back

by dafelst·3y ago·view on hn ↗
Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Any system that requires balancing human suffering against profitability is inevitably going to optimize for profitability.

The fact that this is even a thing is mind boggling.

9 comments
All claims being reviewed by big health insurance conglomerates is the antithesis of privatized healthcare. It incorporates the worst part of public healthcare and destroys the best potential benefit of privatized healthcare.
How is that so? The health insurance conglomerates are in private hands.
Parent probably means that those companies are part of a government sponsored cleptocracy.
This is not properly referred to as health insurance. It is a sickness, aging, and death payment plan. There's no such thing as major medical anymore.

It was private healthcare that backed public law forcing minimum coverage. Why? Because their pool was shrinking. They were getting sick people who needed care, but with premiums skyrocketing, what benefit is there for healthy people to buy in?

But I agree that the private for profit health care system is an abomination only made much worse by making it public law requiring we buy into it. Instead of Medicare for all.

What part of public healthcare is incorporated into health insurance conglomerates? And what potential benefits of privatized healthcare are we missing out on?
Who do you think run all state level Medicaid programs? Government employee health plans? Private conglomerates.

That’s one of many many examples.

The best potential benefit of privatised healthcare comes to those wealthy enough to just pay cash for what they need.
What are some real world examples of beneficial privatized healthcare?
IMHO in privatized healthcare you are not the patient, you are the customer. As such, you should be having a better "customer journey" than in public healthcare: more immediate test/diagnostics, better experience in the hospital (like a room for yourself). And that's it. As a counterpart, it's not clear you are receiving the best medical attention. And of course you (through your employer) are paying for something that can be denied.

Note: I happen to have private healthcare with Cigna in a country with a reasonably good public health system (Spain, though it varies between different autonomous communities), happy to pay the taxes and will defend that public health systems are a staple of any modern country.

Concierge doctors.

To be clear, we are talking about benefit to the patient; there's lots of reasons concierge doctors may not be the best benefit for society at large. But that's immaterial because this is just one example; if we hadn't gone for the worst possible way to scale private medicine, then there could be better examples.

But the point is that you can't seriously look at concierge doctors and say that public healthcare would be better for those patients! And therefore this refutes any claim that public healthcare is the best system overall.

it's funny how whenever a big company does something bad that's actually an example of how socialism is bad
A key component of the free market is the ability to say "no thanks" to an offer to do business.

Can you explain to me how the government telling you "you must do business with one of these insurers or else" is in any way a free market?

Mental gymnastics to avoid acknowledging that they've been brainwashed by capitalism
Can anyone name any usefull innovation that has come from private health INSURANCE in the past 100 years?

Not private hospitals/drug manufacturers - those are arguable - just insurance. What do they contribute?

They got bailed out in Covid, they take money out of the system in good times, they deny you care in the bad times.

Best I can tell they serve no usefull function

Capitalism is all about rent seeking and having middle men that contribute nothing where they only exist to suck money and resources out of the system
My dad used to tell me there are 2 types of jobs, jobs where you use your hands or intellect to make something more valuable from less expensive constituent parts, and jobs where you skim off the top of people doing #1
> Privatized health care as a person's sole option for care is an absolute dystopian nightmare.

Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.

The article suggests that your health care isn't as good as you think it is. You never know if you'll be one of those cases where they make you fight for every bit of care you get.

Some Americans do get excellent care with a minimum of grief. Others think their insurance is fine while they're healthy and only discover later that it doesn't really cover what they imagine it does. And the difference is entirely arbitrary.

The fundamental problem of health insurance is that you cannot know what you will need, and there is no way to make an informed consumer choice, but your need when you have it is absolute. It's pathologically pessimal as a free market. And you usually don't know until it's too late.

You cannot know what you will need, but to leap from that and say that you cannot make an informed consumer choice is a huge and incorrect leap.

Actuaries know, in aggregate, what specific demographics will need. Insurance companies use those statistics to make profit. The view that consumers cannot make informed choices on healthcare needs is incompatible with the fact that risks are not perfectly and uniformly random. Unless, by “informed choice”, you mean one that is correct in hindsight, in which case, I agree.

Having lived the opposite, I have to strongly disagree. I lived the nightmare of US healthcare, where my provider decided to stop working in my state, which meant that I no longer had access to any doctors under health insurance despite it being paid for by my company.

The UK was amazing - no questions asked care for my health was a massive improvement over what I had in the US. Free access to a doctor at any time is more life changing that you can think - every health issue I had I could talk to a medical professional and get guidance. Even free mental health care.

Moved to Ireland last year, with a mixed public/private system, and my health is now slipping a bit. Going to a GP, trying to file for reimbursements, and knowing that every time I have a health concern, it will cost me money, is a powerful suppressing force. I miss the NHS.

Do you think your health care experience represents the median healthcare experience in all 5 countries?

If we divide up people into percentiles based on wealth, 25, 50, 75, 95, how do you think people fare in the different countries? How do you think they the median experience is in America?

