This isn't a political article. Its author has contributed tens of thousands of dollars to Democratic political causes, but the article itself is almost completely opposed to the Democratic Party's thoughts on health care.
Instead, this is an article about business, efficiency, the impact of IT and modern business process on health care, and the impact our current system has on consumers and businesses.
I agree. This kind of article is a de facto test of flagging judgement. For a while now I've been considering having HN learn whose flags to pay attention to. (I already have code to collect stats about rates of crying wolf, but I don't do anything with these numbers yet.)
As someone who certainly "cries wolf", I'll go ahead and ask: how are we to judge "good" politics articles from bad ones?
I read The Economist, and think they occasionally do some pretty good politics articles, and having an on-line version, it would be easy to post them here.
Actually you're not that bad. You only misflag articles 17% of the time.
As for political articles, the test is whether the article is an instance of the ordinary back and forth of debate on some political question, or whether it's about some deeper underlying phenomenon that only happens to be related to politics. E.g. "Politician A accuses Politician B of X" or "Why policy Y is good/bad" are probably both offtopic, whereas "How political campaigns use statistics" is probably ok.
How do you judge misflags? Do you compare against yourself and the other editors kills? Or, do you compare to popular opinion? Which might could be wrong if the community grew too fast. ...Does it help to flag dead articles?
A 17% misflag rate simply means that 17% of the articles you flag don't end up getting killed. Which is pretty good: it means your flags are an 83% accurate predictor of whether an article will be killed.
That has the unfortunate effect of silencing minority constituencies that may have a substantive and HN spirit-compatible reason for thinking that an article is important to get out there and discuss, but whose thoughts do not mirror the prevailing trend of the groupthink.
I suppose it would be a good strategy for those who want their flags counted to flag newer rather than older articles then. The more hours that have passed, the higher the odds are that those who would flag already have.
It would also be a deterrent for those such as myself who flag articles for nauseatingly bad grammar. I don't have that much patience when reading pages with verbless sentences, "there is" vs "there are" mistakes, and that sort of thing. Most 20-somethings do, though. I flagged one just this week after running into a paragraph that started with the following sentence:
Anyway.
The way I had looked at the issue up until now was that this sort of flagging still had some use. Articles would rarely get killed for terrible grammar alone, but if they were also somewhat inappropriate for another reason, then the grammatical errors could push them over the edge.
"As for political articles, the test is whether the article is an instance of the ordinary back and forth of debate on some political question, or whether it's about some deeper underlying phenomenon that only happens to be related to politics. E.g. "Politician A accuses Politician B of X" or "Why policy Y is good/bad" are probably both offtopic, whereas "How political campaigns use statistics" is probably ok."
"Why the US healthcare system is broken" (well written or not) can be judged "politics" by this guideline according to the "Why policy Y is good/bad" part.
That said,
suggestion 1: This would be a great addition to the HN guidelines. Appending the above to "Most stories about politics, or crime, or sports, unless they're evidence of some interesting new phenomenon." would add clarity.
suggestion 2: Can the "misflag rate" be made visible to flaggers as part of their profiles? This would help us improve our flagging.
Here's the answer: No one wants politics articles here. You can tell that this is not a politics article by 1) reading, instead of ignoring, the multiple assertions in the comments that this is not a "politics" article or 2) reading it.
I read it, and it boils down to a discussion of the allocation of health care resources, which is economics/politics.
For instance, if you're going to critique it, he says:
> Such a transition would require the slow reduction of Medicare taxes, premiums, and benefit levels for those not yet eligible, and a corresponding slow ramp-up in HSAs. And the national catastrophic plan would need to start with much broader coverage and higher premiums than the ultimate goal, in order to fund the care needed today by our aging population.
It's very difficult to take away benefits that people already have, which is eminently a matter of politics.
Also, note the "POLICY" at the top of the page. That's pretty indicative that it is politics.
I'm not saying it's not a good article, but it certainly isn't about hacking code or electronics, and only tangentially related to startups (in a way that lots of things are, if you want to make tenuous connections).
pg, however, thinks it is worth having this sort of article, so I am asking, honestly, how one distinguishes a good politics article. It strikes me as being a difficult thing to do, but perhaps he has some insight that I am not picking up. Perhaps it's simply a matter of taste.
The article obviously appeals to hackers (myself included), but I am not sure that it appeals more to hackers than to other intelligent people, so that test doesn't really work.
