Comment by amazingamazing | Hacker News Reader

Comment by amazingamazing | Hacker News Reader

Health insurance fundamentally makes no sense. You can’t exactly hedge your risk like with a car or a house.

The most ethical approach would be to separate care into health care and medical care. Health care should be strictly preventative and diagnostic and be free.

Healthcare as defined below is outrageously expensive to begin with. Going to hospital and seeing some resident for 5 minutes after having a nurse take your blood pressure and weight shouldn’t result in the insurance company being billed $1000.

Part of this resolution will be introducing far cheaper labor and automation. One point people never want to concede is that the actual cost of labor is increasing without commensurate productivity, aka cost disease. Free health and medical care will exacerbate this.

Medical care should be pay for yourself or purchase private insurance.

Medical care here is defined by actual treatment such as surgery, whereas health care includes diagnostics such as a yearly assessment, blood tests, etc.

Of course, it’s easy to want others to pay the bills.

Health insurance should be rooted in solidarity. It is supposed to be a collective mechanism designed to prevent individuals from financial ruin due to unpredictable medical crises. It is not about hedging individual risk, but about sharing it across society, because health problems can strike anyone regardless of preparation or behavior.

Maybe so - in any case a public option wouldn’t inherently indirectly be decided by the public via voting so we will see if people accept the higher taxes or lower spending make it happen.

Health insurance is cost pooling. The hedge is that the young people in the pool have better health.

Except the demographics are such that it won’t work. The other problem is that if free there’s no downward pressure on excessive claims. I’ll leave it to the reader on determining what this is, but in general older people will pay unbounded amounts for poor prognosis.

Why should you pay, for example $100,000 so someone who is 85 can live to 86? Sometimes it’s time to accept reality.

Nobody is paying $100k.

Health insurance absolutely makes sense in terms of diversifying any one individual's risk across the population.

Whether that's best done by the government or private institutions is left as an exercise for the reader.

Given that, up until 2010, the NHS was one of the most efficient healthcare providers and also completely free at the point of use, I think the answer is pretty straightforward.

So, it should be free to get a cancer diagnosis so at least you know what's killing you even though you can't afford to do anything about it. Sounds great.

That’s why you purchase insurance, no?

If you can afford it. If you can't, you are left with your cancer diagnosis and nothing you can do about it but wait around to die.

That would always be true, sadly. For example, the same could be said about water.

In any case the extremely poor already have free insurance in the form of Medicaid so not relevant.

It appears you've never lived with Medicaid. Medicaid makes it clear that the poor don't deserve as much or as good a quality of medical peer as someone well-off.

Yes, I'm one of those radicals that think water is a human right.

Also under the "Medical care should be pay for yourself or purchase private insurance" policy Medicaid would not exist because it is neither of those.

Yup. Medicaid isn’t great. Better to pay poor people to have private insurance. Just my own experience though.

That's not far off from what Medicaid does. It doesn't pay poor people to buy private insurance, but it does it for them. Medicaid is private insurance paid for with government dollars.

Why must it be private insurance specifically? A public insurance option should work as well, even if it is not to the exclusion of private insurance plans.

It doesn’t have to be private, but a public option wouldn’t be properly incentivized for the same reason there’s not public car insurance even though 49 states make it mandatory to have.

It's tricky, because an insurer of your body (for medical care) has a vested interest in you taking good care of it (health care). By offering to pay for these services, they can potentially realize savings by not paying for the surgery that your undiagnosed diabetes or heart disease or whatever resulted in later on.

And since this is capitalism, if one guy offers that (an obvious benefit, or so it seems at least), their competition must do the same. Now the marketing department has us convinced that insuring only for major expenses (high deductible plans, basically) is stupid and that good coverage means only paying copays (which are also on the rise, duh). And it's easy to convince the public of that because paying a $35 copay for a 10 minute exam is still an easier pill for most of us to swallow than $100 or $200 self pay for same, since we're not thinking about the $15,000 premium which can be made nearly invisible to the consumer if their employer is paying for it, etc. Numbers made up of course, but I think the scale is reasonable.

I don't have all the answers, but I do think it's obvious that capitalism is not the correct approach if your goal is a healthy population.

Capitalism isn’t incompatible, but the externalities need to be priced in.

"Health care should be strictly preventative and diagnostic" runs into the problem that not everyone agrees what that means. For a while most Europeans thought that leeching yourself was preventative medicine, or Japanese people thought removing the outer layer of your skin by rubbing it hard with towels was, etc. Nowadays some people have forgotten that vaccines work and don't want to pay for other people to get them.

Health care in the US is definitely stupid and bad and can easily be made better than it is, but all the easy sounding obvious right answers that would fix everything about some aspect of life usually don't pan out in practice.

What's the problem? Just do a Vickrey auction with your insurer, where you bid how much you're willing to spend to stay alive, and they make a counter-bid.

If you win, they spend their bid to keep you alive; if they win, they pay out your bid to your next of kin when you die. A perfectly Pareto-optimal solution of revealed preferences! /s

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