Financial lessons from my family's experience with long-term care insurance
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As to OP, the simplest solution is to move out of the US early enough or become “poor” enough and be in a wealthy blue state by the time you get to this predicament.
I believe it is the largest industry by employment in every single state now.
That compounds the problem even further. Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant.
I'd love to hear what you think "really fixing it" is, please share.
I can report that all (almost all?) of the hospitals and their networks both big and small in the area I am in have had layoffs this year of admin staff and healthcare professionals (nurses, doctors, etc). They have reduced bed counts, and cut programs and treatment options available. All of this was done in the name of the "affordability crisis" and is kind of like the 3rd wave of this kind of consolidation, belt-tightening behavior. And..prices haven't gone down, and they keep cutting.
On the contrary of your statement, I would also do everything I could to allow more (capable, of course) people to become doctors each year, though I'm not sure what all that would entail. It feels criminal to me that we limit residency while a) every doctor I've ever visited is way oversubscribed and in a hurry, and b) specialist appointments are months out.
Browsing HN has conditioned me to react to sentiment like "healthcare...it's a jobs program...solve it by putting people out of work (the market will magically fix it)" to essentially be code for "I support continued abuse and further deprivations against the poor"
I'm not that poster, but there's a really easy fix: Just model the system after Hong Kong's.
There's a tax-funded public system available to every citizen, so that everybody gets treatment. In practice, this is mostly utilized by the poor, and for emergencies like broken bones. You can see specialists via the public system, but there can be a wait of weeks to months. This is all effectively free. You'll never see a bill, or the bill will be extremely small. (e.g., $100 for four days of inpatient care.)
There's a private system for those willing to pay. This is unrestrained capitalism with little regulation and no parasitic middlemen. Want to see a specialist right now -- like later this afternoon, or first thing tomorrow morning? Sure. It'll usually be $200 or $300 out of pocket. No insurance necessarily involved. Diagnostics are also super fast -- same day or next day, usually. If you want an elective surgery, or if you want a superior tier of care (like a nicer hospital room, better food, more flexibility re scheduling,) you can pay for it privately... And usually without getting insurance companies involved.
There is effectively no "prescription" system. With very few exceptions for narcotics and certain stimulants, if you need a drug of any kind, you can buy it OTC. This includes steroids, weird nootropics, viagra (lol at needing a prescription for this), and all kinds of stuff. This vastly reduces the burden on the system.
Hong Kong's system is superior in every respect, and it's especially better at treating you like an adult. The American system is simultaneously complex and infantilizing.
> https://worldpopulationreview.com/country-rankings/medical-b...
Also, perhaps because it's a lot more laissez faire, the private system in Hong Kong is almost unimaginably superior to the private system in the US. It's far cheaper because pricing is transparent and most people pay cash! (Cutting out that middleman.) It's higher quality because there's a lot more competition, rather than collusion among a few major providers.
No it is not.
Lots of experience with the health system in the US, for me, and helping many other navigate the systems.
It's not even close to identical. If you go to ER here and you can't pay, they may provide you with a certain level of 'care' to 'stabilize you' (as the law says they are supposed to, and the feds send some money to hospitals to cover some of this), and you will get billed, and collections calling, and credit report issues, and threats to sue and have your property auctioned (have held one of these letters in my hand, complete with a list of property that was in my name.
Even worse, the 'care' you may get is normally crap. For example I have seen the same people with same condition, at one hospital get a quick surgery and leave with a colostomy bag for rest of life, and other person at other hospital with insurance get placed in a room and treated for weeks - then left with a warning to avoid seeds.
I have seen so many examples of places leaves humans to rot with no insurance - hospitals.
Even with insurance, you can find yourself waiting 6-8 weeks for a doc appointment. I have so many examples.
It is worth recognizing though that not all employed people get medical benefits. Indeed many minimum wage jobs, low income jobs, "casual" jobs etc come with no medical benefits.
It's also worth noting that I some states it's OK to get fired for being sick. At which point you may lose those benefits.
Plus in poor economic times (like being a federal worker right now) losing your medical because you lost your job, seems like a suboptimal outcome.