> Sure I'm lucky to have a good job that pays for it,

That is not where you are lucky.

You are lucky to be healthy enough that you can hold on to that job. Once your health takes a bad turn, and you are unable to work, when you really need your healthcare, that's when you are better positioned to judge the quality of healthcare.

My personal healthcare in Sweden has been higher quality (considering both personal cost and state cost) than my healthcare in US. I have heard complaints the other way of course.

Regardless of our personal experiences, the US spends so an enormous amount on healthcare and gets very little in return by basically all international measurements. Americans who think American healthcare seem to me too insecure to accept that their system is just plain bad. But yes Americans with a lot of money have access to better healthcare than average Americans. That said, this is essentially true in all countries so it's not that relevant really.

> a good job that pays for it

If that's whats necessary to get decent health care in this country, then something isn't right.

An ironic use of the phrase survivorship bias springs to mind
We need to realize that publicized healthcare is the only option. Then we can focus on how to make it more efficient.
The important question is: have you ever made a large claim for a serious long-term illness? If not, you aren't yet in a position to judge the two systems.
Yeah this is a very common sentiment. I feel like most people in the US haven’t actually talked to someone that has experience with socialized healthcare at scale. I had a German professor that was very clear about just how much better healthcare is in the US.
Oh, well as long as you personally have not yet had a problem.

Everything is fine everyone, no need to worry.

I have literally spent years trying to get an MRI for my knee after an accident. Both Kaiser and Anthem won't cover it.
MRI accessibility is regulated at the state level, which determines the number of MRI machines available to the public. I was able to obtain an MRI while on vacation in Europe without any appointment or referral from a physician. The process was straightforward; I explained my needs to the receptionist, and a technician conducted the MRI. The cost was 180 euros.
My family has received multiple radiology procedures including x-ray, MRI, and ultrasound from private radiology businesses (I.e. not the hospital). They are typically 10x give or take less expensive. Last MRI was $600.

Doesn't help if you are stuck in the hospital. But, it's an option otherwise.

I know it's still not cheap, but I needed an MRI a few years ago and it was $350. Talk to your doctor and let them know you want to pay cash. Mine suggested a place.

Don't get one in the hospital if you can help it. They charge 1-2k because they have a full set of people who can't go anywhere else.

I had MRI in EU, it was 160 euro for scan, and another 50 euro for specialist consultation. Public insurance would not cover it, so I paid it myself.

Not sure what is holding you back, but health should be a priority!

I may be completely wrong, but I understand in the US normally people have health care through their employer? so they are not themselves paying the insurer, and cannot change insurer.

If this is the case, then it is no wonder the insurer has no particular care for them. It is the power of the consumer to change provider which gives them influence over the provider.

This is the case, and is, IMO, the central problem with American healthcare. Folks in both political parties argue for or against socialized healthcare, and ignore that a huge amount of the problems could be solved by having an actual free market.

My opinion is that providing healthcare as a benefit should be banned. Employees who have healthcare today should be provided the amount the employer would have spent on health care in wages/salary. The fine details are hard to work out, but I think it is a good starting point.

Even if not employer provided, there's usually little choice in carriers due to anticompetitive practices and regulatory capture.
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy.

No matter what society you live, the advice is the same: try not to get sick.

This might be true, but as someone who has lived in the U.S. and Europe I can say utterly unequivocally that I preferred Health Care in Europe. I wasn't even in one of the European countries with a great reputation for Health Care.

Health Care in the U.S. isn't just bad, its outright fucking brutal. An elderly friend of mine recently fell and went to an urgent care where they couldn't get him into the x-ray machine. They told him to go to an emergency room where he waited for _13_ fucking hours with a broken pelvis. I'm basically 100% sure that such emergency room bullshit literally kills people from stress or exposing them to other sick people. You can't even wait in your damn car and just have them text you - they just force you to sit in this horrible room with a ton of sick people for hours on end.

The U.S. Health Care system absolutely fucking blows.

I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.
> Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs,

You realize we're discussing the US which has all this?

> beauracracy.

It's funny you mention this, because the US spends vastly more on bureaucracy in its health systems than other developed nations.

> Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy.

those are all there because the people that created the system did not think paying for it was good enough. it doesn't have to be that way. and even with wait times being long you still eventually get it. in the privatized system if you are poor and have bad health care you don't get it at all.

Ah, yes, have a privatized public sector, use the gained funds to lobby in other countries, pushing a ideology that destroys public sector/services, use the result of ones own actions to push the conversion to more privatized public sector. The ultimate glider gun ideology.
As someone who grew up in israel, I can confirm your statement is factually incorrect.
Sounds exactly like my private for profit health care provider.
I knew I was going to see this comment.

As if Medicare didn't reject millions of claims too.

A number of physicians just don't accept Medicare because it's subpar.

So then what are your thoughts on those who get denied on a Medicaid plan?
I see you've never had to do a major procedure in a "public" system.

Heh.