You Do Not Have Health Insurance.(baselinescenario.com)
baselinescenario.com
You Do Not Have Health Insurance.
http://baselinescenario.com/2009/08/05/you-do-not-have-health-insurance
54 comments
> It's accurate that what we have is not insurance. Real health insurance would look more like life insurance, with fixed premiums that can't increase if your health degrades over time.
That is what I have. It is called a “hospital plan”. It only covers me when I am in an accident and need to go to the hospital. And it is amazing what cost savings it induces over people with full blown medical schemes.
I found that things such as spectacles is over priced by 300%-400% (you can get away a lot cheaper). Dentists will take useless digital x-rays to rape a medical scheme – and most people don’t mind because they aren’t paying for it. Doctors also take useless digital ex-rays (for any slight back problem) - even though they aren’t experts and will only look at it for a few seconds. Doctors sometimes prescribe the newest (and most expensive) anti-biotic instead of a cheaper thing that will also do the trick. Paying out of pocket eliminates all that.
That is what I have. It is called a “hospital plan”. It only covers me when I am in an accident and need to go to the hospital. And it is amazing what cost savings it induces over people with full blown medical schemes.
I found that things such as spectacles is over priced by 300%-400% (you can get away a lot cheaper). Dentists will take useless digital x-rays to rape a medical scheme – and most people don’t mind because they aren’t paying for it. Doctors also take useless digital ex-rays (for any slight back problem) - even though they aren’t experts and will only look at it for a few seconds. Doctors sometimes prescribe the newest (and most expensive) anti-biotic instead of a cheaper thing that will also do the trick. Paying out of pocket eliminates all that.
The only way to bring down the cost of health care is to make people more frugal, and no one is ever frugal with someone else's money.
If that's true, why does every single country with universal, single payer health care spend about half as much money, per capita, on health care as the USA? Shouldn't they be paying more?
If that's true, why does every single country with universal, single payer health care spend about half as much money, per capita, on health care as the USA? Shouldn't they be paying more?
Minor correction, the US government and Canadian government spend the same per capita on healthcare, but there the average person does not need extra insurance. Per capita countries with universal healthcare spend less.
The reason should be obvious, less paperwork.
The reason should be obvious, less paperwork.
Does my perfectly healthy baby need a doctor with ten years' schooling to give him a vaccination? No.
For what it's worth, my perfectly healthy baby has never been given a vaccination by a doctor. Shots are given by one of the more cost effective and numerous nursing staff, and are scheduled so that they coincide with a regular well-baby checkup.
Not that I disagree at all with your point, just that this particular example doesn't really stand up.
For what it's worth, my perfectly healthy baby has never been given a vaccination by a doctor. Shots are given by one of the more cost effective and numerous nursing staff, and are scheduled so that they coincide with a regular well-baby checkup.
Not that I disagree at all with your point, just that this particular example doesn't really stand up.
Very good points. This is one most people don't realize or fully understand:
> Employer provided health "insurance" can be paid for with before-tax dollars.
Employers that offer health insurance write it off as an expense. They don't payroll taxes on it (unemployment or social security). That means it's roughly 10% cheaper for the employer to offer health insurance instead of pay the equivalent in salary.
From the employee's side, an employee pays tax on salary before medical spending under normal circumstances, but health insurance is untaxed. So if an employee gets higher salary, he'd pay taxes on his salary, then buy his antibiotics. If insurance covers it, no taxes.
That's why insurance covers inane little things - both employers and employees want all medical spending to be covered by health insurance for tax reasons. Health insurance covered = no payroll taxes for employer, no income taxes for employee.
Now, the massive question is -- Why? This seems crazy, no? For most other perks, there's some taxes paid at some point. That's why your company doesn't buy all your food, housing, clothing, everything, and write it all off for you.
Answer: Lobbying. Insurance companies lobby hard and donate lots of money to political candidates. Both parties - Republican and Democrat - are in on this arrangement. This is one of the reasons insurance is so crooked - perverse incentives that both parties support.
On insurance, the Republicans say, "We're lowering your taxes!" The Democrats say, "We're helping people!" That's not quite right for either of them. They're making the system complicated and driving up costs that make the insurance companies and medical complex wealthier at everyone else's expense.
The artificially inflated costs make the system much worse for middle class people, as they lose flexibility in choosing their doctors, getting exact treatments they want, and so on. It hurts people who make responsible health and budgeting decisions, because they'd rather have the salary than the insurance coverage - but then their employer would pay 10% of what they gave in salary, and the employee would pay 30-60% on the income. As opposed to 0%/0% taxes on the insurance. It hurts the poor the worst, because they're least likely to have health insurance at all, and they get stuck in the artificially high priced market.
Just a terrible system all the way around. It'd be much better to cut taxes a few percent for all brackets and eliminate the health insurance writeoff entirely. Or alternatively, allow anyone to write any health expenses off the taxes. There'd be many, many better ways than the current system, which is bad for everyone except insurance companies, some medical people (though many of them feel handcuffed by the system and also dislike it), and of course, the politicians getting campaign money, sports tickets, dinners, vacations, gifts, and the rest of the legally-sanctioned corruption.
> Employer provided health "insurance" can be paid for with before-tax dollars.
Employers that offer health insurance write it off as an expense. They don't payroll taxes on it (unemployment or social security). That means it's roughly 10% cheaper for the employer to offer health insurance instead of pay the equivalent in salary.
From the employee's side, an employee pays tax on salary before medical spending under normal circumstances, but health insurance is untaxed. So if an employee gets higher salary, he'd pay taxes on his salary, then buy his antibiotics. If insurance covers it, no taxes.
That's why insurance covers inane little things - both employers and employees want all medical spending to be covered by health insurance for tax reasons. Health insurance covered = no payroll taxes for employer, no income taxes for employee.
Now, the massive question is -- Why? This seems crazy, no? For most other perks, there's some taxes paid at some point. That's why your company doesn't buy all your food, housing, clothing, everything, and write it all off for you.
Answer: Lobbying. Insurance companies lobby hard and donate lots of money to political candidates. Both parties - Republican and Democrat - are in on this arrangement. This is one of the reasons insurance is so crooked - perverse incentives that both parties support.
On insurance, the Republicans say, "We're lowering your taxes!" The Democrats say, "We're helping people!" That's not quite right for either of them. They're making the system complicated and driving up costs that make the insurance companies and medical complex wealthier at everyone else's expense.
The artificially inflated costs make the system much worse for middle class people, as they lose flexibility in choosing their doctors, getting exact treatments they want, and so on. It hurts people who make responsible health and budgeting decisions, because they'd rather have the salary than the insurance coverage - but then their employer would pay 10% of what they gave in salary, and the employee would pay 30-60% on the income. As opposed to 0%/0% taxes on the insurance. It hurts the poor the worst, because they're least likely to have health insurance at all, and they get stuck in the artificially high priced market.
Just a terrible system all the way around. It'd be much better to cut taxes a few percent for all brackets and eliminate the health insurance writeoff entirely. Or alternatively, allow anyone to write any health expenses off the taxes. There'd be many, many better ways than the current system, which is bad for everyone except insurance companies, some medical people (though many of them feel handcuffed by the system and also dislike it), and of course, the politicians getting campaign money, sports tickets, dinners, vacations, gifts, and the rest of the legally-sanctioned corruption.
"Answer: Lobbying. Insurance companies lobby hard and donate lots of money to political candidates."
Close, but wrong. The employer health care exemption was pushed through mainly by unions, not the insurance industry. It was a benefit negotiated by the unions. It's really not insurance.
Close, but wrong. The employer health care exemption was pushed through mainly by unions, not the insurance industry. It was a benefit negotiated by the unions. It's really not insurance.