A good chunk of the technology articles on HN can be boiled down into eminent matters of politics. The test for whether an article is political or not is whether the article is about something, or whether it's about the politics of something. This article is studiously not about the politics of something.
"it certainly isn't about hacking code or electronics"
I, for one, like articles which intelligently discuss hacking economic and social issues. To me hacking is hacking. Almost all the software hacking I do is a part of a form of economic hacking, i.e. my business plan.
I think your point is reasonable but you are not doing it a service by conflating economics and politics. Economics is only political in the sense that anything can have a political implication - is the discussion of the LHC political because of its enormous cost?
Well... ok, point conceded that they are separate things, but the reality is that they're so often linked that for practical purposes of sites like this they might as well be the same thing.
Reason being, is that a good discussion of the economics of some policy is about the most efficient to make it happen, but invariably the question comes up about whether it should happen or not. For instance, with health care, some people deeply believe that it should be available to all; others think the government shouldn't spend money on that sort of thing. With an article on the economics of cap and trade vs taxing carbon emissions, people will invariably pop out of the woodwork and deny that people can or are creating negative environmental externalities, or if they are, that anything should be done about it. And so on...
So... yes, they're separate, but the resulting discussions are indistinguishable in most cases.
As an example, if you look below at the comments, regarding school vouchers, someone corrects me that a "real" libertarian solution would simply be to abolish the idea of public schools paid for through tax dollars. There's such a fundamental disconnect in terms of someone who wants that, and someone, who, for instance wants a Nordic style state, that discussions aren't likely to go anywhere very good.
"Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results."
The author supports this point in rich and irrefutable detail. Read it and weep.
This article is indeed "not political" but ONLY in the sense that none of the efforts at a solution being debated even slightly address the crucial considerations that he makes. Shame on the solvers...
I don't see a contradiction between the article's title and the subject you mention. Various economic factors distort the provision of healthcare to the point that it kills people. The title naturally highlights this crucial point, understandably so given the author's personal experience with this.
It's quite disturbing that Pronovost had to beg hospitals to adopt a free technique that could cut the average 100,000 deaths from hospital acquired infections down to ~30,000 overnight with nothing but telling your doctors to wash their hands.
This was adopted a long time ago in the UK and became cemented in place with the MRSA outbreaks. Visitors can actually be removed from the hospital if they're seen not using the alcohol based sanitizer.
The last paragraph of the article addresses this specifically:
"Imagine my father’s hospital had to present the bill for his “care” not to a government bureaucracy, but to my grieving mother. Do you really believe that the hospital—forced to face the victim of its poor-quality service, forced to collect the bill from the real customer—wouldn’t have figured out how to make its doctors wash their hands?"
"But health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance."
"For that matter, try discussing prices with hospitals and other providers. Eight years ago, my wife needed an MRI, but we did not have health insurance. I called up several area hospitals, clinics, and doctors’ offices—all within about a one-mile radius—to find the best price. I was surprised to discover that prices quoted, for an identical service, varied widely, and that the lowest price was $1,200. But what was truly astonishing was that several providers refused to quote any price. Only if I came in and actually ordered the MRI could we discuss price."
"By contrast, consider LASIK surgery. I still lack the (small amount of) courage required to get LASIK. But I’ve been considering it since it was introduced commercially in the 1990s. The surgery is seldom covered by insurance, and exists in the competitive economy typical of most other industries. So people who get LASIK surgery—or for that matter most cosmetic surgeries, dental procedures, or other mostly uninsured treatments—act like consumers. If you do an Internet search today, you can find LASIK procedures quoted as low as $499 per eye—a decline of roughly 80 percent since the procedure was introduced. You’ll also find sites where doctors advertise their own higher-priced surgeries (which more typically cost about $2,000 per eye) and warn against the dangers of discount LASIK. Many ads specify the quality of equipment being used and the performance record of the doctor, in addition to price. In other words, there’s been an active, competitive market for LASIK surgery of the same sort we’re used to seeing for most goods and services."
That's because the notion of insurance is wrong. People need healthcare coverage, not insurance.
We are all connected in this stupid country - if the family down the street can't afford preventative care, and the wife gets sick, and can't take care of the kids, and the husband misses work and gets fired from his job, and then they can't afford good nutritious food for their kids, so the kids go to school hungry and don't learn as well and don't test as well, the ripples can last for generations.
