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[-] deltreed@lemmy.world 27 points 1 week ago

It's crazy how we call health insurance, insurance. All it does is slightly discount the bill. It doesn't insure anything.

[-] sugar_in_your_tea@sh.itjust.works -5 points 1 week ago

But it does. If you get cancer, they pay everything after you hit your max out of pocket. So instead of paying $1M or whatever, you pay something like $15k.

Insurance is there to protect you from black swan-type financial ruin, it isn't intended to reduce costs for routine care.

The real problem is that costs vary depending on how you pay. The Rx should always cost $X and theb insurance shouldn't care or know which Rx you pick, they should just pay $Y. The problem imo isn't insurance, but the completely opaque medical pricing system we have.

If pricing is consistent, it's a lot easier to design assistance programs for those who need it.

[-] uis@lemm.ee 4 points 1 week ago

Meanwhile former soviet republics: "Insurance for not going over 15k$? It's not bill insurance. You get healthcare, state gets paying."

But that's not insurance, that's universal healthcare, which is a completely separate thing.

[-] uis@lemm.ee 2 points 1 week ago

Here it's called(translated) Mandatory Medical Insurance.

They can call it whatever they like. Government programs rarely reflect their actual structure.

That said, I don't know much about European healthcare systems, so maybe it is a form of insurance, idk.

[-] uis@lemm.ee 3 points 1 week ago* (last edited 1 week ago)

Government programs rarely reflect their actual structure.

I know how it works in Russia. For citizens no matter how much you pay you get free healthcare. But, depending on region, it ranges from just therapist, ambulance and few hospitals few hours away somewhere in the middle of Siberia to polyclinic full of specialists and a lot of specialized hospitals in one city in Moscow.

But if you need "Emergency, including emergency specialized, medical care" because of "sickness, accident, trauma, poisining and other cases requireing emergency treatment", "Such medical treatment is provided by state and municipal healthcare organizations and is free of charge". Even if you are tourist.

So there is universal part(emergency healthcare) and "insurance" part(peventative healthcare, non-emergency like optometry). "Insurance" is called mandatory because it is basically 5% tax.

Also, it seems in USSA even citizens pay crazy sums for ambulance. While here it is theoretically possible to get fine for falsly calling ambulance, you have to do phonepranking to actually be fined.

I think it's very similar in rest of ex-sisters.

Yeah, the ambulance thing is super dumb. I wish we had universal emergency healthcare, it would at least remove that point of stress. You really shouldn't have to pay if paramedics decide you need to go to the hospital.

But I'm not really sold on the rest. The main issue I have is that what insurance you can get is determined by your employer, and if you don't like it, you lose whatever they would've contributed. If people could pick their own insurance, people would probably be happier, and things like a public option become more useful as a check against private insurance.

I'm not convinced universal healthcare is really going to be cheaper or better for most people though, especially in our already messed up healthcare system. We do need to simplify insurance, because care providers are spending more and more dealing with insurance, which increases costs for everyone without providing value. I'm convinced the ACA (Obamacare) made things worse in that respect, so it simultaneously went too far and not far enough.

But whatever, it could be worse. We pay something like 5%/year for medical care (1.5% for Medicare for the elderly, 3% through my employer plan, and a little extra for incidentals; we're pretty healthy).

[-] uis@lemm.ee 2 points 1 week ago

The main issue I have is that what insurance you can get is determined by your employer, and if you don't like it, you lose whatever they would've contributed.

This is why UHC or at least UHC-like(citizens-only, separate tax) system is better. Here and in previous message when I write UHC, I refer to what any person can get regardless of citizenship. If you count what citizens can get, then MHI would be UHC by that definition.

and things like a public option become more useful as a check against private insurance.

As marshrutkas show, without public option private buisness is race to the bottom in terms of quality. While in cities that run their own public transport it is not as bad. It is interesting, how public perception was changing. In late 90-ies early 00-s people were saying "my city is better because it has marshrutkas", "marshrutkas are faster and more comfortable than old PT buses", while now "I don't want AC-less coffin" and "bring back municipal buses". Because PT always comes, no matter snow, rain or thunder, while commercial microbuses mostly work only in peak hours.