But I agree with your last statement, this system works just fine, for a large enough group, so there's little political incentive to change it.
The same as any fancy restaurant meal is free: They gonna bill ya later
Pricing transparency also does not exist here as GP is claiming it does in Hong Kong. I am supposed to get certain imaging tests done every year, and I never know how much those will cost me until after I have already done them (in the U.S.). Maybe there is some way to get a non-binding estimate ahead of time, but I have never received such a thing and am not even sure it is possible. So I can’t easily “shop around”—or if can, tell me how because I (and I think most people) don’t know how.
I most certainly cannot pay $300 to see a specialist the same day in the U.S. I would have to pay that much to see my GP after waiting 6 weeks despite my employer paying more than $20k/year to insure my family. To see a specialist, I would have to wait a few months and probably pay $1-2k for one visit, not counting any tests or imaging that is ordered.
The description of Hong Kong’s system sounds amazing if true.
NHS budget has last I knew increased many times over since 1948, but the bed count went from about 450k down to about 100k - and those numbers were from more than ten years ago.
A theory is presented to explain this, which is that the more money you put in, the more management you get, and the more management you get, the less time clinical staff have for clinical work; more money results in less clinical output - but more managerial output, which theory argues is the primary focus and product of NHS.
Between the matrix style organizational structure and the many layers (project manager, program manager, director, VP, senior VP, BU president, etc…), I would love to know what, if anything, the higher levels actually DO.
In many org's, they mostly compete with other higher-levels for status.
And the biggest signifiers of status are usually (1) how many lower-level managers ultimately report to you, and (2) how many layers those lower-level managers span.
With the aging population, we'll need more and more health care professionals. I'm not just referring to people over 60, even people 40 upwards require more care.
If I am not mistaken, the current administration has enacted changes that have caused a significant reduction in federal grant funding for hospitals. So, many of the layoffs, as I understand it, are to make up for the coming losses in funding.
I live in a state with plenty of rural areas. There are growing fears of some rural hospitals being forced to completely shut down due to funding cuts.
Yes, a lot of physician work involves diagnoses; but it also involves getting one’s hand dirty. Hospitals are the peak of shop and factory work.
My wife, who worked as an RN in the OR is far handier with shop tools than I am as it’s time-sensitive physical labor!
Meanwhile the jobs program are all of the white collar variety; jobs that purport to support our healthcare workers includes 100% of the health insurance companies and programs.
Thanks to a generational messaging since the 1980s and 1990s, we white collar workers have wormed our way into all aspects of industry.
Eh, I kind of disagree. It would put a lot of insurance people and hospital admins out of a job, but the boots-on-the-ground providers would be fine.
This made be curious, so I looked around. FWIW, healthcare constitutes ~11% of the workforce in the US. It's ~16% in Germany, ~10% in the UK, and ~5% in France.
As a percentage of GDP healthcare is far higher in the US, of course.
If you add in everyone in insurance, pharma, devices, and the jobs those support, that number seems to be closer to 17% of the workforce from what I could put together.
Not sure if those in Europe do it similarly, but it just feels like a huge number of people. Maybe that is the result of demographics and a topheavy population, though.
And thanks to technology and science our first world society's got really good at keeping people alive and relatively comfortable.
Nor does it count any of the people who really should have more or better care but don't get it.
If we fix healthcare costs we can spend more on hospitals. With more hospitals means more jobs and more competitive care costs.
In addition, a lot of those insurance jobs are facing pressure from "AI".
For a simple outpatient procedure, the fee from the hospital dwarfs that of the anesthesiologist and surgeon.
For an inpatient stay, the hospital charges thousands of dollars per night for a room! Makes the Ritz Carlton look cheap!
https://en.wikipedia.org/wiki/List_of_largest_United_Kingdom...
Keeping people healthy is labour intensive.
17% of GDP is spent on healthcare. Claiming 60% of that is just "middleman overhead" makes no sense when the highest European countries spend 70% of what the US spends on healthcare.