Here's the thing. People act as if healthcare is something that has to be earned, and deserved, and not only is this viewpoint inhumane (in the Greatest Nation in the World!), but it's economically indefensible.
If people don't get early medical care, their lifetime economic output can be greatly reduced. And their children are affected. If children aren't taken care of with nutrition and care, their mental abilities, abilities to stay in school, are affected -- and their lifetime economic output is reduced. And targeted poverty (as opposed to where everyone's poor) breeds crime. Which creates greater loss of human economic potential AND greater costs for the government.
The country benefits from more, healthier workers, who can think straight, and don't spend significant portions of their time figuring out how to scrape by. These people can then spend money. Middle- and lower-middle-class people spend far more of their income than higher income brackets, if only they have the money to spend.
Net effect: The benefits to the entire country outweigh the costs, in a system where costs aren't an arms race between health insurance providers, malpractice insurers, and other for-profit companies.
theatlantic: "wow this story is amazing, thoughtful, and powerful, but the title has got to go. How about something catchy like: How American Health Care Killed My Father"
medical reform isn't political in the sense that what we currently have is obviously bullshit and what the politicians propose is obviously bullshit. if we're talking about a non-bullshit solution we're in the realm of fantasy, not politics.
Appealing when presented in the abstract, but I have nightmarish visions of such a system.
On the one hand, you'd further motivate those consumers who were already likely to avoid preventive care and ignore symptoms until they require costly (to me as contributor to the catastrophic plan) emergency and intensive care. And the author's position that folks would be able to withdraw funds that exceed a certain ceiling adds the perverse incentive to risk not spending this money, with the downside being absorbed by the catastrophic plan.
On the other hand, you'd do nothing to discourage consumers with irrational fears about their health from distorting prices upwards, or to discourage unscrupulous providers from fomenting those fears. The plan he describes takes fee-for-service and all its problems to a whole new level. I think of things like the celebrity anti-vaccine mess and the healthcare debate with its distorted media coverage and disingenuous advertising, and I have hard time accepting a consumer-driven market succeeding, even with all the government-collected and -analyzed data in the world.
Even worse, I fear that such a system would result in a tiered system, where the best and brightest providers provide excessive care to those with means while the rest of us continue to struggle with barely adequate, barely affordable care.
I don't think that any system that relies on healthcare consumers making the choice between limiting their usage of healthcare services and spending money is destined for success. Providers need to be rewarded for providing the best outcomes for the lowest cost with the fewest mistakes, not the most and most expensive services. Significant efforts must be made to improve the public health of Americans. The conversation should be about how to make those things happen. All this debate about who pays when is just a side show that is obstructing real reform.
Your fears are ones that one could have about any market. But in general, free markets seem to work better than any of the alternatives across a wide range of markets, and I really doubt that health care would prove an exception to this.
It won't be perfect, of course, but a perfect system doesn't exist. I'm absolutely appalled that I'm paying (on average, as an American) over $1.5 million over my life for the present system, and can't imagine this would remain the case if pricing and outcome transparency were drastically increased. I think that quality and service would improve, while cost would decrease.
You're making the somewhat curious assumption that systematic neglect of "preventive" care (i.e. routine checkups) results directly in the "downside": large-scale, high-cost catastrophic events.
It certainly can, but from the point of view of statistics in human pathology, a complete non sequitur. For every person that neglects a checkup and misses early detection of a highly surreptitious, life-threatening disease, there will be ten for whom it either has no impact or results in low-grade, unremarkable chronic conditions that require occasional office visits and prescriptions.
Having to directly bear the cost of going to the doctor also provides a considerable incentive for leading a healthier life and staying away from bad habits with adverse medical consequences, in the same way that people are disincentivised to do avoidable things that hurt their financial standing in other areas.
Yeah. It's the same way with auto insurance and warranties. The dealer covers the costs of any catastrophic maintainence for the first few years, so the consumer tends to skip out on routine maintainence like oil changes. And at those regular tune-ups, when the mechanics appraise someone of a developing problem, they tend to avoid preventative maintainence, saying, "Nah, I'll just let it fail so the warranty handles it."
. . . ;)
My theory is that the inconvenience of a major failure and the risk to life and limb are much more important to most folks than the tiny costs associated with regular and preventative maintainence. I know they're more important to me!
It's actually been rigorously shown to work the same way with medicine. There was a study on HSA / High Deductable plans already in use, and it found that use of preventative care actually increased compared to the baseline.
