Hacker News Reader

Comment by jjoonathan | Hacker News Reader

Why don't you think exchanges are competitive? I put forward a detailed argument about why I think they increase competition. I'd appreciate a response in kind.

Also, why do you think "you can barely call it insurance anymore"? It used to be that insurance companies in the individual market were allowed to invent excuses to dump their expensive customers and then they were allowed to raise their prices if the customer wanted back in. Basically, the individual insurance market degraded into "pay the full price of any chronic condition you have." I wouldn't call that insurance, I'd call that pay-as-you-go-with-a-middleman. Now that they actually have to provide the "peace of mind" that they sell, I think the argument is much stronger for calling them insurance companies.

So, basically, the opposite of what you said.

View on HN

You seem to imply that insurance companies dumped people after they developed an expensive condition. But that's a load of FUD, as dumping a customer like that's been illegal for decades. Which isn't to say that you could get someone else to pay for your pre-existing conditions before. That's genuinely new.

Anyway. There's no health insurance market anymore. There's a pre-paid healthcare services market which we call "insurance", with a nearly uniform price guaranteed to all (variance in prices regulated by the government), a very specific government-mandated bundle of services that it must provide, a government-mandated maximum profit margin, and a government mandate that the services be purchased.

So if that's your picture of healthy "competition" in a market... well, I guess you're entitled to that opinion but then I kinda wonder what you must think about the rest of the tech startups that get discussed around here.

What used to happen routinely is that when an insurance customer developed an expensive condition a "rescission" team would do a detailed audit of their initial application and medical history, looking for a pretext to break the contract. So if they went to the doctor prior to enrolling and complained about back pain, but didn't disclose that in their application, if that back pain could in any way be connected to their later cancer diagnosis, the contract can be voided and the insurance company could drop the customer and not pay for their treatment.

And the recission teams were even paid on commission. Top prize to the person who figures out how to dump the lady with cancer, second prize to anyone who can figure out what clauses to add to the new contracts to catch people like her in the future!

Also, don't forget the other tricks: shifting billing dates around, losing invoices in the mail, using the customer's income to calculate copays which would bankrupt them before they could afford expensive treatment... the list goes on.

EDIT: this is why I said that the insurance companies had to find an excuse to drop people, rather than just drop people. The really obvious stuff tends to be illegal.

> So if that's your picture of healthy "competition" in a market...

Regulation is not inherently the opposite of competition. Regulatory capture sucks, but so do perverse incentives. The healthcare market has a bad infestation of perverse incentives, and regulation is the only tool we have to go after them.

Well, that or universal health care: http://healthcarereform.procon.org/view.resource.php?resourc...

> I kinda wonder what you must think about the rest of the tech startups that get discussed around here.

I kinda wonder what you think about net neutrality. Good or bad?

Reply on news.ycombinator.com