If you want an actual analysis of why US healthcare costs are higher, I'd recommend the McKinsey study that compared category spending vs OECD countries. Exhibit 2 on page 4.
https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
Administrative costs are way higher in the US, but it only accounts for 15% of the higher cost.
The biggest driver is outpatient care - Americans get way more healthcare and it costs more (quantity * price).
Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero.
The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.
USA is very very good at complicated, cutting edge medical care but not efficient at delivering routine care.
Yes, VCs do put money into pharma, but that's private money very much expecting an (overall) profitable return. (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.)
And yes, for bigger companies, there are tax breaks etc, but most of those are regular tax breaks that any company gets.
I won't get into the chronic disease stats. Other than to say that good primary Healthcare tends to reduce the incidence of chronic diseases.
Quality of care is hard to gauge on a national basis. It's a highly localized product, so experience can be different in very small geographic areas. Equally "quality of care" is s metric with many axies.
Naturally for-profit medical advertises a lot, and they strongly push the "quality of care" message. So the general perception of that is "private is better". How much of that is true, how much is perception, is up for debate. My personal experience (which counts for nothing) having experienced both, is that the standard of medical care is the same. (Fewer tvs in public care though.)
I'm not sure what importing doctors has to do with anything, or if it's even true. Personally I don't really care where a Dr is from.
This is utterly false. Agencies like NIH, BARDA, and NSF fund early-stage biomedical R&D by providing SBIR/STTR grants to biotech and pharma startups. They also fund basic research and clinical trials as well as translational studies.
There is the Orphan Drug Tax Credit and R&D Tax Credit. Also, access to NIH labs, etc.
There is a whole plethora of funding. Moderna’s mRNA platform was heavily backed by NIH and BARDA even before COVID.
Thats what i meant by US subsidizing pharma for the whole world. I didn't mean the us govt.
Would they continue to exist if every single country in the world is doing "collective bargaining"?
curious. what kind of statistics would that show up?
When i was looking into clinical trials for prostate cancer. almost 80% of experimental cutting edge medicine was in usa. They even have spl k2 visa for International patients to participate.
That's not true by the definition of "nationalization" (government ownership)
Switzerland and Netherlands are entirely private insurance. Most European countries have a public system and private system. It's very common for people to purchase supplemental insurance on top of what the government provides.
Prices do vary between companies but many people just use the official insurance comparison tool and choose the cheapest as the services are completely identical. I'm completely against that system and would prefer a national health insurance like Japan.
> health care is a natural monopoly
It obviously isn't, because it wasn't a monopoly before the 1960s when the government got involved in it.
Yeah even your high net worth client that pays 50k in premiums every year wipes you out when they get some complicated form of cancer.
Edit this actually came up in a videogame called Cyberpunk. A lot of people here on HN consider themselves code wizards indispensable to their employer. Google will replace your multiple sclerosis ass.
What's most frustrating about this-- just take the poultry industry. To bring the cost to zero, all it would take is a single hacker to steal one government-regulated chicken and click "Copy" in its elusive little context menu[1].
Try telling that to a young person today. If you're like me you'll get the so-called "Gen Z Stare" in response.
1: Assume a 2d chicken.
And, well, it sucked. People died, black people got injected with radiation, and we experimented on humans.
Ultimately, I don't want poor people to just... die. Because that's bad. So we need some sort of guarantees.
Or, we don't: in which case, I hope you're content scraping bodies off the freeway for free. Someone has to do it if we're not paying for their healthcare and disposal costs. Hope you're not busy next weekend!
Those were experiments done by the government or funded by the government.
If someone can't afford healthcare, and in your vision we should refuse to provide it, then they die. That means, unfortunately, you are advocating for their death.
Which is fine, maybe. Except that we still have to deal with that. If they can't afford to dispose of their own bodies, now what?
No matter how you cut it, we either go back to the government or everything is awful.
Me asking you if you want to scrape bodies off the freeway isnt rhetorical. It might seem that way, because it's so extreme, but that's the reality here.
Someone, somewhere, has to pay for that. We already established that the person themselves cannot do it.