I'm not convinced universal healthcare is really going to be cheaper or better for most people though, especially in our already messed up healthcare system. We do need to simplify insurance, because care providers are spending more and more dealing with insurance, which increases costs for everyone without providing value.

You already described one reason why UHC will be cheaper.

I'm convinced the ACA (Obamacare) made things worse in that respect, so it simultaneously went too far and not far enough.

I'm not an expert in american healthcare system, but as I understand that there is problem of private gatekeepers. Yeah, I can imagine things going worse.

We pay something like 5%/year for medical care (1.5% for Medicare for the elderly, 3% through my employer plan, and a little extra for incidentals; we're pretty healthy).

Per year? Does rate go up every year? Here it's basically just tax: if you don't work - you don't pay, but receive healthcare regardless of having any income just because you are ~~such great human~~ citizen.

[-] sugar_in_your_tea@sh.itjust.works 2 points 1 week ago* (last edited 1 week ago)

without public option private buisness is race to the bottom in terms of quality

Agreed. I've seen examples of that with charter schools (privately run, but funded with tax dollars). With a good mix of charter and public schools, charter schools tend to do a bit better and specialize, but if public schools go away, charter schools become crappy.

I'm a huge fan of public mass transit as a backbone and private transit to fill in the gaps.

So the idea has merit, I just don't know how that mix should work for medicine where competition can be less realistic. Perhaps it should be like transit, public services for emergencies, and private services for scheduled services. Idk, I'm not a policy expert, but there needs to be a middleground between queues for care and massive medical bills for small procedures.

does it go up every year?

The 1.5% tax stays constant and subsidizes retirees' public insurance (and very poor people, or those with specific conditions).

The rest is just what I approximate based on my income and my employer's selected plan. The plan is kinda crappy (1 free checkup and covered preventative care; deductible for everything else with ~$15k max paid by the individual in a given year). I'm pretty healthy, so I get an extra discount, but the amount is fixed and uncorrelated with income. So for someone making much less, it'll be a higher percentage of income.

Most years we spend near-$0 out of pocket (except maybe $20-30 for medicine), but we've spent ~$10k per kid when they were born. I didn't factor that in, I just counted the premiums, which are about 3% of each paycheck.

[-] uis@lemm.ee 1 points 1 week ago* (last edited 1 week ago)

Sorry for late response.

charter schools become crappy.

Worse than public ones were.

I'm a huge fan of public mass transit as a backbone and private transit to fill in the gaps.

I think small personal transport((e)scooters) better fills in gaps. Big personal transport is overkill in city with proper PT. Private transport, I think, is only needed in rare cases, like you need to transport something big. For example moving server across entire city.

So the idea has merit, I just don't know how that mix should work for medicine where competition can be less realistic.

I know that in MHI system polyclinics get funding based on amount of people that registered there. And that people can register in any polyclinic they like, but generally they do in closest to their home.

But with healthcare I think there is no need for competition inside one country. Rather need for competence of doctors. And decent wages. And not have president stealing healthcare money to build palaces for himself.

Perhaps it should be like transit, public services for emergencies, and private services for scheduled services.

I think it's very bad idea, because this heavily disincentivises preventative healthcare. Sickness better to prevent than to cure.

Idk, I'm not a policy expert, but there needs to be a middleground between queues for care and massive medical bills for small procedures.

  1. We are talking about something for masses.
  2. Talking about masses and limited resource implies theory of mass service, or how it more commonly called in English - queue theory.
  3. If you want to not have queues for emergency care, hospitals can just reserve power(machines, operators, etc) for hospitals. If you need more, you(abstract you) either reserve more or build more.

The 1.5% tax stays constant and subsidizes retirees' public insurance (and very poor people, or those with specific conditions).

For 1.5% of tax USA has too little of healthcare. Even for its own citizens.

