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Comment by rayiner | Hacker News Reader

It's absurd to say that imposing a limit is somehow misleading for something sold as "insurance." "Actual insurance" almost always has a policy limit. Everything from car insurance to corporate liability insurance has a limit. I can't think of any "actual insurance" besides health insurance that doesn't have a limit.

Again, I'm not arguing against having health insurance be unlimited. I'm taking exception to your rhetorical mode, which I think is dishonest. By making the issue about the "big greedy insurance company," you obscure the fact that the public will be paying for these benefits. You're selling the public something as a "you can have your cake and eat it too" but that's a bill of goods.

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FWIW, insurance in other countries has limits, but rather high ones.

For example, my private liability insurance (50 EUR/a premium) is limited to 50 million EUR/event. So, yeah, if I ever accidentally create 60 million EUR damage (in one fell swoop), I'll be broke.

My travel health insurance is 12.50 EUR/a, and pays 100% of medically necessary out-patient and hospital treatments (for an unlimited number of trips up to 8 weeks), as well as repatriation, without limit. (This works, presumably, because if shit hits the fan, they'll fly you home and hand you off to the normal health insurance).

I can't emphasise enough how good it is to be in a civilised society where the existential risks are covered and shared. Furthermore, because they are borne by someone (either insurers or gov't), there are also experts dedicated to managing them, and reducing them.

It all works because everyone is insured, so the insurers don't have to worry about adverse selection.

This raises a really important point. A limit that’s basically impossible to hit is very different from a limit that you’re basically guaranteed to hit if you have a major problem.

It's also how single-payer healthcare works in the majority of countries that have it.

The problem is simple - in most developed countries, health insurance doesn't bankrupt the people it serves. It also doesn't have policy limits for common terminal illnesses.

So why does this happen in the US - a country with insanely high costs and relatively mediocre health outcomes?

The problem isn't insurance, it's the influence that unregulated privatised insurance has had on health industry costs as a whole.

Hospitals, medical professionals, pharma companies, and insurance companies are all primarily motivated by profit, and will price gouge patients to the maximum extent possible.

Insurance companies may be regulated intermediaries, but in reality many insurance companies are actually owned by hospital chains.

They simply provide a layer of regulated bureaucracy that disguises and legitimises the price gouging.

So while technically it's true that insurance companies have regulated margins, it's also a misdirection. The true role of the insurers is to provide corporate and bureaucratic cover for the outrageous sharking and exploitative profiteering in the rest of the industry.

Customers - i.e. patients - most certainly do not benefit from this arrangement. Shareholders and CEOs very much do.

>in reality many insurance companies are actually owned by hospital chains.

Huh? In the US, Kaiser is the only integrated provider of insurance and healthcare that I know of. It actually is a fairly good model. Otherwise Cigna, Bluecross etc.. are strictly insurance companies that have contracts with other providers to provide care to their members.

> It's also how single-payer healthcare works in the majority of countries that have it.

Only a couple of countries actually have single-payer healthcare[0]. For those that do, treatment for complex, expensive conditions like cancer is regulated by the government much more strictly than in the US, with the result that patients have far fewer options for (covered) treatment. Incidentally, those countries, like the UK, tend to have dramatically worse cancer survival outcomes than the US does.

[0] The UK (if we ignore the divisions between the NHS in England, Wales, Scotland, and Northern Ireland) is one of the only ones.

Do you have any citation for the "dramatically worse" claim?

No other insurance is like health insurance in terms of the consequences of having a cap (not being made fully whole vs being left to die).

Car insurance has no lifetime limit. The limit is either per year or per event.

Car insurance is sold in a 6-month or 12-month policy term, with a "lifetime limit" during that term. You can buy a new policy at the end of the term, but the insurance company isn't obliged to sell it to you.

Health insurance was typically sold in annual terms, with annual, lifetime (actual lifetime), and often per-event limits. Health insurers were not obliged to sell you the same policy at the same rate, the same policy at any rate, or any policy at any rate, either.

Is there an explicit limit, or is it just implicit based on how many crashes you can possibly get into and get repaired within the policy period?

There are very explicit limits that you select when buying car insurance.

Per incident, though, not total, isn’t it?

Hmm, you’re right. I always figured the non-minimum limits were per term. This Geico policy document I’m reading specifically states it’s per incident.

My renter's insurance technically has no lifetime limit either, but they declined to renew my policy for another year after I made a single claim.

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