Should it be you? Should it be me? Or should it be everyone? If you answer everyone, congratulations, you've reinvented taxes.
The issue here is that these are already solved problems. Why do you think governments invented taxes hundreds of years ago? To steal from you? Look at the big picture.
Look how cheap your cell phone is, despite the amazing engineering that went into it. Pretty much everyone has a cell phone, both rich and poor.
This isn't an argument - this is an ideology, a pure faith.
There's no mechanism for this. Some things are just expensive.
Performing a surgery is expensive no matter what. It requires advanced machines and multiple humans with ideally decades of specialized training.
There may be "cheap" surgeries if there's no regulation, in the same way we have cheap shit on Temu - it's junk and doesn't work.
The cell phone reference you made kind of says it all - yes we have cheap cell phones. Most of them are shit.
We don't want shit medicine, shit surgeries, or shit chemotherapy. We want stuff that works.
Also, elephant in the room: products and services are necessarily different.
A phone is a PRODUCT. Medical care is a SERVICE. The difference being cheap products are good, sometimes, cheap services are bad.
We don't want a surgery to cost 100 dollars because that means the doctors are making, like, 2 bucks an hour. Which means we're living in a third world shit hole.
You don't want to live in a third world shit hole, do you? Great, then we're on the same page.
And, elephant number 2: healthcare can never, under any circumstances, be a free market. No matter how hard you try.
When you get sick and need to go to the hospital you might naively think the market of hospitals is thousands. This is wrong. Its actually a monopoly - there is only one hospital you can go to.
This is because of what healthcare is fundamentally - a service to keep you alive. You will go to whatever hospital is closest, because the human will to live transcends markets and even money as a concept.
This means, in a free market, it's not free at all - it's filled with only monopolies who can effectively charge whatever they want - which is exactly what we see.
The only places this doesn't happen is in places in which healthcare is nationalized. Because said countries know a free market is impossible, they don't even try, and they avoid the monopolization that's inevitable.
Some other people will naively point to systems in which there are both public and private options - and note that the private options are cheap and effective.
But that's only the case because of the public options. When private care has to compete with low cost public care, it will be cheap. If you remove that competition by privatizing all healthcare, then they can, once again, effectively charge whatever they want.
Super inflated prices nobody pays? - law on “U&C prices”
Consolidation of small oncology clinics into huge hospital systems? - law on 340B prices
All of these laws were put into place in an attempt at regulating prices, and as a result, entities exploited the law to give themselves even more profit than if the laws never existed.
Now that’s not to argue the government is solely at fault, but it’s remarkable how much government intervention had made the US system worse, not better.
In short, build an efficiency apartment on family property for an alone-living relative. Family can better provide support; the relative's residence goes back into the housing supply.
The municipality provides usual construction inspections but doesn't prevent the construction for non-pragmatic reasons.
ref: https://duckduckgo.com/?t=h_&q=zoning+to+allow+ADU%2C+in-law...
My father has a neurodegenerative disorder and we've struggled to find a place that will provide consistent care. My mother, a retired nurse, is the one who tends to do a significant amount of the work to feed, clean, and otherwise care for him despite paying over $10k/month. It's infuriating.
This is the third facility he's been in and options are limited because a lot of facilities aren't staffed to provide memory care. Unfortunately, there just aren't many options unless you're wealthy enough to have in-home care.
Insurance companies have to make money, but that's not that good of a deal, and the payout isn't that high ($73k annually) considering you won't be doing much else.
"Long-Term" is sort of a scare tactic that is used to get you imagining that you're going to be needing expensive skilled care for years. That can happen, but isn't normal.
US study:
> The mean age of decedents was 83.3 (SD 9.0) and the majority were female (59.12%), and White (81.5%). Median and mean length of stay prior to death were 5 months (IQR 1-20) and 13.7 months (SD 18.4), respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed by gender (men, 3 months vs. women, 8 months) and net worth (highest quartile, 3 months vs. lowest quartile, 9 months) (all p<.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes, lung disease, heart disease, and stroke).
https://pmc.ncbi.nlm.nih.gov/articles/PMC2945440/
Danish Study:
> The median survival after nursing home admission was 25.8 months, with the 3-year survival being 37%.
https://academic.oup.com/ageing/article/49/1/67/5639744
Tbh, there’s a lot of data on this because it’s easy to measure.
https://www1.deltadentalins.com/content/dam/ddins/en/pdf/car...