This is a great metaphor. Because if you don't change the oil in your car, your engine will slowly grind itself to death.
People need to consume healthcare; it's not a luxury good. And vaccinations are rarely given by the actual drs - that's what nurse practitioners are for.
The problem in the US is not -- let me repeat -- NOT because healthcare services are too available because people don't have to pay. Many people avoid and delay going to the dr, because of costs, or inconvenience -- even for lifesaving tests and treatment.
Hell, I had great insurance that cost $500 a month and still ended up paying amost $2k in total costs when I sprained both my ankles. (Long story.)
And something like 80% of US bankruptcies are due to unexpected medical bills.
The real problem is that there aren't enough doctors, and that's because the doctors' offices/hospitals are trying to be "lean" -- and that's because costs are so great.
Lean is great for software, not for social services. And the reason the costs are so huge is that the whole system, from education to insurance, sucks.
Compare the US to a country like Austria, with body of nationalized healthcare and -- to carry the metaphor -- a limb of private care. I moved here last August and I'm still constantly amazed by how well this country works (and how untrue most of the US' self-aggrandizement turns out to be).
There are barely waiting times to see doctors, even highly sought-after specialists in Austria. You can hop into the ER in a major city and get in and out in under 2 hours. You never see the kind of wait times here that you see in the US, even in suburbia. (I moved here from various parts of Maryland, not exactly the most populous place in the lower 48.)
There are more doctors. There are more female doctors. There are more doctors who really care.
To my mind, this is due to several factors, including but not limited to: a) free higher education, meaning anyone who can do the work can become a doctor; b) low cost/high standard of living, meaning it doesn't take much means to survive while going to school; c) an ethic of social services; d) a nearly-single payer system reduces a huge amount of overhead & cruft; e) it's easy to manage patient billing and relationships with the insuring parties, because there are so few and they are not structured to for-profit; and d) no doctors are being driven out of business by high malpractice insurance premiums, due to all of the factors above.
I had to go to the ER on a road trip thru the country a couple weeks ago. I immediately saw a doctor and nurse practitioner, and they were double-teaming me - one measuring my blood-pressure, the other drawing blood; one checking my blood-ox levels, the other listening to my chest, etc. I had x-rays, I had an EKG, and lab work, all inside of 2 hours. Then I got my medicines and left.
And I paid... $0 for the ER visit, and about $12 for the medicines.
On top of that, I was in there for what I suspected was bronchitis/pneumonia (I have crap lungs). But, unlike every time I've had that in the US, the doctors I saw looked at me and realized it was similar symptoms to both deep-vein thrombosis and congestive heart failure. Which is true. My heart's fine, but no one in the US has ever analyzed me that thoroughly when I presented with "obvious" symptoms. They were so on the ball, it was a world of difference. I felt safe and now I know my heart's fine.
I've never had a medical experience that good in the US. Not for a second did they treat me with the jaded disregard you usually experience in US ERs.
Clearly the cheap and easy availability of great care is not a problem.
I really wish that I knew why Americans are, on the whole, always blaming the end-consumer for what are systemic deficiencies.
People need to consume healthcare; it's not a luxury good. And vaccinations are rarely given by the actual drs - that's what nurse practitioners are for.
The problem in the US is not -- let me repeat -- NOT because healthcare services are too available because people don't have to pay. Many people avoid and delay going to the dr, because of costs, or inconvenience -- even for lifesaving tests and treatment.
Hell, I had great insurance that cost $500 a month and still ended up paying amost $2k in total costs when I sprained both my ankles. (Long story.)
And something like 80% of US bankruptcies are due to unexpected medical bills.
The real problem is that there aren't enough doctors, and that's because the doctors' offices/hospitals are trying to be "lean" -- and that's because costs are so great.
Lean is great for software, not for social services. And the reason the costs are so huge is that the whole system, from education to insurance, sucks.
Compare the US to a country like Austria, with body of nationalized healthcare and -- to carry the metaphor -- a limb of private care. I moved here last August and I'm still constantly amazed by how well this country works (and how untrue most of the US' self-aggrandizement turns out to be).
There are barely waiting times to see doctors, even highly sought-after specialists in Austria. You can hop into the ER in a major city and get in and out in under 2 hours. You never see the kind of wait times here that you see in the US, even in suburbia. (I moved here from various parts of Maryland, not exactly the most populous place in the lower 48.)
There are more doctors. There are more female doctors. There are more doctors who really care.
To my mind, this is due to several factors, including but not limited to: a) free higher education, meaning anyone who can do the work can become a doctor; b) low cost/high standard of living, meaning it doesn't take much means to survive while going to school; c) an ethic of social services; d) a nearly-single payer system reduces a huge amount of overhead & cruft; e) it's easy to manage patient billing and relationships with the insuring parties, because there are so few and they are not structured to for-profit; and d) no doctors are being driven out of business by high malpractice insurance premiums, due to all of the factors above.
I had to go to the ER on a road trip thru the country a couple weeks ago. I immediately saw a doctor and nurse practitioner, and they were double-teaming me - one measuring my blood-pressure, the other drawing blood; one checking my blood-ox levels, the other listening to my chest, etc. I had x-rays, I had an EKG, and lab work, all inside of 2 hours. Then I got my medicines and left.
And I paid... $0 for the ER visit, and about $12 for the medicines.
On top of that, I was in there for what I suspected was bronchitis/pneumonia (I have crap lungs). But, unlike every time I've had that in the US, the doctors I saw looked at me and realized it was similar symptoms to both deep-vein thrombosis and congestive heart failure. Which is true. My heart's fine, but no one in the US has ever analyzed me that thoroughly when I presented with "obvious" symptoms. They were so on the ball, it was a world of difference. I felt safe and now I know my heart's fine.
I've never had a medical experience that good in the US. Not for a second did they treat me with the jaded disregard you usually experience in US ERs.
Clearly the cheap and easy availability of great care is not a problem.
I really wish that I knew why Americans are, on the whole, always blaming the end-consumer for what are systemic deficiencies.
"The problem in the US is not -- let me repeat -- NOT because healthcare services are too available because people don't have to pay."
No, the problem is that healthcare services are too EXPENSIVE because people don't have to pay directly. Third party payer means that people who clip coupons and shop for a month to buy a TV don't even know how much an MRI costs, and are gladly willing to pay for the most expensive one out there because they are spending other people's money.
No, the problem is that healthcare services are too EXPENSIVE because people don't have to pay directly. Third party payer means that people who clip coupons and shop for a month to buy a TV don't even know how much an MRI costs, and are gladly willing to pay for the most expensive one out there because they are spending other people's money.
In Japan an MRI's total cost is ~200$ which is 1/5 of the cost in the US. They are just machines so not using them does not really save money. In the US they sit there unused most of the time, so when they are used it's expensive. If you just use them more the cost per examination quickly drops off.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102211467.h...
Edit: That's from 1991 today I think it's closer to 50 - 100$.
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102211467.h...
Edit: That's from 1991 today I think it's closer to 50 - 100$.
Yeah, because people who clip coupons have great insurance that doesn't force them to use a specific provider which has a specific product for a specific rate?
You ever HAD an HMO? The M is for "Managed" and trust me, they manage it. When I had to see an orthopedist because I sprained both my ankles, I not only had to wait 1.5 weeks, but I had to drive to some random office park 45 minutes away to get the subsequent CT scan he prescribed me afterwards, because that was the option my insurance co. gave me.
Health services are not - NOT! - too expensive because people don't have to pay directly. That is not the problem in the US.
As I described in the above posts, I have paid out of pocket for several healthcare things in Austria -- before I had the social insurance -- and it cost less than the equivalent in the US, with the exchange rate.
