Hacker News Reader

Comment by pyoung | Hacker News Reader

I think you are taking his argument too literally. Using your own examples, someone who chooses a treatment with a $500k/QALY is probably suffering from the same sense of urgency/price insensitivity as the guy bleeding out on the street. Just because that person has some time to shop around, doesn't mean that they aren't getting price gouged. When someones health/life is on the line they are not going to act rationally.

Does the ACA address QALY? Seems like it might make sense to tie health insurance coverage to that metric. I would be more than happy to pay for coverage that covered the low end of the spectrum if it would mean lower premiums.

View on HN

>someone who chooses a treatment with a $500k/QALY is probably suffering from the same sense of urgency/price insensitivity as the guy bleeding out on the street. Just because that person has some time to shop around, doesn't mean that they aren't getting price gouged. When someones health/life is on the line they are not going to act rationally.

What insurance lets you do is decide in advance what you think is reasonable, assuming no government rules about what must be covered (just like the UK does for its entire population).

Nobody (at least before preexisting conditions were not required to be covered) was buying insurance that would cover a $500k/QALY right when they needed it. Instead, they previously bought insurance that the government decided had to cover a $500k/QALY for certain treatments and weren't allowed to make any other decision.

And what if they choose the insurance that didn't cover a $500k/year heart pump and realize in a panic at the last minute that they actually did want to be able to be treated at that high level of expenditure, but can no longer afford it? They're in no worse condition than somebody in the UK who would never be given the option.

I think we are starting to dig into the weeds a bit too much. I am well aware of how insurance works, and how single payer systems contrast to the US system. What the OP was trying to point out was that free market economics can break down in certain situations, and health care is a prime example.

>What the OP was trying to point out was that free market economics can break down in certain situations, and health care is a prime example.

And my point was that such situations account for a very small percentage of situations in health care. Most situations and most medical care expenditures aren't of the type claimed by OP. In other words, it's really not a prime example and many of the highest costs are things that people could decide on. For example, the UK will probably not offer treatments that cost more than about $50,000/quality-adjusted year. It would be possible to offer insurance in the US for substantially less if insurance companies could sell a policy that would stick to that, and many people would take probably buy them (many people choose not to even buy insurance currently).

Reply on news.ycombinator.com