If you get the PPO, you have an in-network annual benefit cap of $2,500. So you're paying your insurance company to pay your dentist for you? And as soon as the bill gets large enough that you'd actually need insurance, they tap out?
Two sets of my grandparents have needed daily helpers for years. And that’s just for regular day to day care. Not in response to a particular trauma.
Insurance is wonderful when it works, but the conditions for it to work can be quite fragile.
“It appears you’re slipping on ice and about to hit a tree with your automobile, to continue your insurance, please deposit $27k within the next 6 seconds”
Adversarial for profit insurance does not make sense as it creates perverse incentives.
The way US health care functions is an argument that the nation's principles (all free capitalism and no public intervention) are problematic.
If I were POTUS for a season, I would make a volcanic erruption in the health system. If I needed to care an elder without insurance, I would pay out of pocket a willing friend or even a homeless and not proceed to euthanasia as a commenter suggested.
As for me, when it is my turn, I plan to do "home attendant services". My understanding is that Medicare will pay, after a doctor has declared I am home bound, medical services at my home. I will have to arrange for meals, bathing, etc. out of my own pocket. When that time comes, I hope to find people at my church who are willing to do this. When it comes close to my time, I would need the doctor to say I need "at home hospice". Then an attendant will stay with me 24 hours a day and give me painkillers etc. until I pass in my own home.
Who is going to tell them?
You'd think with the insane money the system is gouging out of people, every man and his dog would be trying to get a bite?
Also sounds like buying insurance isn't enough there, you'd have to buy some kind of insurer management service to deal with all the bullshit required to claim
Insurance is the only industry where customers are the enemy.
So every area of our lives that feels like it doesn't work like it used to - cost of living, healthcare, education, antitrust enforcement, journalism, accountability at the highest levels - represents a segment of the economy which has been corrupted.
Through this lens, socioeconomic policies start to make sense. For example, if your goal is to skim a fraction of the income from everyone in an economy and redirect those funds to specific goals/organizations/individuals, you could put tariffs on common goods and pass the funds collected on to companies granted large government contracts. Then the largest companies like GM and Ford see their profits reduced or even show a loss, while Grok and Palantir have all the money they need for mass surveillance.
Explanations for regulatory capture aren't normally this reductive, but wealth inequality has reached such monumental proportions that the simplest answer tends to be the right one when the needs of the few outweigh the needs of the many.
I believe that the US healthcare crisis started in 1973 when Nixon signed the HMO Act, which had the effect of tying health insurance to employment:
https://en.wikipedia.org/wiki/Health_Maintenance_Organizatio...
The alternative would have been some kind of single-payer option where US tax dollars would fun Medicare and/or Medicaid for all. Here is an explanation I found:
https://medicaiddirectors.org/resource/understanding-managed...
This differs from a public option, which would be a generic insurance offered by the government at a substantial savings over private:
https://www.currentaffairs.org/news/2019/07/why-a-public-opt...
A public option likely would be 20-50% less expensive than private due to the 80/20 rule and the fact the European healthcare is about 1/2 the cost of US healthcare, so a current $400/month plan might be $200-320/month:
https://www.aeaweb.org/research/regulating-health-insurers-a...
https://nashbio.com/blog/healthcare/the-healthcare-divide-pr...
Unfortunately Obamacare (Romneycare) forced everyone to get insurance or face a tax penalty mandate, which was lifted by Trump in the Tax Cuts and Jobs Act of 2017:
https://www.ehealthinsurance.com/resources/affordable-care-a...
