4 ms·

Obama should do more outreach to industry to promote the idea of more competition in the insurance space.

brianwawok 10y ago
You can't make a bunch of for profit companies act in the best interest of users. We keep trying and failing. Healthcare is a basic human right, and should be provided free of charge to everyone.
- collyw 10y ago
  Like in the civilized countries.
  - talmand 10y ago
    Wonderful argument. Don't do things our way then you are not civilized. That's the way to win people over.
    - abritinthebay 10y ago
      And being offended over someone pointing out the uncivilized healthcare in the USA rather than being at the awful healthcare system is so productive, yes?
      - talmand 10y ago
        Yes. Because I don't care for the divisive nature of the comment. If the person can learn to refrain from such childish comments in the future then I would find it productive. Besides, my opinion of the comment has no bearing on my opinion of the healthcare system in any way. I can be offended by both at the same time thank you very much.
  - robalfonso 10y ago
    While I agree with you, one thing that absolutely drives me nuts with this argument is scale. Norway Pop. 5M (approx) Finland Pop. 5M (approx) England Pop. 53M (approx) Canada Pop. 35M (approx) United States Pop. 318M (approx) The scale is way off from many other countries who have implemented the kind of healthcare reform being talked about. When you get to hundreds of millions of people all kinds of issues arise that you don't see elsewhere. China and India are the only countries more populous than the United States and I'd be nervous to experience their health care system. In fact you have to go quite far down the population list to get a first world country where that kind of healthcare is being implemented (happy to be proven wrong here)
    - mywittyname 10y ago
      We already have the healthcare system in place, and it already works well. The problem is cost. While it's impossible to say what the cost driver is, when you look at the performance of companies in the healthcare sector, you'll see they're doing extremely well, outpacing the S&P500 by 50% over the past decade. [1] So at least some large portion of this cost increase is going into the pockets of executives and shareholders. [1] https://personal.vanguard.com/us/funds/snapshot?FundId=5485&FundIntExt=INT https://personal.vanguard.com/us/funds/snapshot?FundId=5485&...
- r_smart 10y ago
  There's no free lunch. If the government is paying for it, it's not free of charge. And in this country, there's a long record of exponential price costs when the government is the customer. Our premiums would go up, they'd just be called taxes then. You could maybe nationalize all the hospitals or something and make doctors government employees, but I don't think we'd like the outcome. Just the transition would be a nightmare. And that's ignoring the legal aspects of it. It's not so easy as just waving your hand and saying "Free Healthcare! Free for everyone!"
  - kennydude 10y ago
    > but I don't think we'd like the outcome The NHS is fantastic.
    - talmand 10y ago
      The NHS may be fantastic for one country, doesn't mean it would be for another.
      - Ntrails 10y ago
        I'm pretty sure it would be fantastic for the majority - but not for a vocal minority who have a large amount of power.
        talmand 10y ago
        I would agree for the most part.
        r_smart 10y ago
        Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well. The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting. I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.
talmand 10y ago
A major percentage of the problems with US health insurance and medical industry is directly due to government interference in the marketplace. We saw an example of it with the housing market crash that dragged the economy down with it. You can see the same thing happening today with the runaway costs of universities. I would prefer they just take a step back for a while.
- naravara 10y ago
  Why is the default posture whenever the government does something badly to throw in the towel rather than fixing the damn problem?
  - talmand 10y ago
    Who's throwing in the towel? Why is it a common assumption that the government can fix, with more government, the problems government created? Maybe fixing the damn problem is for the government to reduce its involvement in the problems it created?
    - beisner 10y ago
      I might be inclined to agree with you if a majority of western governments hadn't already figured out how to do it well (or well enough).
      - talmand 10y ago
        What works for one doesn't always work for the other. I think it would be quite easy to do such comparisons to determine that. It worked for that area of 10 million people so surely it should work just as nicely with that area of 300 million people.
    - mywittyname 10y ago
      The government didn't create the problem. They have just been unsuccessful at combating the real issue. The issue is our entire healthcare system is for profit and there is no market driver to reduce costs. Insurance companies collude with the AMA, hospitals, and pharmaceutical companies to raise prices on all aspects of healthcare. The government needs to create that driver to reduce cost, since the industry is unwilling to. This could be many things, from public hospitals that provide free or low cost care (reducing the need for insurance), to creating a mutual insurance company whose charter is to minimize healthcare cost (creating competition in the marketplace).
brandonb 10y ago
(I worked on the healthcare.gov rescue team and now run a healthcare startup running a clinical study with UCSF Cardiology.) I think what's needed is likely more than outreach: there are two big problems with the insurance market right now that prevent competition. First, the barriers to entry to start a new health insurance company are incredibly high. There have been four health insurance startups (Oscar, Clover, Bright, SeeChange) launched in the last several years. SeeChange went out of business. Bright has yet to launch. Oscar and Clover are active in a handful of markets, but for 90+% of people, their choices are limited to the insurers that existed before the ACA. Why is it so hard to start a new health insurance company? First, it requires $50m+ in reserve capital to get a state license before you can sell your first policy. Second, once you're in business, your ability to negotiate prices with hospitals is determined by your scale, so new entrants are at an inherent disadvantage: they're negotiating on behalf of perhaps 10,000 members. United, in comparison, negotiates on behalf of 70 million people. There's an inherent vicious cycle here of worse prices => fewer members => worse prices. Second, the Affordable Care Act built in several financial mechanisms--risk adjustment, reinsurance, and risk corridors--to stabilize premiums. Some of those are being defunded by Congress, and so the result is that in some places, premiums are destabilized; in others, insurers are withdrawing entirely. Our general political disfunction is now having a very specific and negative impact on people's lives. Does this mean government regulation is all bad? I don't think so. There are certainly places where repealing regulation could help create a competitive market, but also places where adding carefully-crafted regulation could promote competition. For example, passing a law requiring hospitals to charge all insurers the same rate (they can set the rate to whatever they like) would mean that new insurers are competing on a level playing field with the giants. Functioning reinsurance would lower the reserve capital requirements for a new insurance startup to stay in the market for long enough to build a membership base. With those two changes, would level of competition and innovation in health insurance be the same as in photo sharing apps? Not quite. Healthcare is a complex business. But I think we could get substantially closer to that level of innovation, and that would be good for everybody.