I kinda wish Hacker News would skip the political articles. There are plenty of technical things about health care to cover (e.g. databases for health, clinical trials, input cost reduction).
That being said, I lived under US government health care for a goodly chunk of my life (IHS), and until they fix that, they really have no biz working on anything else.
IHS is the Indian Health Service? They don't care about that because Indians have no political power. It's unbelievable the kind of corruption and incompetence that exists inside that agency.
FWIW, Medicare, Medicaid, the VA, and medical care for soldiers are all pretty good on the US scale.
FWIW, Medicare, Medicaid, the VA, and medical care for soldiers are all pretty good on the US scale.
Ahoyhere's comment isn't the half of it. The incident happened at Walter Reed Army Hospital, which is the same place that US president's usually go for care. If stuff like that could happen there (it may have been a different branch in DC), what's the rest of the system going to be like?
I worked for a medical software company for seven years, converting Medicare specs for outpatient code editing into working programs. We would get regulatory updates once a quarter, make changes to the code and the data, test and ship. The fun part was that we would usually receive the reg changes 3 weeks before the hospitals had to have the updated application. Also, their reference application didn't match what was written in the specs. Worst of all, the spec changes were often unreadable and we would have to call DC to figure out what they meant. It will not surprise many of you to learn that they wouldn't know either and would "have to get back to us". I could go on and on...
Really? The VA? Did you miss all the scandals about the Walter Reed medical base in DC, where soldiers were mistreated, ignored and neglected, and even one killed himself in his room and no one noticed for 2 days? The hospital had no idea until his parents called and forced them to look for their missing son. This was a guy who was evacuated due to a semi-suicide attempt, and they didn't even bother to monitor him. Shameful.
Not to mention the older vets, especially from Vietnam. They are screwed at every turn and the previous administration cut their benefits even more.
The Walter Reed scandal would really reinforce what people have been saying about for profit healthcare.
Walter Reed is a huge military complex with Army and contractor buildings on the base. Most vets that go to Walter Reed end up under the military care. This is the old colonial style buildings that most people see. They are in pretty good shape and most vets don't have a complaint about Army care. The real fiasco is the private contractors. This is the part of Walter Reed people read about in the paper. They work under VA but since they are for-profit companies, you know the rest.
People like to use Walter Reed of why the gov't shouldn't get into healthcare at all. Walter Reed is an example of why private, healthcare companies have no business being in healthcare.
Great clarification. I lived 10 minutes away from there - and it was on the news all the time - but I never heard that side of the story. Very illuminating.
I can believe American Health care killed your father. The people who have insurance, are afraid to go to the emergency room with chest pain, afraid the pain is gas and they can't afford the high out of pocket costs they have to pay.
He says he is a democrat, but a reasonable interpretation of the article points towards the republican solution of taxing health care benefits. The problem is that both the industry and consumers are very insulated from price sensitivity, so costs shoot out of control and providers have little incentive to improve quality. People need to be paying for far more of their care out of pocket with cash. We need price wars between hospitals.
Why is it that you Americans are so two dimensional? Every possible idea for social reform must either be the republican or democrat position. If it can't be pigeon-holed into one of those viewpoints, it's not worth discussion. If it can, it quickly devolves into some form of partisan debate.
Your two party system is killing you in every area, and you don't even know it.
hehe, yes I suppose. I was thinking two dimensional with the understanding that the number of dimensions to an argument (dimension == viewpoint) was infinite.
The argument itself though is very one dimensional. :)
Yeah, I don't understand why people accept/reject an argument based on which political party supports it, and why one party has to define itself in opposition to the other on every topic. Shouldn't we be looking for good solutions? Not just good solutions endorsed by our party of choice, but overall good solutions...
> social reform must either be the republican or democrat position
Uhh, no. It just so happens that in this case some Republicans are the only people putting forward the idea of taxing medical benefits as ordinary income, to reduce the role of insurance in the system. I don't even vote, let alone think in terms of democrat vs republican.
A market based fix for health care isn't really a "Republican solution". If, for instance, we had an "everyone pays for their own care out of pocket" system, and we had state or federal subsidies for those that couldn't afford their care, we'd have a market backed by government aid.
School vouchers to promote competition in schools is, IMO, a "libertarian solution", and one worth thinking about. School vouchers to get kids out of studying evolution and into bible classes is a much murkier idea, but one that I fear is the reason behind a significant portion of Republican backers of similar initiatives.