The rest is just what I approximate based on my income and my employer's selected plan. The plan is kinda crappy (1 free checkup and covered preventative care; deductible for everything else with ~$15k max paid by the individual in a given year). I'm pretty healthy, so I get an extra discount, but the amount is fixed and uncorrelated with income. So for someone making much less, it'll be a higher percentage of income.

This is main problem of private healthcare. No job = no healthcare. Well, one of main. Other is conflict of interests.

but we've spent ~$10k per kid when they were born.

I'm sad again. It's terrible. I hope your country will improve. Such things should not happen.

Private transport, I think, is only needed in rare cases

It's needed for medium distance trips that mass transit doesn't serve, like getting from an airport to a specific destination where transit would take far too many transfers.

So:

  • mass transit to go longer distances and along busy routes
  • walking and cycling for short distances
  • private transit when time counts on underserved routes; also for shuttles for large employers

I think there is no need for competition inside one country

I disagree. Without competition, you can only manage price through political channels, which just results in lobbying and cronyism. Having paying customers choose one provider over another establishes pricing tiers, and properly rewards better providers and punishes worse providers.

The issue is that many people don't feel comfortable making decisions on medical care (everyone wants "the best"), but I think there needs to be pressure or there's little incentive to stand out and do a better job than everyone else.

The more the government gets involved, the more gov't palace building you'll see.

Sickness better to prevent than to cure.

True. But refusing to serve someone in an emergency because they haven't kept up on preventative care is unethical.

That said, I think people don't get preventative care due to cost, and preventative care is expensive because of a variety of stupid reasons that I think would largely go away if most people paid cash.

People are happy to spend a bunch on supplements in the name of health, so I think people would pay for it.

limited resource

But that's the thing, it doesn't need to be limited. Doctors don't want competition so they put pressure to discourage new doctors. Insurance companies also make it difficult for new doctors because they demand high certifications.

If medicine is restructured, your regular doctor could be a nurse, and you'd only go to a doctor if you had something the nurse couldn't handle (rare). But because of liability nonsense, they're prevented from actually doing their job, so we have more people chasing fewer resources.

I think people will get creative if they actually see the bill.

For 1.5% of tax USA has too little of healthcare

That's not true. That tax is for Medicare, which only serves the elderly (65+) and very specific other groups. Medicare is widely well regarded, and politicians want to expand it to everyone as a public option. But if we do that, I'm concerned it'll cost a lot more and they'll stop fighting so hard to keep prices under control (classic monopoly issues).

I think Medicare is best when it's competing with private health insurance. If everything moved to public insurance, we'd have pressure to cut physician salaries (they're a much smaller lobby than pharma), which reduces attractiveness of medicine as a career, which would increase wait times and whatnot.

Maybe we should roll it out to the poor, but I don't it should be universal, at least not in the US.

Such things should not happen.

Eh, $10k for each kid averages out over the long term. I'm relatively well-off (not rich, but solidly middle to upper middle class), so I can handle occasional costs, especially planned costs like having a baby. I then get $2k/year as a credit for each child until they're 17, so that's nice.

Most years I pay nothing outside the premium. So it averages out to being pretty affordable.

[-] uis@lemm.ee 1 points 1 week ago

It's needed for medium distance trips that mass transit doesn't serve, like getting from an airport to a specific destination where transit would take far too many transfers.

Depends on how you define medium distance here. Probably it is not "two bus stops away", but rather "neither inside the city, nor between them". Then suburban tranins like these.

  • mass transit to go longer distances and along busy routes
  • walking and cycling for short distances

Agreed, but cycling for short distance(depending on definition) in city most of times less convenient that walking or using regular scooter(which in some countries legally same as walking). But this depends on infrastructure, and I can imagine cases where it is more convenient: when you can store bycicle without moving it upstairs. For same reason it is very convenient to use bycicles in rural areas.

Without competition, you can only manage price through political channels, which just results in lobbying and cronyism.

