Comment by xnx
1 year ago
It will always be a challenge to allocate limited healthcare resources. It's an unsettled question why the US accepts such an expensive means (private health insurance) of doing so.
1 year ago
It will always be a challenge to allocate limited healthcare resources. It's an unsettled question why the US accepts such an expensive means (private health insurance) of doing so.
> why the US accepts
Because we don't have another option. Your job dictates your insurance, not you, and most jobs explicitly search for insurance companies that don't end up costing them much (but cover enough that people still think they have coverage, maybe).
There's stories going around right now about how BlueCrossBlueShield is going to be dictating the amount of time during a surgery that anesthesia will be covered. https://duckduckgo.com/?t=ffab&q=blue+cross+blue+shield+anes...
Of course, these stories are happening after individuals have made their elections for insurance AND after the companies that would be choosing the various insurance companies to pick from would have already selected their projected insurance provider.
> Your job dictates your insurance, not you, and most jobs [...]
This is answering the question with a very narrow focus on what any one person can do. Sure, when I filled out my job's open enrollment last month, there was no checkbox labeled "Evil Corporation Insurer (y/n)", but there's no inviolable law of nature that requires the US to be this way.
Exactly. There's a lot of talk about trade and other countries "ripping off he US", but almost no mention that the US pay significantly more for the same drugs sold in other countries.
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I agree! There's no inviolable law.
What there _is_, is too much pain and too many spoons that each and every person needs to manage every day, and most (nearly all) people are unable/unwilling to let even more important things drop.
We also have crab mentality in the US, where if one person hopes for, or even gets, something better, they're pulled back down.
And we have an efficient, powerful propaganda machine that tricks people into voting against specific areas of their interests - see "I love ACA, but I hate Obamacare" commentary.
The work to fix this is terrifyingly hard and *huge* and the people that will choose to fight and improve the situation will be making absolutely enormous sacrifices to do it.
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Changing the laws is an option. But it's not happening because many of our politicians are corrupt.
That is absolutely true, even no matter the government, even a non-capitalist socialist commune must allocate and there's no right answer. It can become insidious in capitalism. We have organizations like Kaiser who say "we'll run the hospital and focus on preventative care, if we spend $50 today that avoids $50,000 a few years from now" - Kaiser notably does hospitals AND insurance in a vertically integrated manner. That's all reasonable. Then a United might see "we can spend $5,000 today and patient will be healthier-ish, or $200 yearly for a medically equivalent treatment". And so they do the actuarial math that the patient will die in a few years, they calculate revenue from that patient based on how long they might stay on the plan, and find the solution that maximizes profit. So the mentality isn't Kaiser-like "i.e. we're on the hook for this patient, let's minimize their health problems to save money", it's more like "we will minimize the cost of this patient full stop, if that means they don't get care then they don't get care"
They're limited only because of poor regulations and caps on the market, exclusivity agreements of hospitals, tying of healthcare to jobs etc.
Privatizing hospitals further would not help the vast majority of Americans. Without non-privatization agreements, the average American could not seek or afford the medical attention they need.
As someone that's lived on the Canadian border for the past 20 years, I frankly think we need more regulations. Drug prices in the US are so absurdly high that most terminally sick Americans will happily drive back and forth to Windsor if it means treatment they can afford. It's a testament to America's core dysfunction, something that Canada can somehow get right on their first try but America... well, we struggled to put Shkreli behind bars.
It isn't like US public system, medicare, is great. I still end up buying my folks supplemental. This narrative of pubic vs private misses most of the nuance.
there's so much nuance in an insurance company having billions left over every year after subtracting payouts from premiums! it's sooo complex and nuanced