"School vouchers to get kids out of studying evolution and into bible classes is a much murkier idea"
But you're trying to have your cake and eat it too. You're basically saying "People deserve freedom! But not so much freedom that they can do things I don't like!"
The line is that with my tax dollars, I don't want to fund madrassas or kids studying jesus riding around on a brontosaur. If you want that, you do it on your own dime.
Basically, I would see school vouchers as being a way to compete between different schools teaching more or less the same things along more or less the same guidelines, and perhaps with no restrictions, on, say, hiring union labor.
I think the state has a duty to provide non-religious education to everyone, even if you're the lone Christian in a heavily Muslim area, say (or vice versa). If everyone could send their kid to a religious school, in some areas, the market would simply not provide for non-religious education.
"The line is that with my tax dollars, I don't want to fund madrassas or kids studying jesus riding around on a brontosaur."
That line of argument can be extended in all kinds of ridiculous directions. Should we ban Hummers off the roads? After all, they're driving on roads paved with your tax dollars, and you do not approve!
We should also ban rapists from drinking tap water. After all, my tax dollars pay for water treatment, and why should scum of the Earth like them get to drink it?
Do you see what I'm getting at? If you are going to insist that none of your money goes towards things you do not directly approve of, you're going to have to go for a 100% free-market economy - and by that I mean no police, no fire brigade, no public roads...
"Basically, I would see school vouchers as being a way to compete between different schools teaching more or less the same things along more or less the same guidelines"
... except if the schools teach things you disagree with. Like I said, it's "We should have freedom! But only for things I agree with"... which doesn't strike me as very free at all.
As an aside, one of the problems I see with the various interesting people of the internet is that, for a bunch of allegedly smart people, they harbor a lot of hatred and prejudice. You can't surf without running into hate-filled articles bashing the religious, unions, immigrants, poor people, etc ad nauseum.
But then you get into the dark and murky anthropological waters of the separation between religion and society.
For example, the law currently disallows polygamy - but if you look at all the cultures around the world you will find that monogamy is somewhat of a Judeo-Christian idea to begin with - at the very least there are many societies where it is perfectly acceptable.
So now the question must be asked: is our desire to have a monogamous society coming from our Christian roots, or is it something that transcends religion and becomes a shared ideology?
There are a great many issues where it's not easy to say "this comes from religion" vs. "this comes from our social order".
> There are a great many issues where it's not easy to say "this comes from religion" vs. "this comes from our social order".
The world is certainly a complex place.
State-sponsored teaching that evolution is bunk, and that the koran/bible/FSM is literal truth, though, is probably crossing the boundary, and that's what we were discussing, not monogamy.
> State-sponsored teaching that evolution is bunk, and that the koran/bible/FSM is literal truth, though, is probably crossing the boundary, and that's what we were discussing, not monogamy.
The problem though is that, from the government side anyways, the two arguments are not separable. As soon as you propose to limit/expand the freedoms of one special interest group, all of them swarm out of the woodwork.
The problem is also that you cannot say "this is crossing the boundary" without first defining what the boundary is. Sure, teaching creationism (for us) is well beyond this ephemeral concept of "the line", but fair governance requires us to actually define where "the line" is.
> If everyone could send their kid to a religious school, in some areas, the market would simply not provide for non-religious education.
The availability and quality of schools is already a key consideration when choosing a neighborhood to live in. Forcing every last kid in Chinatown to go to a school at odds with their traditions is an affront to liberty. Offering the one Jewish family in Hicksville, Alabama the option of (a) moving to a bigger city, (b) commuting to a decent school, (c) homeschooling or (d) putting up with local school they hate the least, is more palatable to me.
In most cases, the solution would be, "don't live in Hicksville, Alabama if you can't stand the schools." But even if you have to, at least you have options (b) and (d). Public schools don't even give you that much.
Remember that secular humanism is also a religion. A truly non-religious curriculum would be limited to objective truths. Theories about origins could not be discussed because while they may be based on evidence, they are ultimately a conclusion that is drawn via a particular worldview. However I think it would be the arts that would suffer more, since any discussion of morality would be hamstrung for lack of context.
No, school vouchers are not a libertarian solution.
A libertarian solution will not use one person's tax dollars to pay for the education of another person's child.
Which is of course the big problem with school vouchers. Much of the initial usage would be to subsidize religious education (since almost all private schools are religious here).