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Knowing these facts, what's really going on? Two things:
* Obamacare did little to address the natural monopoly aspect of healthcare, so costs exploded
* Republican concerns about government overreach into our private lives (knowing our info and determining who receives care) and negative impacts on private health industries have not been heard
Natural monopolies are things that everyone needs, such as water, sewer, trash, electricity, education, healthcare, etc:
https://en.wikipedia.org/wiki/Natural_monopoly
Meaning that eventually running a capitalist system results in 1 or 2 companies controlling the entire market and charging whatever they wish, since high cost of entry prevents competition. Without competition, there is no supply and demand curve to counteract price increases. In other words, whoever controls the water can sell it at any price. Or insulin, or Epipens, or Hepatitis C treatments.
The only way to bring costs down on a natural monopoly is through regulation. Society chooses which firm(s) will supply the good or service, and how much it will cost. Overages are paid through subsidies, which can be high, but are at least under public review, unlike when private industry controls a market.
These are the reasons why healthcare got so expensive. But the meaning behind it, that's more nuanced.
The US is very into individual responsibility. Our belief is that a strong citizenry ensures a strong nation. Because we defeated not just fascism in WWII, but the rise of socialism and communism during the Cold War. Our privately funded athletes beat state-funded athletes in the Olympics. Our private industry runs more efficiently than (for example) national construction projects in Russia and China which built cities that nobody lives in. We have our own pork barrel projects, but they tend to be limited by public scrutiny, unlike in communist nations.
The US is also very into privacy. We have medical privacy laws like HIPAA which may not exist with state-funded medical care. Now, this is a half-truth, because Europe has arguably the same or better privacy than we do. Because there is little incentive to sell medical information there, unlike here.
What it really comes down to is that people who are used to paying through the nose for US health insurance after a lifetime of hard work aren't ready to see others receive it for free through the government. They don't want someone determining how long they have to wait for care, or if they receive it at all. They perceive government red tape as making health providers even more expensive or putting them out of business. As in, why would doctors go to medical school merely to be paid little more than teachers and other public servants? Yes, privacy may be impacted with single-payer. But in the US, the answer is usually about $$$.
Sadly, this debate has resulted in the lose-lose we see today: rising costs with no backstop, and threatened privacy due to regulatory capture by health companies which have misaligned incentives and are too big to fail.
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My solution to this political impasse would be a gradual transition to single-payer healthcare (probably Medicare for All) on an opt-in basis, either at the state or individual level. Knowing that taxpayers who opt in may pay a higher rate for a time to supplement those on private insurance. Until enough people are in the single-payer system that it becomes self-evidently better and the majority switch to it. Similar to private school vouchers, except going the other direction: public healthcare vouchers.
People could still buy private insurance to supplement Medicare for All and go to the front of the line. I don't like it, because I believe that healthcare is a human right that shouldn't depend on money, but this is America. If someone has the money to pay doctors overtime, then it probably makes little economic sense to stop them.
Medical research should go back to the previous university/publicly funded model. So grants would be available for companies pursuing billion dollar cures for cancer and other diseases which diminish quality of life or its duration. Then medications would be sold at close to wholesale price. This eliminates the current problems where pharmaceutical companies sell treatments instead of cures, that tend to start out very expensive.
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Sorry this got so long. I believe that you'd receive a similar summary from an LLM, and that without this context, a debate would fall into dogmatic attacks that lead nowhere.
Edit: fixed small typos.
I think one problem is that healthcare in many cases is meant to tackle the 1.5-2 sigma problems -- so naturally few people really encounter bad healthcare. The others thing they have good healthcare, until they are unlucky enough to encounter an issue.
I'm shocked how many people on my exact same health plan at work think it is a great plan.
The more immediate/pressing your need for risk coverage, the worse it is for them to sell it to you. The less you need it, the better it is for them to sell it to you and the worse for you to buy it.
Pretty different than ice cream or cars or housing. Too many people just think “oh corporate greed” without thinking about the underlying economics (partly because of how us culture pretends markets are magic).
In the past, insurance companies (think: liability, fire, life, shipping) responded to a claim by hiring a lawyer and negotiating down. Like most contracts.
So states began creating insurance commissions, which serve as law firms that defend consumers from insurance companies. In practice, their existence forces insurance companies to pay what they are owed.
