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Comment by kolpa | Hacker News Reader

Insurers are paid in premiums, not health outcomes. An insurance company is incentivized to help avoid costly claims, but if you are likely to make costly claims, and they can't drop you, they are incentivized toward healthcare choices that kill you before you need long-expensive term care.

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> An insurance company is incentivized to help avoid costly claims, but if you are likely to make costly claims, and they can't drop you, they are incentivized toward healthcare choices that kill you before you need long-expensive term care.

Insurance companies don't make the choices - providers do. In the US, insurers have very little control over providers' decisions in most care settings.

Ironically, under capitated care, the provider acts as the insurer, and is expected to balance both the medical outcomes for the patient and the overall cost to the system directly in their decision-making. For some reason, that's the model that people seem to advocate in this (and other) HN threads about healthcare, which boggles my mind: I can't understand why patients would want their medical provider to have an inherent conflict of interest from the start.

Because the choice for many is not mostly loyal physician vs. HMO or corporate employee doc. It’s HMO doc vs. no doctor visit.

> Because the choice for many is not mostly loyal physician vs. HMO or corporate employee doc. It’s HMO doc vs. no doctor visit.

Huh? Where are you bringing HMOs into this? Nobody's talking about HMOs.

To be clearer: There’s a spectrum between 100% cash market, to indemnify plans where you e.g. you have a flat 10% co-pay, to “in-network” plans like PPOs, and pre-paid plans with corporate employee docs (e.g. Kaiser). Not all HMOs have employee physicians as you noted.

My point is that third-party free medical services are out of reach of most Americans. Even if the doc is separate from the insurer, they have to follow their claims process. You generally have to take your employers plan. The less fortunate take Obamacare and its limited doc networks, or are totally out of luck!

I agree they can’t be trusted but they’re not being evil that way. They’re still trying to pick the low hanging fruit of easing lifestyle disease burden like heart disease, diabetes, and tobacco use.

Ruining your health just means they pay for $$$$$/day hospitalizations. That’s far worse than paying for your maintenance pharmaceutical cocktail and some specialist visits.

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