The extremely high cost of education, the overhead of insurance company management (it takes time and money to deny all those claims), handling insurance claims (a huge % of administrative work for doctors' offices), the usurious cost of malpractice insurance, and of course, the profit motive in creation of medicine (which naturally raises the cost of the FDA's resources), etc., etc. all conspire to create the expense.
These costs can be drastically reduced in a single-payer system, or one close to it, especially one with free higher education.
(Austria is not quite single-payer, although every single citizen is insured by the govt. There are, I think, 3 types of social insurance, and some people have additional "hospital memberships" (~US$700/yr) or additional private insurance.)
Not to mention that taking away the costs of preventative care, tests, and early intervention can, over a lifetime, reduce the total cost of a person's required healthcare.
Why on earth do you want to blame the people who need the MRI, whether they choose the Budget Rent-a-Wreck or the Premium version? (How ridiculous!)
You ever HAD an HMO? The M is for "Managed" and trust me, they manage it. When I had to see an orthopedist because I sprained both my ankles, I not only had to wait 1.5 weeks, but I had to drive to some random office park 45 minutes away to get the subsequent CT scan he prescribed me afterwards, because that was the option my insurance co. gave me.
Health services are not - NOT! - too expensive because people don't have to pay directly. That is not the problem in the US.
As I described in the above posts, I have paid out of pocket for several healthcare things in Austria -- before I had the social insurance -- and it cost less than the equivalent in the US, with the exchange rate.
The extremely high cost of education, the overhead of insurance company management (it takes time and money to deny all those claims), handling insurance claims (a huge % of administrative work for doctors' offices), the usurious cost of malpractice insurance, and of course, the profit motive in creation of medicine (which naturally raises the cost of the FDA's resources), etc., etc. all conspire to create the expense.
These costs can be drastically reduced in a single-payer system, or one close to it, especially one with free higher education.
(Austria is not quite single-payer, although every single citizen is insured by the govt. There are, I think, 3 types of social insurance, and some people have additional "hospital memberships" (~US$700/yr) or additional private insurance.)
Not to mention that taking away the costs of preventative care, tests, and early intervention can, over a lifetime, reduce the total cost of a person's required healthcare.
Why on earth do you want to blame the people who need the MRI, whether they choose the Budget Rent-a-Wreck or the Premium version? (How ridiculous!)
I completely agree with you analysis of all the problems with the American system, though I'd suggest a different way to address the problem because there's some very real downsides to Austria's system as well.
For fixing America's medical and insurance - in lieu of of free higher education, it'd be simple to drastically reduce requirements to practice medicine. To practice medicine in the United States, doctors have to go through crazy rites of passage, including years of their lives and hundreds of thousands of dollars. Groups like the American Medical Association have intentionally tried to keep the requirements very high, as that keeps doctors' fees and wages up by restricting supply.
Undergraduate + medical school + residency is way more than necessary to become a competent doctor. Could anyone really claim with a straight face that 4 years of intense study, plus 2-4 years of hands-on apprenticeship wouldn't far more than enough to practice a specific kind of medicine? People pick up many skillsets as difficult as medicine to a competent degree in a lot less than 10 years and hundreds of thousands of dollars of costs.
As for Austria, it's an interesting case, huh? Austria has one of the longest traditions of social services in Europe - Otto von Bismarck, Prussian Chancellor, was huge on it. Austria has lots of practice and does a pretty good job of offering a number of services.
There's a few downsides, though. Of course, most people have probably heard the argument about how it slows growth and innovation, and there's some truth in that. Typically people counterargue, "Yes, but it's a worthy tradeoff to improve quality of life in the present." And there's merit in that too.
But using Austria as a specific example - one of the real dangers of socialization of important elements of an economy is that it makes it much easier for the government to go totalitarian, as was seen under the Nationalsozialistische Deutsche Arbeiterpartei, the National Socialist German Workers' Party.
Limited socialism can work with a very strong constitution to limit governmental powers. But without that, politicians become in control of the courts, military, and economy. That's a very dangerous combination.
One of the tricky parts about socialism is that it can't adjust fast enough to fill diverse wants and needs. Governments are rock-and-hard-placed: A fast moving, fast changing government makes lots of mistakes. A slow moving, slow changing government doesn't adapt very fast.
But one thing socialism is really, really, realy good at is making what Clauswitz (another Austrian-Prussian, genius military scholar) called "total war". That's where your entire economy, culture, and civilization is focused on conquering or destroying another civilization.
Every major combatant during World War II went to a more socialized economy, including the United States and England. Government assumed control of much of the production and media. The Allies needed to, because the Germans and Japanese were that focused. One of the reasons that France fell is because it was severely overwhelmed in terms of technology: Less aircraft, less artilery, less mechanized infantry. The American and English governments saw this, and took greater control over their economies.
But could any of this have happened without government control of economies in the first place? A charismatic, psychopathic Austrian-Prussian Lance Corporal took over leadership of the National Socialist Worker's Party (Nationalsozialistische, shorthand "Nazi"), and they already had large control over the nation's factories, food, banking, education, medicine, media, and so on. The "trusting the government" culture lets the inevitable bad government run by a psychopath run amok.
You could take North Korea as another example - they have the fourth largest army in the world (fourth! despite being #47 in total population!). All they produce effectively is military, but they do a pretty good job of it.
So a bit of a tangent there - I'm with your analysis completely about why the costs are high in the United States. I just also point out the very real dangers of state control of the economy. More government power leads to an easier path to totalitarianism and aggressive war. That's one of the reasons Bismarck, a real expansionary conquerer type himself, introduced the culture of social services to Prussian Austria. It builds national loyalty, especially with government-run education. It endears the people to the government and makes them reliant on it. And it lets them flip into "war mode" easily when the political leadership wants to.
There can be some advantages, but there's quite real dangers. I share the take as a casually interested historian, and would be very happy to hear some other people's replies and analysis.
For fixing America's medical and insurance - in lieu of of free higher education, it'd be simple to drastically reduce requirements to practice medicine. To practice medicine in the United States, doctors have to go through crazy rites of passage, including years of their lives and hundreds of thousands of dollars. Groups like the American Medical Association have intentionally tried to keep the requirements very high, as that keeps doctors' fees and wages up by restricting supply.
Undergraduate + medical school + residency is way more than necessary to become a competent doctor. Could anyone really claim with a straight face that 4 years of intense study, plus 2-4 years of hands-on apprenticeship wouldn't far more than enough to practice a specific kind of medicine? People pick up many skillsets as difficult as medicine to a competent degree in a lot less than 10 years and hundreds of thousands of dollars of costs.
As for Austria, it's an interesting case, huh? Austria has one of the longest traditions of social services in Europe - Otto von Bismarck, Prussian Chancellor, was huge on it. Austria has lots of practice and does a pretty good job of offering a number of services.
There's a few downsides, though. Of course, most people have probably heard the argument about how it slows growth and innovation, and there's some truth in that. Typically people counterargue, "Yes, but it's a worthy tradeoff to improve quality of life in the present." And there's merit in that too.
But using Austria as a specific example - one of the real dangers of socialization of important elements of an economy is that it makes it much easier for the government to go totalitarian, as was seen under the Nationalsozialistische Deutsche Arbeiterpartei, the National Socialist German Workers' Party.
Limited socialism can work with a very strong constitution to limit governmental powers. But without that, politicians become in control of the courts, military, and economy. That's a very dangerous combination.
One of the tricky parts about socialism is that it can't adjust fast enough to fill diverse wants and needs. Governments are rock-and-hard-placed: A fast moving, fast changing government makes lots of mistakes. A slow moving, slow changing government doesn't adapt very fast.