You can't make a bunch of for profit companies act in the best interest of users. We keep trying and failing. Healthcare is a basic human right, and should be provided free of charge to everyone.

collyw 10y ago
Like in the civilized countries.
- talmand 10y ago
  Wonderful argument. Don't do things our way then you are not civilized. That's the way to win people over.
  - abritinthebay 10y ago
    And being offended over someone pointing out the uncivilized healthcare in the USA rather than being at the awful healthcare system is so productive, yes?
    - talmand 10y ago
      Yes. Because I don't care for the divisive nature of the comment. If the person can learn to refrain from such childish comments in the future then I would find it productive. Besides, my opinion of the comment has no bearing on my opinion of the healthcare system in any way. I can be offended by both at the same time thank you very much.
- robalfonso 10y ago
  While I agree with you, one thing that absolutely drives me nuts with this argument is scale. Norway Pop. 5M (approx) Finland Pop. 5M (approx) England Pop. 53M (approx) Canada Pop. 35M (approx) United States Pop. 318M (approx) The scale is way off from many other countries who have implemented the kind of healthcare reform being talked about. When you get to hundreds of millions of people all kinds of issues arise that you don't see elsewhere. China and India are the only countries more populous than the United States and I'd be nervous to experience their health care system. In fact you have to go quite far down the population list to get a first world country where that kind of healthcare is being implemented (happy to be proven wrong here)
  - mywittyname 10y ago
    We already have the healthcare system in place, and it already works well. The problem is cost. While it's impossible to say what the cost driver is, when you look at the performance of companies in the healthcare sector, you'll see they're doing extremely well, outpacing the S&P500 by 50% over the past decade. [1] So at least some large portion of this cost increase is going into the pockets of executives and shareholders. [1] https://personal.vanguard.com/us/funds/snapshot?FundId=5485&FundIntExt=INT https://personal.vanguard.com/us/funds/snapshot?FundId=5485&...
r_smart 10y ago
There's no free lunch. If the government is paying for it, it's not free of charge. And in this country, there's a long record of exponential price costs when the government is the customer. Our premiums would go up, they'd just be called taxes then. You could maybe nationalize all the hospitals or something and make doctors government employees, but I don't think we'd like the outcome. Just the transition would be a nightmare. And that's ignoring the legal aspects of it. It's not so easy as just waving your hand and saying "Free Healthcare! Free for everyone!"
- kennydude 10y ago
  > but I don't think we'd like the outcome The NHS is fantastic.
  - talmand 10y ago
    The NHS may be fantastic for one country, doesn't mean it would be for another.
    - Ntrails 10y ago
      I'm pretty sure it would be fantastic for the majority - but not for a vocal minority who have a large amount of power.
      - talmand 10y ago
        I would agree for the most part.
      - r_smart 10y ago
        Milton Friedman has some interesting points about welfare programs and how they interact with immigration. Particulary, that you can have massive unchecked immigration, or extensive welfare programs, but the two don't interact well. The NHS is probably a good example. The UK has historically had low to moderate rates in immigration and the NHS. The US has had a ton of immigration, but no NHS. It seems like half of the country wants to have unchecked immigration and extensive welfare programs, but the consequences of that kind of policy will quickly become bankrupting. I would imagine that vocal minority would be fine with a single-payer system. Again, look at what happens to pricing when the government is your sole customer. And given the influence they can wield, it would be a bonanza for them.