So long as the kids learn their three Rs, why is it anyone's business but theirs and their parents' what else they learn? Or how they get it done?
Seems to me designing laws allowing some to discourage access to theological/scientific/ideological education that others may desire is the unjust approach.
The goal of the establishment clause, of freedom of assembly, speech, and press, is to protect individual ideological freedom from government interference, is it not?
What danger is there to religious or ideological liberty in allowing vouchers to be used at Catholic schools or Muslim schools or schools with Young Democrats cirriculum or schools with an atheist/skeptic focus? That the government would appear to be funding religious or ideological education? It is a danger to appearances only. The government is not paying more for the extra lessons, and the parents have freely chosen the school.
What danger is there to religious or ideological liberty in requiring--through legal or economic means--that children be educated in a school with only politically approved cirriculum? Two dangers: that the unconscious political or religious mores of a powerful majority will find their way into the approved cirriculum and that it fundamentally denies anyone with a minority view the ability to educate their children within their traditions.
It seems to me that the second case is far more destructive to our goal. The idea that we would like to economically prevent most Muslims from educating their children as Muslims ought to be repulsive to a society theoretically committed to religious freedom. Nor is there safety in sticking to a 'neutral' cirriculum; poli sci and civics have to be taught, American History has to be taught, and science has to deal with the evolution/intelligent design thing at some point. Defining neutrality on popularly divisive topics isn't easy -- and supposing the group that agrees with you will retain political control in the long run is foolishly optimistic.
There is the danger--nay, the certainty--that parents given the freedom to educate their children according to their whims will teach them destructive and false ideas. But this is simply an instance of the highest cost of maintaining a free society: tolerating certain evils because the associated liberty is worth it. It is not the job of the government to serve as a dogmatic gatekeeper, rather it is the job of free citizens to persuade one another in the public forums.
It is my opinion that allowing parents to educate their children any how or way they please, without bias for or against any institution except on the basis of its meeting a minimal functional standard, poses no danger to personal liberty and is in fact a great boon.
All you've done is taken a "Republican solution" and injected government control into it. The part of it that remained Market-based (i.e. the part that would work) would be the sole domain of conservatives.
Erm, there's a sort of gradient with free market on one end and government control on the other. "Injecting government control" puts you at a different level on that gradient than you would be in a purely free market.
"Conservatives" don't hold a monopoly on using a market. In most cases, they're not even completely in the "free market" portion of the gradient.
Please stop with the partisan labels. They're really not all that helpful.
Oh yeah, when I'm sick I really want my care to wait on the outcome of a bidding war between hospitals. How about a reverse eBay, where I post my life-threatening condition and hospitals bid on it in a dutch auction until the price gets low enough for my insurance company to click 'buy it now'. And if nobody bids, I just pay the auction listing fee, and die relatively economically. I mean, what could go wrong!
OK, I am not being entirely serious here. but I think market solutions don't work that well when it comes to healthcare because patients can neither be fully informed consumers (without a medical degree) nor can they exercise a free choice about when they plan to fall ill. Consider: having your house burn down is also a bit unpredictable, so you buy insurance for that. And indeed, the costs of a home fire can run into the hundreds of thousands, not incomparable to the cost of health problems. And yet, fire insurance is way, way cheaper than health insurance. Why?
Hint: it's not due to competing fire departments. We used to have those, but we got rid of them for a reason.
EVERYBODY will have health problems and use their health insurance. Very few people will have their house burn down and use their fire insurance. Therefore, there is a massive difference in price.
That is because everybody uses health insurance for things that really shouldn't be insured.
My Dad was recently complaining that his prescription coverage was cut, so he was now paying about $100/mo for his prescriptions. I asked how much the pills would cost with no coverage, and he dug out the bills and determined they would cost about $600/mo. This sounds outrageous I suppose, until you realize that he pays about $1100/mo for insurance. Granted, that is for more than just drugs, but if insurance was really for unaffordable things, it wouldn't cost that much. My dad is still paying for his monthly prescriptions... just in a roundabout way.
Anecdotes aside, the article points this out too. Would you expect your fire insurance to cover the cost of batteries for a smoke detector? Of course not. But if it did, the batteries would most likely cost more, since instead of having to sell to millions of battery buyers in Wal-mart, battery makers would be selling to mere dozens of fire insurance companies, who would pass on the costs to those buying the insurance, and hence have no incentive to control battery costs. Even worse, the administrative costs of having people constantly file battery-replacement claims would dwarf the cost of the battery itself. So people would suddenly be paying $25 more a month to avoid buying $2 worth of batteries.