But one thing socialism is really, really, realy good at is making what Clauswitz (another Austrian-Prussian, genius military scholar) called "total war". That's where your entire economy, culture, and civilization is focused on conquering or destroying another civilization.
Every major combatant during World War II went to a more socialized economy, including the United States and England. Government assumed control of much of the production and media. The Allies needed to, because the Germans and Japanese were that focused. One of the reasons that France fell is because it was severely overwhelmed in terms of technology: Less aircraft, less artilery, less mechanized infantry. The American and English governments saw this, and took greater control over their economies.
But could any of this have happened without government control of economies in the first place? A charismatic, psychopathic Austrian-Prussian Lance Corporal took over leadership of the National Socialist Worker's Party (Nationalsozialistische, shorthand "Nazi"), and they already had large control over the nation's factories, food, banking, education, medicine, media, and so on. The "trusting the government" culture lets the inevitable bad government run by a psychopath run amok.
You could take North Korea as another example - they have the fourth largest army in the world (fourth! despite being #47 in total population!). All they produce effectively is military, but they do a pretty good job of it.
So a bit of a tangent there - I'm with your analysis completely about why the costs are high in the United States. I just also point out the very real dangers of state control of the economy. More government power leads to an easier path to totalitarianism and aggressive war. That's one of the reasons Bismarck, a real expansionary conquerer type himself, introduced the culture of social services to Prussian Austria. It builds national loyalty, especially with government-run education. It endears the people to the government and makes them reliant on it. And it lets them flip into "war mode" easily when the political leadership wants to.
There can be some advantages, but there's quite real dangers. I share the take as a casually interested historian, and would be very happy to hear some other people's replies and analysis.
Have you read the book "Dreadnought"? I think you'd really enjoy it; it's by RKM and it's subtitled: "England, Germany and the coming of the Great War."
It's one of the most entertaining books I've ever read.
What is interesting to me, though, is how Great Britain was an amazingly capitalist power. I never really realized the extent to which the entire empire -- which never really made that much money for the government -- was just a thin candy shell around British commerce, which made England the wealthiest nation in the history of the world. It's staggering to see, during the Naval Arms Race, how tiny england, with half the population of massively industrialized Germany, dedicated itself to laying 2 keels to every 1 that Germany laid down.
I agree with your sentiment that the socialist countries forced a degree of socialism on the more independent, capitalist nations. Look at Great Britain! It causes physical pain to look back and see what the taxation picture was before the world wars.
But.
There are other emergences of socialism that are called for and accepted because they're the best workable way of providing something that's necessary, either for business reasons or the demands of human liberty.
Sure, maybe someone can figure out a way to have all private toll roads, and make that work without ridiculous regulation and abuse ... in the meantime, we have to move goods. We're going to socialize that, fully realizing how hard de-socializing is, because we have crap to get done.
On the other end of the spectrum, child labor laws. I'm of one accord with the thrust of an observation made by Paul Graham -- 'maybe child labor laws are saving kids from something they don't need saving from; maybe 17-year-olds could do something.' Bravo! Until we can figure out a way of carefully instilling a culture of real productivity into youth, however, we had an existing problem of four-year-olds working with machinery that sometimes ate their fingers.
At the moment, health in the States is a joke compared to the rest of the first world.
Currently, the system of incentives we have pressures people to sacrifice their precious health for a few extra short-term dollars. Because of the economic circumstances of their parents, children will die in this country that would have grown to adulthood in the rest of the first world. The incentives are set up to encourage reckless behavior that will eventually result in a crushing burden of debt, so people will be trapped in poverty who could have escaped in other countries.
These are massive, existing problems in the US. Now, you can't blame a country for doing what the rest of the first world has done, which is to say: let's fix the problem.
It seems unreasonable to expect any other behavior.
It's one of the most entertaining books I've ever read.
What is interesting to me, though, is how Great Britain was an amazingly capitalist power. I never really realized the extent to which the entire empire -- which never really made that much money for the government -- was just a thin candy shell around British commerce, which made England the wealthiest nation in the history of the world. It's staggering to see, during the Naval Arms Race, how tiny england, with half the population of massively industrialized Germany, dedicated itself to laying 2 keels to every 1 that Germany laid down.
I agree with your sentiment that the socialist countries forced a degree of socialism on the more independent, capitalist nations. Look at Great Britain! It causes physical pain to look back and see what the taxation picture was before the world wars.
But.
There are other emergences of socialism that are called for and accepted because they're the best workable way of providing something that's necessary, either for business reasons or the demands of human liberty.
Sure, maybe someone can figure out a way to have all private toll roads, and make that work without ridiculous regulation and abuse ... in the meantime, we have to move goods. We're going to socialize that, fully realizing how hard de-socializing is, because we have crap to get done.
On the other end of the spectrum, child labor laws. I'm of one accord with the thrust of an observation made by Paul Graham -- 'maybe child labor laws are saving kids from something they don't need saving from; maybe 17-year-olds could do something.' Bravo! Until we can figure out a way of carefully instilling a culture of real productivity into youth, however, we had an existing problem of four-year-olds working with machinery that sometimes ate their fingers.
At the moment, health in the States is a joke compared to the rest of the first world.
Currently, the system of incentives we have pressures people to sacrifice their precious health for a few extra short-term dollars. Because of the economic circumstances of their parents, children will die in this country that would have grown to adulthood in the rest of the first world. The incentives are set up to encourage reckless behavior that will eventually result in a crushing burden of debt, so people will be trapped in poverty who could have escaped in other countries.
These are massive, existing problems in the US. Now, you can't blame a country for doing what the rest of the first world has done, which is to say: let's fix the problem.
It seems unreasonable to expect any other behavior.
You seem to be confusing Nazi's for actual socialists. They were corporatist fascists. Corporatism may look a lot like socialism but it isn't necessarily so.
Saying socialism leads to Totalitarian fascism is a gigantic line to cross. I'd say that maybe the #1 reason of totalitarianism is introducing democracy to a country that hasn't learned to question its leaders. Hitler and the Nazi's came to power legally through the introduction of several bills, but no one opposed them. The German constitution at that time was riddled with holes because it was a franken-constitution from the US UK and Switzerland. Checks and balances were already weak, and separation of powers was weak, but people didn't press them which was mot of the problem. Much of the Nazi's rise to power has nothing to do with socialism but much more to do with corporatist control via the marriage of industry and government. As well as the failure of the people to uphold their own democracy.
Remember that fascism is the antithesis of democracy because it puts people in groups and manages them. This marries corporatism in a way that it allows certain groups to affect the economy more. While in some sectors there was much top down corporatism, in Nazi Germany especially supplies for war. In others there was bottom up where companies would request things of the government to do.
Not only that you seem to be confusing Germany and Austria. Austria was conquered by propaganda, some democratic means, but mostly a marching of troops into it.
Your argument falls flat because in any democratic system where people don't take it upon themselves to uphold the checks and balances of government will decline as government gains more power. Just look at Putin's Russia, or the "Democratic" PRC.
Saying socialism leads to Totalitarian fascism is a gigantic line to cross. I'd say that maybe the #1 reason of totalitarianism is introducing democracy to a country that hasn't learned to question its leaders. Hitler and the Nazi's came to power legally through the introduction of several bills, but no one opposed them. The German constitution at that time was riddled with holes because it was a franken-constitution from the US UK and Switzerland. Checks and balances were already weak, and separation of powers was weak, but people didn't press them which was mot of the problem. Much of the Nazi's rise to power has nothing to do with socialism but much more to do with corporatist control via the marriage of industry and government. As well as the failure of the people to uphold their own democracy.