  1. I should have mentioned it is about competetion between public and private healthcare. At least diagnosing and treatment part. Something MRI or CT is fine because I think it is almost impossible to cut corners here, so race to the bottom should have no negative impact here. But with something like lab tests cutting corners can lead to more false results.
  2. Who chooses? If patient, then most of the times metric used by patient is not quality of medicine. If not, then it's either academia channels or political channels.
  3. Kinda repeats 1, but because of 2, I think competition based on price is very bad for healthcare.
  4. Having private healthcare results in a lot more of lobbying and cronyism than not having it. And what UHC would lobby for? More healthcare for everyone? Isn't that entire purpose of UHC?

Having paying customers choose one provider over another establishes pricing tiers, and properly rewards better providers and punishes worse providers.

  1. Pricing tiers... Life shouldn't have pricing tiers.
  2. While I belive, that future generations will have better education, even then most of the times patient's quality metric is not quality of healthcare itself. Unless instead of doctors there are bunch of homeopathic chiropracts. I said about patient instead of society(customer) because society's choice is definition of political channels. At least in democracies.

The issue is that many people don't feel comfortable making decisions on medical care (everyone wants "the best"), but I think there needs to be pressure or there's little incentive to stand out and do a better job than everyone else.

  1. About quality metric above
  2. The only way to do better job than everyone else in healthcare is possible when everyone else misdiagnoses or mistreats. And this can only made possible through scientific research. Capitalism loves to use results of science, but hates doing science, take patent law as example of this.

The more the government gets involved, the more gov't palace building you'll see.

Academy of Sciences existed over 4 political systems and over 4 economic systems. Even under Putinism it doesn't look like goverment place as most corporations. What we call goverment place look should better be called along the lines of dictatorship place look. Because this is how power that does not represent interests of society should be called.

But refusing to serve someone in an emergency because they haven't kept up on preventative care is unethical.

True. My point wasn't preventative care instead of emergency, but preventative care should be if not part of UHC, then at least provided to every citizen by state.

That said, I think people don't get preventative care due to cost, and preventative care is expensive because of a variety of stupid reasons that I think would largely go away if most people paid cash.

Especially if their entire bill is 0.

But that's the thing, it doesn't need to be limited. Doctors don't want competition so they put pressure to discourage new doctors. Insurance companies also make it difficult for new doctors because they demand high certifications.

  1. Maybe I should have said said finite, maybe some other wording. What I wanted to say amount of doctors is not infinite. So there WILL be a queue.
  2. It seems to depend on country, but here the only "certification" is degree in medicine.
  3. "Doctors don't want competition so they put pressure to discourage new doctors" is consequence of turning science into capitalism.

If medicine is restructured, your regular doctor could be a nurse, and you'd only go to a doctor if you had something the nurse couldn't handle (rare).

Nurse that can diagnose is called feldsher. Has secondary special education(between secondary and higher).

That tax is for Medicare, which only serves the elderly (65+) and very specific other groups.

That's why I said too little.

Medicare is widely well regarded, and politicians want to expand it to everyone as a public option. But if we do that, I'm concerned it'll cost a lot more and they'll stop fighting so hard to keep prices under control (classic monopoly issues).

  1. As I understand until from my sofa, until recently Medicare couldn't negotiate drug prices and only bought them at any price manufacturer said.
  2. Except it is classic monopsony. Monopsony fights to keep price as low as possible, contrary to monopoly.

I think Medicare is best when it's competing with private health insurance.

Maybe. Maybe not. Medicine is not making chairs or making phones.

If everything moved to public insurance, we'd have pressure to cut physician salaries (they're a much smaller lobby than pharma), which reduces attractiveness of medicine as a career, which would increase wait times and whatnot.

This is valid concern. Result here doesn't seem completely predictable to me, because as I understand physician's wage is disconnected from price private hospitals charge. Cutting salaries is likely, but not the only outcome, because a lot of money was spent on communicating with private insurances.

Maybe we should roll it out to the poor, but I don't it should be universal, at least not in the US.

Having healthcare is better than not having it, but if it will be limited to poor and old, then it will be heavily underfunded like public transport.

Eh, $10k for each kid averages out over the long term.

I mean in certain somecountries it is part of UHC.

I then get $2k/year as a credit for each child until they're 17, so that's nice.

Better than nothing.

this post was submitted on 15 Jun 2024
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