America’s Health-Care Crisis Is a Gold Mine for Crowdfunding

https://www.bloomberg.com/news/articles/2017-06-12/america-s-health-care-crisis-is-a-gold-mine-for-crowdfunding

57 73 9 years ago

subverter• 9 years ago

Woah, woah – you're telling me people voluntarily help each other pay their medical expenses without the government forcing them to?!

michaelchisari9• 9 years ago

Crowdsourcing medical expenses is a point of national and economic embarrassment, not pride.

maxxxxx2• 9 years ago

I always find it sad that people have to raise money for for surgeries or serious health issues. It's great that people donate but this should simply not be necessary in an advanced society.

ahallock• 9 years ago

This is not an argument.

sp3322• 9 years ago

You're telling me that a representative government would help people afford healthcare, even if it cost money? But the AHCA currently has a 17% approval rating and will get passed anyway? http://www.businessinsider.com/quinnipiac-poll-shows-17-perc...

pcwalton• 9 years ago

Nobody is arguing that charity care doesn't exist. The question is whether charity care substitutes for a functioning health system.

yequalsx• 9 years ago

You might be interested in reading about the free rider problem. This is a well known phenomenon in economics. Also consider that there are no instances of charities providing for the basic needs of a nation's poor. It was with government programs that things like universal education and healthcare became a reality.

ohazi• 9 years ago

Don't be silly. Sardonic libertarians don't believe in the free rider problem!

davidw• 9 years ago

Well, some of them - the popular ones, or ones with friends with money - get help. It's kind of like high school, but some of the losers die!

adamnemecek• 9 years ago

What about those that don't have many friends?

michaelchisari9• 9 years ago

Or what about our own proven biases?

Pretty versus ugly, young versus old, white versus black, man versus woman, overweight vs average weight, high school dropout versus university graduate, religious versus non-believer, etc., etc., the ability to look past all of these things and donate purely based on need is not something crowds have ever been good at doing.

aphexbr• 9 years ago

Some people voluntarily help some other people with some costs. There's a lot of people who don't get the care they need for whatever reason, even in a system where there's a lot of volunteers.

To get the best deal for everybody, governments in most countries step in to create a system where everybody pays in and the best deal for everybody is made (with the option for extra private care if you can afford it). You get a basic guaranteed level of healthcare in return for your taxes, as part of your participation in society. Corporations are prevented from deciding they need to charge you more than your annual income for the medication keeping you alive, while you're free to change jobs and start businesses when you wish, because you're not trapped in an insurance plan that you'll lost the moment you do something else.

Only in America is this seen as wrong. Everywhere else gets cheaper bills with zero chance of personal bankruptcy just because you got the wrong disease/got ill before/etc.

ryguytilidie• 9 years ago

As someone said below, we should be embarassed we live in a society where someone needs to raise funds or go broke for medical treatment.

I'm starting my own business and the cost of health insurance is absolutely insane. If we come to the conclusion that we want our fellow countrymen to die or go broke versus live healthy, I think we should just shut it all down and call it a day.

hippich8• 9 years ago

Cost of insurance is just a reflection of cost of medical care. Nothing current government does affect cost of medical care. If anything, they suppress flow of cheap money to medical providers which only inflates its costs even more.

bdamm• 9 years ago

Not true; the government has an enormous impact on the cost of health care. The American health care system is enormously inefficient, costing almost twice as much for less effective care than most other developed nations. How can this be other than because of the government?

One source: https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_s...

sp3322• 9 years ago

Cost of insurance is so unrelated to the cost of healthcare, that when my grandfather recently went in for a procedure, no one at the hospital could tell him how much it would cost. They just take the amount that was negotiated with his particular insurance company. Different people get charged different amounts, and there is no way to get a "quote" ahead of time!

jrowley• 9 years ago

Ignoring state specific insurance programs like medi-cal, medicare funded care for over 50 million Americans in 2015. To say the government doesn't affect cost of is care is a bold claim.

criley2• 9 years ago

"Nothing current government does affect cost of medical care"

This is a shockingly ignorant statement, the kind of cheap criticism that comes from someone very far away.

Did you know that CMS (Centers for Medicare and Medicaid Services) is the largest American healthcare payer?

In 2015, private insurance total healthcare expenditure was $1,072.1 billion ($1.072T).

But Medicare and Medicaid spent $1,191.3 billion ($1.191T).

The federal government's ability to act a single healthcare purchaser larger than the entire private market has a dramatically large effect on the cost of medical care -- it suppresses as the rock-bottom CMS rates are significantly below private reimbursement.

