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Comment by ma2rten | Hacker News Reader

I think there are two parts to the answer. Firstly, health care in the US is extremely expensive. There are long articles written about this but IMO a main reason is market failure. The US, especially republicans, place a lot of value on free markets but people are willing to pay almost anything not to die.

The second part of the story is that the US is richer than Europe. I moved to the US from Western Europe. Before I moved here I didn't expect how much more everything is more expensive here, but at the same time salaries are also higher. The US's GDP per capita is $62k, Germany's is $47k. But that doesn't tell full story. In the US there is a big difference between low paying and high paying jobs, rural and urban areas.

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Overly naïve and simplistic rhetoric about "the market" invariably fails to mention that while ideal markets are effectively forced to price commodities as close to the minimal margin of efficient production, it doesn't take much of a barrier to entry for suppliers to silently shift to pricing at the point of pain because they know it makes them all more money.

The recent collapse of movie theatres clearly illustrates that there is no reason they could be getting away with making $10 margins on popcorn, of all things, other than customers were being charged exactly as much as they would tolerate without telling the proprietors where to stick it.

> but people are willing to pay almost anything not to die.

No, not really. This is a narrow picture of reality. People are often willing to sabotage their own bodies and drive their bodies toward obesity, clogged arteries, and liver disease while not spending the money to go to a doctor for annual checkups or flu shots.

The dollar menu is cheaper & tastier option than buying a salad and people consistently choose the cheaper, tastier option

I think the clearest evidence for market failure is the complete lack of price transparency. Medical providers simply don't compete on price.

Prices quoted aren't actually prices. You have zero idea how much it's going to cost you until you get the bills, often split across dozens of providers, and what you see are the results of negotiations between providers and insurers.

No offense meant but, before Obamacare was enacted I had an excellent healthcare premium of $77 per month. Now comparable care is $400 per month.

However Obamacare changed the scene, I dont support it.

You're also now 10 years older. Health insurance pricing never goes down as you get older, only up. That $77 might have been $150-200+ for someone your age now 10 years ago.

This was an immediate reaction, I went from being able to afford healthcare to not affording it.

Well it got rid of insurers denying coverage or charging more for pre-existing conditions, which is obviously the morally right thing to do, but is roughly like being able to buy fire insurance while your house is already half burned down. IMO the conclusion is just that insurance is a bad model for healthcare coverage.

Which is why it had the individual mandate to prevent people from doing that.

Obamacare didn't make healthcare more expensive. It just distributed the cost differently.

Was $77 the entire price of the healthcare coverage? Or was that just the portion that you paid?

It was the entire portion, was not through an employer.

It sounds like you had the equivalent of “short term health insurance.” They might not have called it that back then, but it’s sold now under that name (with limitations on how long you can remain in the policy that were relaxed recently) to remain ACA compliant. You can still buy these type of plans (at least in my state, North Carolina) for under $100/mo. There are lifetime maximums, exclusions for pre existing conditions, and high deductibles, but that’s probably the same as what you had pre-ACA as well.

These plans are typically referred to as “junk insurance” but if you can’t afford or just don’t want a more comprehensive plan they’re better than nothing.

It's not. I had a low deductible and a low yearly maximum out of pocket. They didnt deny me for a pre existing condition, my knees, and I had 2 knee surgeries while on the insurance and my low deductible and co-insurance meant I spent less the $3000 for both surgeries combined.

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