Remember that fascism is the antithesis of democracy because it puts people in groups and manages them. This marries corporatism in a way that it allows certain groups to affect the economy more. While in some sectors there was much top down corporatism, in Nazi Germany especially supplies for war. In others there was bottom up where companies would request things of the government to do.
Not only that you seem to be confusing Germany and Austria. Austria was conquered by propaganda, some democratic means, but mostly a marching of troops into it.
Your argument falls flat because in any democratic system where people don't take it upon themselves to uphold the checks and balances of government will decline as government gains more power. Just look at Putin's Russia, or the "Democratic" PRC.
You certainly raise a lot of interesting and valid points. I don't disagree.
I think that most people (including me!) would argue that just because somebody (or some government body) calls itself socialist, doesn't make it so. Everything I know about the Nazi government points to that -- they called themselves socialist, but they weren't, not really. Very similar to their line on religion, too. With one hand they claimed to be Christian, but on the other hand, Hitler and his govt implemented policies that were meant to greatly reduce the popularity of religion (e.g. church taxes -- still in existence today!).
Socialism doesn't necessarily mean a centrally controlled or planned economy, or govt owning businesses, or govt employing everyone and the division of resources. That, to me, sounds more like communism. Socialism the way it's practiced in most of the EU today involves a type of capitalism, with an underpinning of higher tax rate, worker/consumer protection laws, and social services.
So those things don't necessarily go hand-in-hand.
Austria really is a perfect test case, because the emperors had a rather populist bent compared to other emperors/empires. You nailed that for sure.
But... its military is absolutely pathetic. They have no budget, no war machinery, no devotion, and no popular support. All this despite, or perhaps because of, youth conscription. (Every male has to do 9 - 12 mos I think, in military or social services. Which pretty much means guarding the border and helping out in avalanches.)
I don't know where you're from, if you're aware of the perception of the military/govt in Austria. If you are, forgive me if I am repeating things you already know :)
But, for example, the Austrian military recently purchased a small batch (I think 6?) of old fighter jets. Not all, apparently, in working order (and it's questionable if they even have sufficiently trained people to make use of them). They will never get used. And this has become a quintessential national joke -- about how they bought a bunch of broken planes, how they think they're relevant but they're not, etc. Not just on the street, but in the newspapers.
The cities are surprisingly rich with anti-nationalists, people who think nationalism is a disease, who hold protests and summits against government, capitalism, racism, the EU, socialism (quite a lot of communists here) and so on.
The economy isn't centrally controlled; it's not as easy to start a business as in the US, but it's still very easy; it is, in my mind, a great mix of socialized services and free market. There are consumer and worker protection laws, but the tax rate is not nearly as high as, say, Denmark.
You can even get unemployment benefits if you quit your job (or are self-employed), to encourage worker mobility (which puts pressure on employers to shape up) -- and yet the unemployment rate is extremely low.
But despite all these goodies, Austria is hardly a country where government is Mother and Father, and the people are ready to fall in line and fight for her.
Compared to the US, Austria is as unpatriotic as they come. Nobody sings songs about Austria. Nobody talks about how they are so grateful to be "free" (or the Austrian equivalent). Nobody goes around saying "Well, sure there are problems, but our x system is the best in the world!" There is simply not the same kind of beloved national mythos we have in the US (although people do seem quite fond of the last real emperor and empress).
Nobody even displays the flag.
In fact, I'd go so far as to say that Austrians are a spoiled lot, because they have no idea how good they have it. :)
As for innovation - one of the things that has helped me the most have been "alternative therapies," including an immune system booster medication called Bronchovaxom.
Turns out it costs nothing, because it's a bunch of dead bacteria, works extremely well... and isn't available in the US. Guess it doesn't make enough of a profit to make the FDA approval process worth the money?
Profit motive is only a motive for certain kinds of innovations. Many of the biggest life-saving inventions in healthcare came from love of humanity or curiosity, not profit motive (think antibiotics and vaccinations).
EDIT: As an aside, regarding people being willing to fight for the country... every European I've told about the Pledge of Allegience has been absolutely gobsmacked. They don't believe that in the land of the free, every day, millions of schoolchildren are forced on pain of punishment to kiss up to the government. Now that's kinda brainwashy, if you think about it.
I think that most people (including me!) would argue that just because somebody (or some government body) calls itself socialist, doesn't make it so. Everything I know about the Nazi government points to that -- they called themselves socialist, but they weren't, not really. Very similar to their line on religion, too. With one hand they claimed to be Christian, but on the other hand, Hitler and his govt implemented policies that were meant to greatly reduce the popularity of religion (e.g. church taxes -- still in existence today!).
Socialism doesn't necessarily mean a centrally controlled or planned economy, or govt owning businesses, or govt employing everyone and the division of resources. That, to me, sounds more like communism. Socialism the way it's practiced in most of the EU today involves a type of capitalism, with an underpinning of higher tax rate, worker/consumer protection laws, and social services.
So those things don't necessarily go hand-in-hand.
Austria really is a perfect test case, because the emperors had a rather populist bent compared to other emperors/empires. You nailed that for sure.
But... its military is absolutely pathetic. They have no budget, no war machinery, no devotion, and no popular support. All this despite, or perhaps because of, youth conscription. (Every male has to do 9 - 12 mos I think, in military or social services. Which pretty much means guarding the border and helping out in avalanches.)
I don't know where you're from, if you're aware of the perception of the military/govt in Austria. If you are, forgive me if I am repeating things you already know :)
But, for example, the Austrian military recently purchased a small batch (I think 6?) of old fighter jets. Not all, apparently, in working order (and it's questionable if they even have sufficiently trained people to make use of them). They will never get used. And this has become a quintessential national joke -- about how they bought a bunch of broken planes, how they think they're relevant but they're not, etc. Not just on the street, but in the newspapers.
The cities are surprisingly rich with anti-nationalists, people who think nationalism is a disease, who hold protests and summits against government, capitalism, racism, the EU, socialism (quite a lot of communists here) and so on.
The economy isn't centrally controlled; it's not as easy to start a business as in the US, but it's still very easy; it is, in my mind, a great mix of socialized services and free market. There are consumer and worker protection laws, but the tax rate is not nearly as high as, say, Denmark.
You can even get unemployment benefits if you quit your job (or are self-employed), to encourage worker mobility (which puts pressure on employers to shape up) -- and yet the unemployment rate is extremely low.
But despite all these goodies, Austria is hardly a country where government is Mother and Father, and the people are ready to fall in line and fight for her.
Compared to the US, Austria is as unpatriotic as they come. Nobody sings songs about Austria. Nobody talks about how they are so grateful to be "free" (or the Austrian equivalent). Nobody goes around saying "Well, sure there are problems, but our x system is the best in the world!" There is simply not the same kind of beloved national mythos we have in the US (although people do seem quite fond of the last real emperor and empress).
Nobody even displays the flag.
In fact, I'd go so far as to say that Austrians are a spoiled lot, because they have no idea how good they have it. :)
As for innovation - one of the things that has helped me the most have been "alternative therapies," including an immune system booster medication called Bronchovaxom.
Turns out it costs nothing, because it's a bunch of dead bacteria, works extremely well... and isn't available in the US. Guess it doesn't make enough of a profit to make the FDA approval process worth the money?
Profit motive is only a motive for certain kinds of innovations. Many of the biggest life-saving inventions in healthcare came from love of humanity or curiosity, not profit motive (think antibiotics and vaccinations).
EDIT: As an aside, regarding people being willing to fight for the country... every European I've told about the Pledge of Allegience has been absolutely gobsmacked. They don't believe that in the land of the free, every day, millions of schoolchildren are forced on pain of punishment to kiss up to the government. Now that's kinda brainwashy, if you think about it.