We need insurance commissions for health insurance. If there is a reason why the policy shouldn't pay (services received after policy expired, for example), the insurance commission has to sign off.
This is how normal insurance works. Health insurance, of course, is not normal insurance.
If my house burns down, there's both public harm and private harm. The public harm is the danger to bystanders, the loss of neighboring real estate values, etc. The private harm is the fact that I lost most of my equity and have to declare bankruptcy to get out of my mortgage.
Insurance is focused around preventing private harm.
So the state is now on it's own in preventing public harm (already the case), but also now liable to remedy the private harm too.
I personally know many millionaires who lost their mansions in the LA fire. I'm glad tax payers aren't paying to rebuild their $20 million dollar houses.
That's an extreme example, but insurance benefits those who have something to lose the most.
Let's keep government insurance focused on things that private industry refuses to insure, like unemployment and health insurance for sick people.
And also doesn't consider when the LTC starts. It could start at any time, even before working age.
Healthcare is a triangle. There are three players. You, Insurance, and Doctor.
All three are adversaries and allies in different ways.
Family at first but USE PROFESSIONALS. Due to scummy ins company wanting docs.
How is that health care? Babysitting is now health care???
We need a better way to deal with dementia. Not health care.
A literal babysitter to make sure they eat and don't run into the street.
I don't see dementia as sickness. Brain illness maybe.
So we have to warehouse these feeble folk. That is the problem.
We need a more humane way rather than Doctor K's method..
What about the poor old guys girlfriend?
There’s a reason companies got away from offering these policies, they were losing money on them.
You were right in one thing: that yes, it’s going to be insolvent. Why? Because the idiots in legislature were convinced by the anti-safety-net bastards to add an exemption carve-out that fucked the entire financial plan. If you let anyone opt out of Medicare it wouldn’t have existed for six weeks. And now those bastards have the nerve to turn around and say oohhhhh noooooo it’s not even fiscally stable!
But, homeless industrial complex? Ridiculous conspiracy theory nonsense.
For anyone not blinded by that nonsense - the WA LTC benefit would fill in the gaps for people who do not qualify for Medicare long term care, which is basically everyone who is going to need the Medicare benefit, and keep them from going bankrupt, destroying their family or simply dying for lack of care in that year it takes before Medicare kicks in for them.
There was a brief window where you could get LTC insurance from any provider and use it to opt out of the tax. High income earners did that because it was cheaper than paying the tax and also because receiving the benefit required you to stay in WA. The opt-out window has since closed, and if you haven't opted out by now, you will forever pay that tax if you work in WA.
Aetna knows exhausted and stressed moms are less likely to persist. It is blatantly fraudulent but they get away with it because no one has the time or money to get their executives thrown in jail.
It's a massive shame how he is treated right now. Right after the deposition of one mass murderer CEO, another would-be mass murderer insurer backtracked their plans to limit time under anesthesia.
Deposition works.
Even those who believe human lives are equal (they are not) have to admit the price of one dead (bad) person outweighs the number of people who would have died or had serious complications from rushed procedures.
(1) It’s expensive (2) Everybody has to pay (3) The government’s gotta run it
But there are plenty of countries with functioning healthcare systems that are private? The Swiss, for instance. Moreover depending on what counts as "government’s gotta run it" (paying for it? administering it? actually providing care?) you can argue that the German or even Canadian systems aren't government run, at least to some degree.
America has had multiple attempts at solutions for healthcare over the years, each started with good intent and then waylaid by various causes to produce what we have right now.
A sibling comment mentions political compromise to pass the ACA, as an example of this.
Another example is that HMOs were started with inherent goodness, but got “corrupted” (in my mind) by profit seeking.
To directly answer your question: a core tenet of the Republican tent is minimal government involvement in day to day lives of the citizenry. Ergo, the Swiss system won’t work because it involves a lot of bureaucracy. Republicans link bureaucracy to cost, and feel this is not an appropriate use of tax payers dollars.
The holes in this political doctrine are not part of my answer here fwiw. Please no “but…” comments to that end :)
The difference now is the republicans have changed, and nuanced issues are just not welcome on the platform of a party following a cult of personality.
