not violence to fail to reimburse someone.

If someone cannot pay his bills, then he declares bankruptcy, the debts are wiped out, his creditors take a haircut and he moves on with his life. In many/most states he will get to retain his home and perhaps his vehicle. It’s not the end of the world?

Is it ideal? No, of course not. It’s better than dying, and of course it’s not murder.

> Is the care life-saving or pain-preventing?

Those can be the same thing for some people. Chronic pain patients have a dramatically worse mortality rate.

> If someone cannot pay his bills, then he declares bankruptcy, the debts are wiped out, his creditors take a haircut and he moves on with his life.

I’ve done this. Due to medical expenses, in fact. It costs money up front, and was difficult to navigate as a well educated person with family support.

The idea that this is an easy option for a single person with no supports and a disabling condition is insane.

Many doctors won’t see you after, either. Bankruptcy doesn’t mean people you burned have to keep doing business with you.

What's stopping people from switching to a better insurance provider?

Most Americans get their health insurance through their employers. You are technically free to not sign up for this and purchase your own health insurance, but when you consider that you then give up the employer subsidy to your monthly premium, and that said subsidy often amounts to thousands of dollars each year, it does not make financial sense to participate in the market.

Most health insurance (and the lowest cost insurance) in the US is tied to a person's employer, a system that shifts the balance of power substantially to large corporate employers over workers and small companies.

Furthermore, absent major life events (job change, marriage, new child, etc) there is only one time of year when health insurance changes can be made, a time of year called Open Enrollment.

Finally, if you are self employed and you don't live in a state with a well functioning Obamacare market, your health insurance options are often quite limited.

You can only switch providers during an open enrollment period, or a qualifying life event.

In other words, it is frequently made impossible, by law, to switch providers.

Well, in the US, most people get insurance through their employer, who pays part of the cost. Switching would mean having to pay all the cost yourself, which would be economically painful.

And why doesn't the employer switch? Because health care plans typically have doctors that they like more than other doctors ("in network" vs "out of network"), so most people gravitate toward the preferred doctors. ("Like" means "cover better", so the patient pays less.) If your company changes health care insurers, then many people would have economic pressure to switch away from their current doctors, which is a hassle.

TL;DR: There's a lot of friction in various forms here. That's why. Yes, people can switch, but it's expensive and painful, so most don't, even though the option is technically there.

Affordability, restrictive "open enrollment periods", simple lack of variety/choice in the plans being offered, etc.

Surely you are not that naive, please carry yourself in these conversations with a modicum of self-respect.

Yes. Crazy as in truly psychopathic. Not the name calling version. Here’s chatgpt on the medical/psychological definition of psychopathy:

Key traits associated with psychopathy include: 1. Affective Traits: • Lack of empathy (emotional detachment from others’ suffering) • Shallow emotions (restricted emotional range) • Absence of guilt or remorse • Callousness 2. Interpersonal Traits: • Superficial charm • Grandiosity (inflated sense of self-worth) • Manipulativeness • Deceptiveness or pathological lying

People defend planetary scale psychopathy because it’s quite literally business as usual.

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