And something like 80% of US bankruptcies are due to unexpected medical bills.
This is simply unproven. There is a study by Elizabeth Warren who often makes this claim in the media, but her study does not prove it.
Her criteria for "medical bankruptcy" include, for example, a person who spends $50,000 on hookers/gambling/coke, and $1001 on syphilis treatment. She also has no control group.
This is simply unproven. There is a study by Elizabeth Warren who often makes this claim in the media, but her study does not prove it.
Her criteria for "medical bankruptcy" include, for example, a person who spends $50,000 on hookers/gambling/coke, and $1001 on syphilis treatment. She also has no control group.
You're right, their definition of 'medical bankruptcy' does include that person if the $1,001 wasn't covered by insurance, in the cases where they were comparing the results to their 2001 study which used the same criteria.
Their new results, however, apply a stricter standard, upping the bottom line number to $5,000 or 10% of household income, and they report a change of less than 1% if they eliminate the hard $5,000 and just go with 10% of income.
You seem to be claiming that people who are going to go bankrupt even if you remove their medical expenses are somehow meaningless data points for the question being asked by the study. That makes no sense, though. The cases that make it into the study are 'Medical debt below threshold, bankrupt anyways', 'Medical debt above threshold, bankrupt regardless', 'Medical debt above threshold, bankrupt as a result'. You're saying that we shouldn't care that the first category is proportionately shrinking, because it may be the case that the second category is accounting for all of that shrinkage. Even if that were true, that's still a reliable indicator that medical costs are growing.
Your "no control group" criticism makes absolutely no sense here. What are they controlling for? They aren't running an experiment, they're reporting on the proportion of bankruptcies that meet a particular definition, and how that proportion has changed over time.
Their new results, however, apply a stricter standard, upping the bottom line number to $5,000 or 10% of household income, and they report a change of less than 1% if they eliminate the hard $5,000 and just go with 10% of income.
You seem to be claiming that people who are going to go bankrupt even if you remove their medical expenses are somehow meaningless data points for the question being asked by the study. That makes no sense, though. The cases that make it into the study are 'Medical debt below threshold, bankrupt anyways', 'Medical debt above threshold, bankrupt regardless', 'Medical debt above threshold, bankrupt as a result'. You're saying that we shouldn't care that the first category is proportionately shrinking, because it may be the case that the second category is accounting for all of that shrinkage. Even if that were true, that's still a reliable indicator that medical costs are growing.
Your "no control group" criticism makes absolutely no sense here. What are they controlling for? They aren't running an experiment, they're reporting on the proportion of bankruptcies that meet a particular definition, and how that proportion has changed over time.
I'm disputing this claim: "80% of US bankruptcies are due to unexpected medical bills."
I'm not disputing this claim: "80% of US bankruptcies meet Elizabeth Warren's Criteria #1."
Her criteria is simply an arbitrary cutoff, and does not prove causality. If a person spent 10% of income on medicine, but 30% on gambling or taxes, it is unfair to attribute the bankruptcy to medical spending.
The control group would be needed to measure whether medical costs are correlated with increased bankruptcy.
Incidentally, total bankruptcies went down (in absolute number). Medical bankruptcies (by her definition) roughly stayed the same in absolute number. This is most of the explanation for the increased proportion of medical bankruptcies.
I'm not disputing this claim: "80% of US bankruptcies meet Elizabeth Warren's Criteria #1."
Her criteria is simply an arbitrary cutoff, and does not prove causality. If a person spent 10% of income on medicine, but 30% on gambling or taxes, it is unfair to attribute the bankruptcy to medical spending.
The control group would be needed to measure whether medical costs are correlated with increased bankruptcy.
Incidentally, total bankruptcies went down (in absolute number). Medical bankruptcies (by her definition) roughly stayed the same in absolute number. This is most of the explanation for the increased proportion of medical bankruptcies.
Even if it's 8%, it's 8% too much.
> And something like 80% of US bankruptcies are due to unexpected medical bills.
Actually, the claim (by proponents) is a bit over 60% and even that is fishy.
http://meganmcardle.theatlantic.com/archives/2009/06/why_war...
Actually, the claim (by proponents) is a bit over 60% and even that is fishy.
http://meganmcardle.theatlantic.com/archives/2009/06/why_war...
The fact that health insurance is tied to employers is a major challenge for the kinds of companies people on Hacker News try to start. For the first year or so of our company, we didn't offer health benefits, and that cost us candidates. Plenty of A-players need to cover families, and can't do it on the individual market. To understand how severe this problem is, work from the assumption that you simply cannot buy individual insurance at any reasonable rate.
The current system distorts both the health care market and the job market, and makes it harder both to start and grow new companies.
The current system distorts both the health care market and the job market, and makes it harder both to start and grow new companies.
Out of curiosity, were you ever able to find a solution for individual healthcare? You mentioned elsewhere that you were denied, and I'm hoping you meant that this was just an initial setback. This wasn't in California, was it?
He fails to mention the restrictive state laws on the books that heavily regulate who can pay for what in health care. With 90% of health care being basic and routine care, we should only need insurance in catastrophic situations.
For example, a health care start-up in Seattle (Qliance, website: http://qliance.com) had to lobby to have the State of Washington's laws clarified so they could legally operate, while the insurance industry lobbied to make their innovative model too costly to operate.
I bet if everyone in America had affordable basic health care, such as that provided by Qliance, the health care debate would become more or less mute.
For additional reference, the Direct Primary Care Coalition: http://www.dpcare.org/
For example, a health care start-up in Seattle (Qliance, website: http://qliance.com) had to lobby to have the State of Washington's laws clarified so they could legally operate, while the insurance industry lobbied to make their innovative model too costly to operate.
I bet if everyone in America had affordable basic health care, such as that provided by Qliance, the health care debate would become more or less mute.
For additional reference, the Direct Primary Care Coalition: http://www.dpcare.org/
There are several things I believe to be true regarding health insurance:
1) It's not insurance, since the thing you're paying for is guaranteed to happen. It's a pre-paid service plan
2) Congress made a mistake during WWII by tying health insurance to jobs. This has proven impossible to rectify, leaving serious doubt in my mind of Congress' ability to iterate or improvise as conditions change. So whatever you get, you get. Don't expect a little fix here and a little fix there.
3) Insurance policies themselves are so complex people don't know what they are buying. Some easy standardization needed here
4) Simple optimizations performed by millions of independent algorithms that optimize and learn from each other over time create solutions many orders of magnitude greater than one complex big design up front solution
5) It's broken. But simply because something is broken does not mean that any fix is better than the current status quo. If my house started burning, I would not try to put the fire out with gasoline simply in an effort to do something.
1) It's not insurance, since the thing you're paying for is guaranteed to happen. It's a pre-paid service plan
2) Congress made a mistake during WWII by tying health insurance to jobs. This has proven impossible to rectify, leaving serious doubt in my mind of Congress' ability to iterate or improvise as conditions change. So whatever you get, you get. Don't expect a little fix here and a little fix there.
3) Insurance policies themselves are so complex people don't know what they are buying. Some easy standardization needed here
4) Simple optimizations performed by millions of independent algorithms that optimize and learn from each other over time create solutions many orders of magnitude greater than one complex big design up front solution
5) It's broken. But simply because something is broken does not mean that any fix is better than the current status quo. If my house started burning, I would not try to put the fire out with gasoline simply in an effort to do something.
"The vast majority of us are, actually, poor. The combination of job loss and serious illness could wipe out almost anyone."
That is why 'you do not have health insurance'. The very fancy employer provided plan I had at one point was no use when I broke my arm after quitting that job to start a start-up.
The role of the government is to be the 'enabler'; what better way is there to enable than to assure you that tripping over a rock won't be the end of everything you dreamed of?