"There are people not good enough for health care and helping them would violate this natural order".
That doesn’t make it the wrong policy decision. Lots of systems we happily manage with similar dynamics. But I don’t think denying that basic fact is the right path forward. The moral hazard is real and worth acknowledging.
Smokers for example have more lung disease and cancer which cost money to treat, but usually not until they are in their 60s so they still spend their entire life paying into the system, but then they die soon after, saving on age related healthcare costs. And that is on top of smoking disqualifying someone from many treatments and surgeries, making smokers a net-win for healthcare costs to society.
Being really fat also seems to have similar effects, although the the finances are much closer so perhaps the second order effects from being fat cancel them out. But on paper they are still a bit cheaper than the average person.
Many people will argue against it because it "feels wrong" and they think unhealthy people should be punished (for example with higher insurance fees) and don't want to admit that unhealthy people are subsidizing their own healthcare, doubly so if you add in the sin taxes they have been paying their whole life that often result in more state income than their entire life-time medical costs add up to. But there has been numerous studies across the decades in Europe and the US showing how much cheaper unhealthy people that die earlier are to care for compared to the 90 year old granny walking everyday and risking broken hips and taking 30 different medications a day.
I think bad health is usually its own punishment.
Insurance is just risk-pooling. The most effective risk-pooling requires a bigger pool. That's why we have big insurance companies and bigger companies offer better employer healthcare plans.
Well, the biggest pool is the entire US population. So, we should just do that.
We already have socialized medicine. If my coworker smokes, I pay for that. If we're going to do socialized medicine, we should do it right.
Basically what Obamacare was originally intended to be before they had to compromise to get it passed.
https://en.m.wikipedia.org/wiki/2010_United_States_Senate_sp...
Afaik that's the gist of it. The ACA has been maimed on various fronts (e.g. the mandate "everyone must have health insurance" is no longer practically in effect), but it originally started out very similar. Far more than to, e.g., the UK's NHS which is fundamentally quite different.
You all need to think about what’s going to happen to you when you can’t move anymore. Will you have enough money? Triple it. Maybe 6x it. Only the rich will be able to live healthy unless you’re diligent about your own health or strike it rich in an IPO.
https://www.mckinsey.com/mgi/our-research/dependency-and-dep...
https://www.cato.org/cato-journal/spring/summer-2018/demogra...
https://www.cato.org/commentary/clear-eyed-look-our-demograp...
This is why life necessities are often treated as a public responsibility. Health care is one of the few that is treated as a luxury.
There seems to be very little talk about making medical education cheaper and more accessible. Why wouldn't it be cheaper if we had more MDs and nurses? What if we made it easier to become an MD ?
The insurance system is a cartel and they are greedy. However the regulations (upheld by the government) enable it.
The insurance system is a profit seeking institution, that functions as intended. Why dont you talk about that BURNING aspect?
In places with Catholics, you usually get the bishops advocating for the local Catholic hospital system.
It turns out the real world is a big complicated messy place and there's rarely a simple answer like "delete government!"
But the weird deification of him, now displaced by the new guy’s cult of personality is so awful and toxic. He’s either a giant among men or a demon, and both positions are wrong.
I'm not sure there's any realistic way to enhance the availability of specialists. You can't 'stub' your way through providing the care of a skilled gastroenterologist by substitution with a NP, though PAs in specialty care are becoming common.
If you are facing death, no one wants the off brand, budget cancer treatment. No one is going to shop around for the best value cancer treatment.
If you have a heart attack, no one is going to call around for the best price on the ambulance.
It is like a luxury market. People shop around for the best doctor/treatment with no regard at all for the price.
So it is like complaining that a luxury service market is expensive.
The only way around this is a completely state run health care system that you have no choice.
That they're nonsensically broken out as a separate insurance category is intrinsically linked to the problems the article describes
(3) isn't correct either. It needs to be regulated in some way. Government doesn't have to run it. I think it should be treated more like a utility
Agree with your second point.
That's basically impossible. You will only know if you made the right choice once you are actually starting to use the insurance.