Sounds absurd I'm sure, but that is exactly how our comprehensive health insurance works today.
If people actually used health insurance for things that are equivalent to a house burning down, it would function more like other insurance, and get cheaper. I'm 26, and my most expensive health expense to date was my birth. The next closest thing was probably when I had my adenoids out when I was 7. After that, when I broke my big toe ($900). None of those are akin to having a house burn down or getting in a car wreck. The first two were predictable and all three could be payable with credit or HSAs. It makes no sense to pay thousands of dollars a month so you can go to the doctor for free when it would only cost $150 anyway.
Yes, but most people's health problems are not as severe as to cost hundreds of thousands of dollars. Your argument assumes everyone will become so ill as to require massively expensive treatment at some point, but they don't.
My point, though, is that multiple competing private health care providers create administrative overhead without delivering the benefits of competition because sick people are a captive market, and thus normal market forces are unable to operate properly. If you look into the history of private fire companies you'll see problems which are echoed in today's health care system.
The analogy to fire departments doesn't work. Your fire insurance doesn't pay the fire department to save your house, it pays you to repair/replace it. That one's free market all the way.
Furthermore, there are many free markets in which consumers cannot be fully informed which work just fine. I know very little about the design of video cards, the maintainence of automobiles, how to remodel a house, what makes a good lawyer, whether my glasses are good for my vision, or myriad other things I pay others for on a regular basis. Nonetheless, I am able to navigate these markets just fine and make tradeoffs according to my personal values. The combined effect of consumer reports, public opinion, and paid personal advocates seems to get me there okay.
I submit that in a free market, most would have no more difficulty shopping for a docter than they do for a mechanic.
And while patients cannot choose when or how to fall ill, they can choose what to treat, what to treat well, what to invest in preventing, and what to simply tough out. The dire necessity of my owning a car does not prevent competition between car dealerships.
People need to be paying far less for preventative care out of pocket. When they have to pay for preventative care, a lot of them (especially low income) just skip it. And then small problems turn into big, expensive problems.
We want diabetics to come in for periodic foot exams so they don't have to get their feet amputated later.
> People need to be paying far less for preventative care out of pocket. When they have to pay for preventative care, a lot of them (especially low income) just skip it.
We've posted the links repeatedly - preventative care improves quality of life but doesn't reduce cost.
And, pre-natal care is FREE in the US, yet many poor folks don't bother.
In other words, both assumptions for your argument are false.
"preventative care improves quality of life but doesn't reduce cost"
That strikes me as a very questionable assertion. Health problems always get worse with time, becoming more complex and expensive to fix the longer you leave them. How could prevention possibly not reduce costs?
> That strikes me as a very questionable assertion. Health problems always get worse with time, becoming more complex and expensive to fix the longer you leave them. How could prevention possibly not reduce costs?
(1) Folks who live longer consume more medical resources, not less. (Dying is always expensive but living also has costs, so shorter lived people cost less.)
(2) Preventative care doesn't always work. In fact, it usually doesn't. If it's cheap enough, that can be okay, but if it isn't....
(3) Saving someone from one or even a couple of causes of death is rarely enough. (That's why it often makes sense to ignore prostate cancer. Yes, it may get worse if left untreated, but old men die of lots of things.)
The numbers always matter. Health care is hellishly complicated.
Ah, you're talking about lifetime costs. I was thinking in terms of per-incident.
You also seem to be thinking in terms of end-stage "keep them alive vs. let them die" issues. I was thinking more along the lines of toothaches, infected cuts, etc. Yes, it does get more complex - both medically and morally - as the patient gets older.
I'll agree with you on the "hellishly complicated" part though. The politics of elderly care are a moral minefield.
> Ah, you're talking about lifetime costs. I was thinking in terms of per-incident.
Lifetime is the only rational way to think about it on "govt scale".
Per-incident is really hard to sample correctly. Yes, if you can get someone to not be diabetic, you've saved money, but we're already trying a lot of preventative care so if you look at the incidents as opportunities, you're wrong.
Yes, we're already doing a lot of preventative care, and we're not seeing the results that its advocates claim. (Simple example - Every doctor already says "lose weight".) Most chronic diabetes folks are fairly resistent to preventative care, at least the inexpensive sort, and the expensive stuff isn't close to cost effective AND they backslide.