That is why 'you do not have health insurance'. The very fancy employer provided plan I had at one point was no use when I broke my arm after quitting that job to start a start-up.
The role of the government is to be the 'enabler'; what better way is there to enable than to assure you that tripping over a rock won't be the end of everything you dreamed of?
So you are saying you don't have insurance because you canceled your coverage when you quit?
If you want the government to pay for your coverage say so, but don't say you have no insurance when you chose to cancel it.
Edit: Perhaps I was misunderstood. I don't mean that quiting caused you to loose insurance (and therefor don't quit). I mean quit if you want, and keep your insurance. You chose not to keep your insurance after you quit. This was your choice.
If you want the government to pay for your coverage say so, but don't say you have no insurance when you chose to cancel it.
Edit: Perhaps I was misunderstood. I don't mean that quiting caused you to loose insurance (and therefor don't quit). I mean quit if you want, and keep your insurance. You chose not to keep your insurance after you quit. This was your choice.
So you are saying you don't have insurance because you canceled your coverage when you quit?
You say that as if you see nothing whatsoever wrong with bundling health coverage with employment - and not just employment, it has to be employment at a standard 9-to-5 company that's large enough to actually offer coverage. And God forbid you're not in the higher echelons of the economy and you have to work an hourly grind; look forward to a year's wait at the job before you can get covered.
To me this is just ridiculous; IMO, you absolutely should be able to quit your job for whatever the hell reason you want without ending up uninsured.
I don't care if the government pays or not, frankly - I just want to see a reasonable individual market open up, where the mere fact that you're in the market does not automatically mark you as high risk. If this means forcing all of America to join a risk pool, then so be it, even if I'm healthy and young I'm happy to pay the extra taxes for the increased mobility it affords you career-wise.
You say that as if you see nothing whatsoever wrong with bundling health coverage with employment - and not just employment, it has to be employment at a standard 9-to-5 company that's large enough to actually offer coverage. And God forbid you're not in the higher echelons of the economy and you have to work an hourly grind; look forward to a year's wait at the job before you can get covered.
To me this is just ridiculous; IMO, you absolutely should be able to quit your job for whatever the hell reason you want without ending up uninsured.
I don't care if the government pays or not, frankly - I just want to see a reasonable individual market open up, where the mere fact that you're in the market does not automatically mark you as high risk. If this means forcing all of America to join a risk pool, then so be it, even if I'm healthy and young I'm happy to pay the extra taxes for the increased mobility it affords you career-wise.
> look forward to a year's wait at the job before you can get covered.
No. It's wait a year before the company pays your premium. In every company I've ever been at you can pay it yourself from day one if you like.
It's a monetary bonus. It has nothing whatsoever to do with availability of insurance.
> you absolutely should be able to quit your job for whatever the hell reason you want without ending up uninsured.
Perhaps you (and from the mods, most of the readers) are not aware that you can. It's called COBRA. You have to pay the premiums yourself, but it doesn't cost any extra. While you were working it came out of your salary, now it comes out of your saving (or your new job).
No. It's wait a year before the company pays your premium. In every company I've ever been at you can pay it yourself from day one if you like.
It's a monetary bonus. It has nothing whatsoever to do with availability of insurance.
> you absolutely should be able to quit your job for whatever the hell reason you want without ending up uninsured.
Perhaps you (and from the mods, most of the readers) are not aware that you can. It's called COBRA. You have to pay the premiums yourself, but it doesn't cost any extra. While you were working it came out of your salary, now it comes out of your saving (or your new job).
But it's not bundled with a 9-5. I had health insurance for the 15 months I was working on my own startup. I paid for it myself, out of savings.
If you don't have a pre-existing chronic condition, you can usually get health insurance for a fee. That fee will probably be high. But it's just another expense you need to budget for when you plan out the financials of starting a company.
If you don't have a pre-existing chronic condition, you can usually get health insurance for a fee. That fee will probably be high. But it's just another expense you need to budget for when you plan out the financials of starting a company.
There is no reason that individual coverage should be so high. I don't mind buying my own insurance. I just want the same price the big buyers get. And I want the cost to be deductible without having to establish a corp that pays a salary to me simply so it can buy the insurance on my behalf.
Can you enlighten us on how you can keep your employer provided health benefits after you leave the company. He could have taken the COBRA, but that is seriously expensive and has an expiration date (3,6,12 months, not really sure). When you leave a company that bundles health you don't choose anything.
COBRA is not seriously expensive. Why does everyone think it is? It costs exactly the same amount it cost you while you were employed. It just comes out of your savings instead of your wages.
It lasts a year and a half, after which you should have another job, private insurance (if you want to be self employed), or medicaid if you can't find another job.
It lasts a year and a half, after which you should have another job, private insurance (if you want to be self employed), or medicaid if you can't find another job.
From my experience:
It is expensive. I was paying $1.2k per month on my COBRA.
It is not the same amount it costs while you were employed. It is the cost the company would otherwise pay for the benefit. What companies deduct from your paycheck is not the full amount, which under COBRA you will be responsible for. In addition, the company pays the benefits with pre-tax dollars (so they actually have an incentive to provide the most expensive insurance), while you now will be paying COBRA with after-tax dollars (hopefully from your savings). And remember there is no steady income coming in anymore.
Private individual insurance is very restrictive. It is not the same kind of coverage one would expect with a group insurance through the employer.
It is expensive. I was paying $1.2k per month on my COBRA.
It is not the same amount it costs while you were employed. It is the cost the company would otherwise pay for the benefit. What companies deduct from your paycheck is not the full amount, which under COBRA you will be responsible for. In addition, the company pays the benefits with pre-tax dollars (so they actually have an incentive to provide the most expensive insurance), while you now will be paying COBRA with after-tax dollars (hopefully from your savings). And remember there is no steady income coming in anymore.
Private individual insurance is very restrictive. It is not the same kind of coverage one would expect with a group insurance through the employer.
COBRA does not cost "exactly the same amount it cost you while you were employed". It costs you what your employer paid for that coverage. Virtually all employer-provided health care is heavily subsidized, often to the tune of 50-90%.
It's weird that you have such strong opinions about this subject, given your superficial grasp of it.
It's weird that you have such strong opinions about this subject, given your superficial grasp of it.
Part of the problem is that no one has health insurance - they have heath care coverage (for lack of a better term).
Insurance is meant for rare, but disastrous things. Health insurance would only cover surgery, cat scans, things like that. But it would NOT cover ordinary medical bills.
Personally that's what I pay for. It's called major medical, or high deductible insurance. You have it for years and never once use it.
There's probably no chance of the US covering this type of care for everyone. But that's what classical insurance is: pool everyones money to handle a disaster.
Trying to cover people for ordinary care is welfare, not insurance.
Insurance is meant for rare, but disastrous things. Health insurance would only cover surgery, cat scans, things like that. But it would NOT cover ordinary medical bills.
Personally that's what I pay for. It's called major medical, or high deductible insurance. You have it for years and never once use it.
There's probably no chance of the US covering this type of care for everyone. But that's what classical insurance is: pool everyones money to handle a disaster.
Trying to cover people for ordinary care is welfare, not insurance.
That's both true and irrelevant. Young healthy males have no trouble getting either high-deductable coverage or conventional HMO/PPO coverage. Everybody else is playing roulette in the individual insurance market no matter what product they're trying to buy. When we started our company, we tried to get individual high-deductable coverage. None of us have any "interesting" medical histories. Denied.
The US health system is broken in ways I don't think you fully comprehend.
The US health system is broken in ways I don't think you fully comprehend.
For the record I have family high deductible coverage and had no trouble getting it.