talmand 10y ago

A major percentage of the problems with US health insurance and medical industry is directly due to government interference in the marketplace. We saw an example of it with the housing market crash that dragged the economy down with it. You can see the same thing happening today with the runaway costs of universities. I would prefer they just take a step back for a while.

naravara 10y ago
Why is the default posture whenever the government does something badly to throw in the towel rather than fixing the damn problem?
- talmand 10y ago
  Who's throwing in the towel? Why is it a common assumption that the government can fix, with more government, the problems government created? Maybe fixing the damn problem is for the government to reduce its involvement in the problems it created?
  - beisner 10y ago
    I might be inclined to agree with you if a majority of western governments hadn't already figured out how to do it well (or well enough).
    - talmand 10y ago
      What works for one doesn't always work for the other. I think it would be quite easy to do such comparisons to determine that. It worked for that area of 10 million people so surely it should work just as nicely with that area of 300 million people.
  - mywittyname 10y ago
    The government didn't create the problem. They have just been unsuccessful at combating the real issue. The issue is our entire healthcare system is for profit and there is no market driver to reduce costs. Insurance companies collude with the AMA, hospitals, and pharmaceutical companies to raise prices on all aspects of healthcare. The government needs to create that driver to reduce cost, since the industry is unwilling to. This could be many things, from public hospitals that provide free or low cost care (reducing the need for insurance), to creating a mutual insurance company whose charter is to minimize healthcare cost (creating competition in the marketplace).

brandonb 10y ago

(I worked on the healthcare.gov rescue team and now run a healthcare startup running a clinical study with UCSF Cardiology.) I think what's needed is likely more than outreach: there are two big problems with the insurance market right now that prevent competition. First, the barriers to entry to start a new health insurance company are incredibly high. There have been four health insurance startups (Oscar, Clover, Bright, SeeChange) launched in the last several years. SeeChange went out of business. Bright has yet to launch. Oscar and Clover are active in a handful of markets, but for 90+% of people, their choices are limited to the insurers that existed before the ACA. Why is it so hard to start a new health insurance company? First, it requires $50m+ in reserve capital to get a state license before you can sell your first policy. Second, once you're in business, your ability to negotiate prices with hospitals is determined by your scale, so new entrants are at an inherent disadvantage: they're negotiating on behalf of perhaps 10,000 members. United, in comparison, negotiates on behalf of 70 million people. There's an inherent vicious cycle here of worse prices => fewer members => worse prices. Second, the Affordable Care Act built in several financial mechanisms--risk adjustment, reinsurance, and risk corridors--to stabilize premiums. Some of those are being defunded by Congress, and so the result is that in some places, premiums are destabilized; in others, insurers are withdrawing entirely. Our general political disfunction is now having a very specific and negative impact on people's lives. Does this mean government regulation is all bad? I don't think so. There are certainly places where repealing regulation could help create a competitive market, but also places where adding carefully-crafted regulation could promote competition. For example, passing a law requiring hospitals to charge all insurers the same rate (they can set the rate to whatever they like) would mean that new insurers are competing on a level playing field with the giants. Functioning reinsurance would lower the reserve capital requirements for a new insurance startup to stay in the market for long enough to build a membership base. With those two changes, would level of competition and innovation in health insurance be the same as in photo sharing apps? Not quite. Healthcare is a complex business. But I think we could get substantially closer to that level of innovation, and that would be good for everybody.