Here's a question - smoking has gone down by 50% over the past 20 years. Are we spending less on lung cancer?
> The politics of elderly care are a moral minefield.
Yup. 70% of US medical spending is on old people. If you're going to cut spending by 30%, a huge fraction of that has to come from old people.
Probably because it keeps people alive longer, so that they need more care. Smokers, allegedly, are much cheaper to care for in the long term than non-smokers, because they die early.
Because preventive medical intervention and testing doesn't work. Lifestyle changes work, but getting a bunch of fat cola guzzlers into doctors' offices more often has no impact on the care they will later require.
The article addresses this by saying there could be vouchers or some way for the government to encourage people to go to them. And don't forget that in his system, the low income people would be subsidized anyway, so they might be in a better position to get preventative care than they are now.
There are no set topics on hacker news for a reason. As I understood it, the main criteria was for submissions to be intelligent and informative. This article is one of the most rational discussions of the US health care system I have seen, and it's worth reading if you want to find out how it works.
I think the key is that every story on the home page helps you to better understand how something works or why something happened. You know, the hacker part of "hackernews".
We should probably save the flags for stories that are being manipulated by spammers or small groups. Anything else will rotate off the home page in a few hours anyway.
The thing I worry about is that these stories attract people interested in discussing politics, who in turn post more stories, which may not be quite as good, which in turn attract more people, and so on and so forth.
Politics/economics are low hanging fruit that anyone can dig up a story on and comment on. Erlang vs Scala in terms of creating distributed systems... not so much. The first will always crowd out the second, given enough time.
I share your concerns but what if you want to discuss politics with the inhabitants of Hacker News? The community here is the best on the web by far. I want to discuss any number of things and hear the views of the smart, technical people who hang out here. I often enjoy the non-code articles more than the "on topic" ones.
It's a tough, but interesting, question. Limiting the topics allowed reduces the functional value of the group. But loosening it too much will reduce the quality of the group itself. I don't know the solution (yet).
Perhaps, but that would be unfortunate. When I get together with my friends, we can discuss whatever we want without needing to worry that the very choice of topic might lead to the group being diluted and eventually poisoned.
Personally I am not convinced what happened to Reddit and Slashdot etc would happen here anyway. It is quite possible that Reddit has accomodated all the people who wanted a current-style Reddit and they are all happy where they are. There is a finite number of people, after all, despite how it sometimes seems.
The people arguing against political topics here, based upon the experience at Reddit, do so referring to a single data point in a highly complex environment. I am far from convinced the argument is valid at all. Sure, discourage puns in comments and [PIC] links, couldn't agree more. But I am not sure forbidding whole topics as a rule is a good idea. Plenty of smart hackers are also interested in politics, and they might not be interested in participating in multiple discussion sites. If HN limits itself too much, they might get bored and leave.
Anyway, just my speculation on an interesting topic, not trying to mount a formal argument or anything.
The article has little to do with politics and the subject which is the economics of health care is well thought out and presented.
Although it refers to the US health care system, the narrative applies to health care delivery in general and is applicable to other countries.
You are right that it is non-technical, but it is of a higher quality and more intellectually satisfying than countless other submissions here. Presumably you also have flagged Signaling and Indian Higher Education though I'm not sure whether your nationality would make that more appealing to you.
"Presumably you also have flagged Signaling and Indian Higher Education though I'm not sure whether your nationality would make that more appealing to you."
One wrong doesn't justify another. But sure, flagged that too. I don't vote up or down based on "nationality". An inappropriate (for HN) article (subjective judgment to be sure) is surprisingly nationality independent.
If you had any idea about the complex mix of nationalities that are my daily life you'd realize that I couldn't give a damn about the country being discussed. I'm not interested in discussions of that country's internal politics. The article about Indian education was flagged for a different reason, it seemed irrelevant to HN how the Indian general education system worked. Really interesting topic for an article in The Economist, but I came here for code and related subjects.
My mistake. I assumed that your revelation that you are British was intended to suggest that you did care about the country being discussed and that you would find it more interesting if it was, perhaps, Great Britain.
"The 'flag' and wait for a moderator doesn't seem to be working as well as it used to."
How can we judge how well the system is working when we have no direct insight into it? Perhaps a moderator reviewed the post and found it to be of merit?
Instead, this is an article about business, efficiency, the impact of IT and modern business process on health care, and the impact our current system has on consumers and businesses.