Comment by jsperson | Hacker News Reader

Comment by jsperson | Hacker News Reader

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> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand.

Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected side benefit is that a large percentage of their patients are un/underinsured. They can quote the prices for most common procedures from memory.

The other day I was getting a blood test and they asked if I wanted to bill my insurance or pay cash for it. I asked about the cost and they said "two-sixty". My response: "For two hundred sixty bucks we better bill the insurance. They laughed: no, $2.60 (it was an add on to another test for my physical). When I got home I googled pricing - the exact same test normally bills for around $65.

We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. Thus the best way forward is to try what has been successful elsewhere.

The annoying thing is, most people would agree that the whole system sucks... until you start talking about politics and suddenly you'd think a bunch of people have a love affair with their insurance company and healthcare providers.

> until you start listening to politicians who have a vested interest in making the general public believe such things

FTFY

People "love their health insurance" when they have it forever through their employment, and feel safe in their position.

80% of people in the US, including 50% of Republicans, support M4A precisely because they are not part of the upper-crust minority who are afforded such luxuries.

I've never heard of a prominent Republican politician voice support for taxpayer funded healthcare. It would require a significant increase in federal income/FICA taxes. And in the enormous portion of federal spending that Medicare/Medicaid is, it doesn't even include outpatient services/medications for everyone over 65.

Of course, this would be mitigated by the elimination of health insurance premiums and other redundancies, but a federal taxpayer funded solution would result in a more transparent wealth transfer, whereas the employer sponsored tax deductible health insurance gimmick allows for better discrimination on who receives healthcare, and ideally reduces the amount of wealth transfer by reducing the healthcare many people receive.

> I've never heard of a prominent Republican politician voice support for taxpayer funded healthcare.

Just goes to show where our "representative" democracy has gone. The number I quoted is for voters registered Republican.

People will talk the talk, but they won’t walk the walk when it comes to paying.

My conversations are usually reminiscent of this:

https://www.youtube.com/watch?v=r2TxX0E4U1A

"People love their insurance!" Is a dead giveaway that a politician is a sock puppet. Biden kept saying it during the primaries.

I'm not a politician and I will say: I love my insurance. Because it's actually pretty great.

My insurance is good, but I wouldn't need it if we had a sensible alternative, and neither would you. And many other less fortunate people (including those in my immediate family) wouldn't need it either. Not wanting to give up your insurance because you "love" it (fucking gag me) is "fuck you I got mine" energy. Cancerous to a society.

I hate my insurance. I hear its great for America, but it's shit compared to back home

I see that alot in the stuff my insurance bills. $60 test they paid $3 for, another $180 test they paid $21 for or a $37 test that paid $2.80.

How can you shop around when prices are that distorted?

> Other countries seem to have solid solutions for "socializing" medicine

What baffles me the most is that most "socialized" systems functions much like a tax-paid insurance policy that covers everything and has no profit motive.

Even in a normal insurance situation you're "paying for someone else's treatment". That's the whole point of insurance.

Most of these systems works like an extra payroll tax: it is a tax on salary as percentage, as opposed to a car or house insurance that is linked to the value of the risks insured, not the income of the payer. This is why some people are opposing to that system, the tax vs insurance debate.

It is not just tax-paid insurance. Main point is that single-payer is essentially monopolist buyer and can use its market power to push prices down. Which is good to get cheap and good medical care, but may lead to systemic underfinancing of healthcare and associated problems.

I had a full blood screen....first number $2000, Negotiated price $1600, Out of Pocket $48.

It's all funny money til it lands in my lap, then suddenly it's real.

Lab costs are outsourced, and they charge separately from a doctor's bill. Biopsies are completely separate as well.

> We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets.

The government is perfectly capable of ensuring access to a market without regulating it to death. The SNAP program (Food Stamps) is a great example of how this works in a separate market with very little elasticity in demand.

I don't understand this.

Almost every other developed country has a system that works for healthcare. It's almost always single payer or something where you definitely don't go shopping around for hospitals.

Doesn't it start to feel a bit like indoctrination when arguing for a "free market" when no other developed country has a free market for healthcare?

Is everyone else stupid? What aren't they seeing? Especially in the age of the internet?

I just can't follow this logic.

I would love to get someone who argues from the "free market" point of view do some introspection and explain the logic in a way that doesn't feel like repeating the same 2-3-4 ideas which as far as I can see, are common talking points in the US.

So, repeating the question, what is every other developed country missing?

Why aren't they all doing this, if it's obviously superior?

I’m very much a free marketer for most things, as it seems to work well. It’s possible that it might work for health care too, but I don’t think we really know. For a lot of folks the free market is an article of faith, and I think that’s where a lot of support for this idea comes from.

Even if a free market could work in the US, I have no idea how we could get from here to there without making things worse along the way.

I look forward to the utter absense of any answers to this question, or the entertainingly inventive ones.

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