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Comment by pitaj | Hacker News Reader

Emergency situations are exactly what insurance is for. Emergencies account for a minority (<15% IIRC) of health care spending.

Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans:

- remove the tax exemption for employer-provided insurance

- add a tax exemption for individual/family insurance, including a rebate for the amount of money payroll (social security and medicare) taxes would affect the amount of money available for that insurance

This way, people don't lose their insurance when they lose their job, and people have more insurance options. This would also likely have a beneficial affect on insurance competition.

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But, as described in the article that system does not function.

Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance.

Further, even if the facility you visit does accept the insurance, that's no guarantee that all doctors within that facility accept that insurance.

Even further, there's no guarantee you'll be conscious to validate that you go to a facility that accepts your insurance.

The insurance system needs to be fundamentally repaired before it can be used to support a "free market" healthcare system.

"That system" as described by parent has not been tried, at least not in recent memory. What we see happening now are thousands of unintended consequences from government meddling with the free market.

I think you mean from the "free market" - which is neither free, nor genuinely a market - usurping the good-citizen responsibilities of mature and sane government.

Please read above as to why free market fails for emergency services

Proper insurance pays you for insured losses you incur.

When my car is damaged in an accident, I take it wherever I want to have it repaired. I don't have to think about whether the shop is "in network" or not. My insurance pays for the cost of the repair, up to the limits of my coverage. Simple.

I'm not sure if you have ever done this but there are a lot of caveats to that. Many car insurers will have you shop around for a good price, have you pick one of their preferred repair providers or may decide that damage you claim happened in the accident was preexisting. The job is called "claims adjuster" and I'd be surprised if no one from the insurance company visited you when you filed a claim.

in real life your car insurance company will tell you where to take it

> Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance.

Does acquiring a credit card ensure that businesses will accept it? When you select your insurance plan, check who accepts it. Problem solved.

Is there any chance that facilities that don't "accept" my credit card would be able to:

* Not inform me they don't accept my credit card

* Provide the goods and/or render the services

* Charge my 10 times the standard price for those goods and/or services because my card was not accepted?

No sane person would agree that this would be an acceptable regime for credit cards. Yet it's the world we live in with health insurance.

A "free market" is only effective with price transparency and discovery mechanisms. This is not possible in the current healthcare and insurance system as it exists today.

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Aside from that, you failed to even engage or address the following points from my earlier comment.

> Further, even if the facility you visit does accept the insurance, that's no guarantee that all doctors within that facility accept that insurance.

> Even further, there's no guarantee you'll be conscious to validate that you go to a facility that accepts your insurance.

I think both of those points address and rebut your "check who accepts it" argument. Do you have any response to those?

If you read the article you'll find that the problem is that while the hospital may accept your insurance, a particular doctor won't. Also for some reason some doctors don't even know what insurance programs they'll bill.

Seems easy to solve by forcing doctors to accept the insurance plans that their hospital does.

Seems easier to solve by just having a single entity paying the doctors'/hospitals' costs.

And only have emergencies around there and don't lose consciousness! It's simple math people!

Buy insurance that has good coverage for the places you are likely to be. Why is that a problem?

...because even if you end up at a hospital where your coverage is great, they often have doctors or providers that won't accept your insurance, and there's just about no way to know this beforehand.

So force hospitals and doctors to align on insurance acceptance, seems pretty simple.

And buy travel insurance any time you want to drive more than a hundred miles or so?

Move to Europe or mostly any place outside the US and be able to forget about this idiocy.

This! We have totally forgotten the definition and purpose of insurance.

The purpose of insurance is to pre-pay for a new roof every fifteen years and a teeth cleaning every six months.

> That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans

Among people who support "free market healthcare", who specifically is seriously pushing a plan like this? It is not something I've seen before.

Well I don't have any legislation on the docket anywhere, but I would fully support the complete separation of health insurance from employment compensation. It's just another layer of obfuscation between the consumer and provider in the marketplace.

I'm doing it, and a few other libertarian type people. I agree with your statement though: we are a minority. Most who call themselves free market do not see how employer provided plans make things worse.

This was famously denounced by Milton Friedman a long time ago.

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