Insurance should be used for what it is — an financial instrument to protect against unforeseen and catastrophic financial loss.
Car insurance doesn’t pay for tires or oil while it could be argued that bad tires increase the risk of accident. However tires and oil are an inextricable requirements to owning a car.
This idea that health care should be paid for by someone else has always puzzled me. It’s the equivalent of food being “free.”
For the legitimately poor, there is definitely a role for government just as governments don’t let people starve to death, but for everyone else — its just wacky that the government ought to be involved at all beyond safety regulation. We went wrong when some groups started claiming health care as a right — nobody has a “right” to the labor of other people. In other words — I don’t have a right to make you produce something for me.
Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.
> Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.
No, they have spiralled out of control because health care is something where no real market can exists, so you need good regulation (which the USA doesn't have). If you have an urgent and life-threatening health problem you can't shop around for a cheaper hospital or decide to go to none at all if the alternative is death. So they can charge whatever they want if there is no regulation.
You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available.
There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you wouldn't need to shop around, you would decide based on each hospital's reputation.
Unfortunately hospitals don't publish their median wait times, patient outcomes or even their prices. If they were forced to publish those things, maybe a market would emerge.
You can live on Doritos and donuts for weeks or years. You can be an ill-informed and lazy consumer and survive. I have learned when I can substitute oil for butter without problems and when it'll cause disaster.
How many people on HN have done the reading to know when a fecal occult blood test can and can't be substituted for a colonoscopy? And those are generally tests that don't have urgency. When you're in the hospital because you've been vomiting for 6 hours and are passing out, are you going to say yes to the abdominal CT? This recently came up with a friend, who called me for advice. I was with a doctor in the moment, who said that he didn't see why it was indicated (for a host of reasons). The doc got on the phone with friend who handed the phone to the physician's assistant who was going to bring him to the CT, and argued the guy out of the CT. This took knowledge, effort, and persuasion. Who here is going to be able to self-diagnose and say, "Skip the CT -- I'll have it if X has not improved in 24 hours and Y continues to decline."
For many reasons, in the US there is a lot of "defensive medicine" practiced. The doc would rather order the CT than defend against a lawsuit, and for him/her it takes less time to order the CT when the patient rolls in than wait 24 hours while observing the patient in the hospital. But it's not actually in the patient's best interest. Our incentives are not aligned, and patients do not have the time or baseline knowledge to evaluate individual treatments.
You can live for weeks without food, it can be stored easily (unlike services which aren't stored at all), and the barrier to entry is low... Many people even have their own food gardens. It's also very amenable to nearly complete automation. Therefore food is super cheap.
>I understand that healthcare is more expensive than food for all those reasons. What I don't understand is why there can't be a market for it. Expensive services can have markets too.
At the moment the only thing I can think of that are expensive services are also luxury services. Most people consider health care to be a basic service that should be open to those who need it, regardless of wealth.
Back to the food analogy, people who can't afford the food they need to live are given food stamps. Even so, there is still a market for food. People know ahead of time what the exact price of the thing they are buying with their food stamps. Nutritional information is available on the packaging.
Why exactly can't I know ahead of time how much will each hospital in my area charge if I have a heart attack and have to go to their ER? Why can't I know which hospital has better survival rates, or the shortest wait times?
That information is all that is needed to have a healthcare market. It should not be impossible.
I understand that healthcare is more expensive than food for all those reasons. What I don't understand is why there can't be a market for it. Expensive services can have markets too.
They are all medical procedures that are not covered by insurance. As the number of providers increases and the technology advances, prices drop and quality increases.
Those are not required procedures, so obviously there is much more of a chance for a real market there. But you can't just compare that with e.g. ER or cancer treatment.
Because the idea that cancer treatment as well as other exotic treatments needing to be covered by insurance is a pile of horse manure - i'm saying it as someone whose grandmother died from cancer and someone who has a few friends that successful beat down cancer.
Lets engage in an intellectual exercise. 10MM USD (today) and for 1 person cancer is gone. Should we include coverage for cancer into all policies?
Your lifetime odds for cancer are like 50%. If insurance doesn't cover life threatening illnesses and life-saving treatments, what's the point in paying for insurance?
I agree it should cover them (in theory). I would even agree that healthcare should be a human right. But even under a zero profit model, for the cases where the treatment is so expensive, what would the financials look like for all the insurance payers? Is it actually even possible?
This is naive voice of someone who has never needed an effective healthcare system or faced many of the challenges that many do, such as chronic problems, unemployment etc.
What happens if it was your brother or sister dying? Not paying for them! Nice chap.
Healthcare costs are high because of lack of regulation and the ability for private enterprises to set costs. Profitability is not ethical when it comes to doing no harm. I’m sorry I can’t treat you, you can’t afford that option.
It’s simply not true. In the 4 countries I have lived in, the US was the only one with very expensive heathcare, and in the other 3, which all have what Anericans call socialized medicine, healthcare was even more detached, but much cheaper.
what do you mean by that in the UK I got treatment based on my NI contributions which in the US is unavailable unless you can prove you can personally pay $1500 a month for the rest of your life, to pay for the anti rejection drugs post operation.
I'm puzzled when Americans say this, because their government spends far more on healthcare than other governments, and also doesn't provide universal healthcare.
The US is the worst situation: expensive government provision, that doesn't prevent the harm caused by lack of access, but which also causes harm with too much access for the wealthy.
Car insurance doesn’t pay for tires or oil while it could be argued that bad tires increase the risk of accident. However tires and oil are an inextricable requirements to owning a car.
This idea that health care should be paid for by someone else has always puzzled me. It’s the equivalent of food being “free.”
For the legitimately poor, there is definitely a role for government just as governments don’t let people starve to death, but for everyone else — its just wacky that the government ought to be involved at all beyond safety regulation. We went wrong when some groups started claiming health care as a right — nobody has a “right” to the labor of other people. In other words — I don’t have a right to make you produce something for me.
Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education.