What was the reason you were denied? Everyone was denied? Did you try any other companies?
Perhaps state laws make a difference.
What was the reason you were denied? Everyone was denied? Did you try any other companies?
Perhaps state laws make a difference.
I don't know about this person's specific situation, but state laws do make a difference. In some states, the high-deductible coverage can be obtained by a single 20-something for $60ish a month. Here in NY, we have this goofy community rating law, where premiums on individual insurance plans can't be affected by your age. So there is no individual insurance option, even for 20-somethings and even with a high-deductible, that doesn't cost at least a few hundred dollars a month. Do a few searches on eHealthInsurance.com and you'll see what I mean.
Ordinary medical bills have skyrocketed as well in the current system. I have personally been charged 3 times as much without insurance as I would have with insurance for a basic blood test, with a scheduled appointment. Things are even worse at the emergency room - an uninsured friend of mine was invoiced for thousands of dollars when he went to the ER for an infection. No hospital time, just a prescription for antibiotics.
I'm not an expert on the reasons why that is the case. My understanding is that it is because 1) Health insurance companies are powerful negotiators compared to individual payers, and 2) Medicare/Medicaid pays "market rate" for services, so the market rate is driven up to increase margins on services paid for by the government. ER prices are driven up even further because the ER has to treat people even if they cannot pay.
I'm not an expert on the reasons why that is the case. My understanding is that it is because 1) Health insurance companies are powerful negotiators compared to individual payers, and 2) Medicare/Medicaid pays "market rate" for services, so the market rate is driven up to increase margins on services paid for by the government. ER prices are driven up even further because the ER has to treat people even if they cannot pay.
Well, I don't have 10 billion trillion dollars or whatever obscene amount of money the government thinks it can spend either. If you're going to pick an insurance company based on financial stability and sanity, the US government is probably the worst possible choice.
"You do not have health insurance."
The logic at the beginning of the post to justify this hyperbolic title was atrocious. Shouldn't be on Hacker News.
The logic at the beginning of the post to justify this hyperbolic title was atrocious. Shouldn't be on Hacker News.
Explain please. I thought the distinction between what he called "employer-subsidized health care" and an insurance program was fair. It's not insurance if the very thing you insure against, a catastrophic loss, makes it likely that your coverage will be dropped. Insurance is supposed to be the spreading of risk, not the milking of those that are low risk while denying coverage to those that are on the red side of the equation.
He's right about most "health insurance" being "employer-subsidized health care," but he's wrong that the reason is that it could go away. My car insurance will go away if I lose my job and stop making payments, that doesn't make it "not insurance."
I need just a single word to refute everything he said:
COBRA
(Can't afford it? That's a different story - but you do have insurance as he defined the term.)
COBRA
(Can't afford it? That's a different story - but you do have insurance as he defined the term.)
And when your COBRA expires?
COBRA is a (usually) spectacularly expensive, short-term solution. As an entrepreneur, it puts you in a position where you can be forced to change jobs or suspend a venture to get coverage for your family. It's a bad answer.
COBRA is a (usually) spectacularly expensive, short-term solution. As an entrepreneur, it puts you in a position where you can be forced to change jobs or suspend a venture to get coverage for your family. It's a bad answer.
COBRA lasts at least a year and a half, and costs EXACTLY as much as your insurance cost when you were working.
COBRA is not spectacularly expensive, it's simply how much insurance costs, whether your company pays for it, or you do. If your company did not pay for health insurance, your salary would be higher.
If you have no money, that's bad, but saying you "have no insurance" because you can't afford it is silly. Talk about affordability if you like, but don't make nonsense posts about not having insurance.
COBRA is not spectacularly expensive, it's simply how much insurance costs, whether your company pays for it, or you do. If your company did not pay for health insurance, your salary would be higher.
If you have no money, that's bad, but saying you "have no insurance" because you can't afford it is silly. Talk about affordability if you like, but don't make nonsense posts about not having insurance.
COBRA costs exactly as much as the total insurance cost when you were working. Almost all health insurance plans are employer subsidized, sometimes pretty heavily. So your 150 dollar a month plan could end up costing you 400 bucks a month to keep when you hit COBRA.
Edit: Perhaps I wasn't adequately clear. My point is that you are responsible for the ENTIRE insurance bill when you go on COBRA, your part and your employer's contribution. Sometimes that contribution is quite large and it results in COBRA bills that aren't affordable, especially when compared to individual insurance options.
Edit: Perhaps I wasn't adequately clear. My point is that you are responsible for the ENTIRE insurance bill when you go on COBRA, your part and your employer's contribution. Sometimes that contribution is quite large and it results in COBRA bills that aren't affordable, especially when compared to individual insurance options.
A family of four can expect to pay between 1200-1500/mo on typical conventional HMO/PPO coverage on COBRA.
(I was agreeing with you, just adding a data point).
(I was agreeing with you, just adding a data point).
> costs EXACTLY as much as your insurance cost when you were working.
There is usually an additional "administrative" fee added to the premiums as well.
There is usually an additional "administrative" fee added to the premiums as well.
Political FUD.
EDIT: Apparently I look like a troll, so let me rephrase: Not Hacker News.
This issue is political and highly contentious. Members of Congress have been making the same points on television for the last week.
I'm not making any claim about the correctness of the author's argument. But it's pretty clear that his intent is to change the reader's opinions/behavior with frightening ideas:
69 percent of respondents in the poll said they were concerned that the quality of their own care would decline if the government created a program that covers everyone.” Since most Americans currently have health insurance, they see reform as a poverty program – something that helps poor people and hurts them. If that’s what you think, then this post is for you.
You do not have health insurance. Let me repeat that. You do not have health insurance.
EDIT: Apparently I look like a troll, so let me rephrase: Not Hacker News.
This issue is political and highly contentious. Members of Congress have been making the same points on television for the last week.
I'm not making any claim about the correctness of the author's argument. But it's pretty clear that his intent is to change the reader's opinions/behavior with frightening ideas:
69 percent of respondents in the poll said they were concerned that the quality of their own care would decline if the government created a program that covers everyone.” Since most Americans currently have health insurance, they see reform as a poverty program – something that helps poor people and hurts them. If that’s what you think, then this post is for you.
You do not have health insurance. Let me repeat that. You do not have health insurance.
No, actually it's not. If you're in the individual health care market you are totally fucked. They will simply refuse to sell you coverage or cancel your coverage for arbitrary reasons. Under a group policy you have some reasonable protections and guarantees, but as an individual it is impossible to obtain true health insurance for any meaningful definition of the term. I speak from experience.
I concur, not from personal experience but from that of friends.
That on top of the article about rescission that was in here yesterday, should make people think. You insure against catastrophic losses. It defies logic that the insurance companies should be able to retroactively cancel your policy.
That on top of the article about rescission that was in here yesterday, should make people think. You insure against catastrophic losses. It defies logic that the insurance companies should be able to retroactively cancel your policy.
My car insurance doesn't cover an oil change. Nor would any reasonable person expect it to. Normal costs are not something to be insured against. Having customers pay out of pocket for most health care costs would create market pressure to reduce these costs. Does my perfectly healthy baby need a doctor with ten years' schooling to give him a vaccination? No. On the other side of the coin, if I'm paying for it, wait times would decrease. Maybe I'm willing to pay a little bit of a premium if an appointment means being seen when my appointment is scheduled for rather than a half hour later.
What prevents this happening is perverse incentives from federal (and state) income tax policy. Employer provided health "insurance" can be paid for with before-tax dollars.
Amazing fact: those who aren't young and healthy consume a disproportionate amount of health care. The only way to bring down the cost of health care is to make people more frugal, and no one is ever frugal with someone else's money.