Of course, this only examines the impact of the federal government directly on the market as its largest participant -- it does not BEGIN to examine the massive statutory/regulatory influence the government has on the price of health care.

If anything, they suppress flow of cheap money to medical providers which only inflates its costs even more.

It's the exact opposite.

CMS/federal healthcare spending is the ultra-low cost one, flowing an enormous sum of cheap-per-person money to any service provider that will take them.

It's the massively-inflated private reimbursements which service providers love.

The largest shares of total health spending were sponsored by the federal government (28.7 percent) and the households (27.7 percent). The private business share of health spending accounted for 19.9 percent of total health care spending, state and local governments accounted for 17.1 percent, and other private revenues accounted for 6.7 percent.

https://www.cms.gov/research-statistics-data-and-systems/sta...

The more you know.

thephyber3• 9 years ago

Nothing current government does affect cost of medical care.

Off the top of my head:

* 68% of all medical costs in the US are borne by governments (MediCare, Medicaid, VA, public-sector employee programs). They aren't allowed to negotiate drug prices in effective ways, driving up their costs

* Most health insurance in the US is employer-sponsored specifically because of Congress-created tax law. Without it, the individual market would probably be much healthier and more competitive.

* Congress is responsible for legislation that forces all emergency rooms in the US to provide life-saving care to any person, regardless of their ability to pay. @see EMTALA [1]

* "COBRA" [2] (pricy emergency health insurance coverage option after you leave an employer) was created by Congress.

* Governments set laws which define how and when litigation can be applied to medical workers + hospitals. Legislators could decide to enact tort reform, should they choose to.

* Governments control the medical licensing requirements and how graduates of medical institutions from other countries can work in US health care (they currently can't, for the most part).

* FDA and other government regulators control how fast new drugs come to market (and can effectively price some potential drug makers out of the market).

* Congress controls patent regulation

[1] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...

[2] https://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Re...

mdorazio• 9 years ago

Exactly this. A big reason preventing me from quitting my day job and working on my side business full-time is cost of healthcare. When you have to pay the insurance premiums yourself and still end up with multi-thousand dollar deductibles, the prospect of losing employer-subsidized care is really hard to swallow. If Americans really want to support growth of small businesses, we need to seriously consider single payer.

xenihn• 9 years ago

A big reason preventing me from quitting my day job and working on my side business full-time is cost of healthcare.

Working as intended.

virmundi• 9 years ago

I did just that. You can quality for up to 700 in the ACA markets as long as you "make" 35k. If you make less than that, it shouldn't matter. Just pay your rates.

fpgaminer• 9 years ago

As far as I know * , you can write off your personal health insurance premiums as expenses on your taxes when you're filing as a sole proprietor or an SMLLC (and I assume something similar under S and C corps). So ... at least that's a ~30% discount.

* Based on a little research I did; I'll find out for sure next April :P

P.S. Another nice thing about going solo is your 401k. You can set up a Solo 401k, which has a MUCH higher contribution limit. 401k through employer is limited to ~14k, while a solo 401k is up to something like 50k. Plus, you get to pick your 401k provider, and as far as I could tell Solo 401k through Vanguard was _significantly_ better than the criminal fees I was subjected to under my previous company's 401k.

This is all assuming your side business is successful enough to fill that extra 50k bucket :P

grondilu• 9 years ago

I'm starting my own business and the cost of health insurance is absolutely insane.

Why do you think that is? Why is medicine so expensive? Don't we live in a highly-technological society? Shouldn't the price of medical treatment follow the downward path taken by other technical domains, like computer devices?

bitJericho• 9 years ago

Because computers have made it easier for the rich to steal.

maxxxxx2• 9 years ago

In medical it's the other way.

michaelchisari9• 9 years ago

Because medicine (and medical care) is considered truly inelastic. When you need it, you need it. There's no comparison shopping or waiting until you can afford it.

The free market rules that work for consumer goods start to really break down for inelastic goods.

hkmurakami8• 9 years ago

You're paying for others using very cutting edge and expensive drugs, procedures, equipment, EOL treatments, etc.

You're also paying for dramatically increased litigation risk faced by care providers, which is being passed onto you.

You're also paying for intermediaries at each step in the care chain who believe they are entitled to healthy margins.

If we want to make healthcare cheaper, we need to start by deciding who we want to take away from, whether it be EOL life extension (which tends to be way overdone), pharma profits, or taxpayer funds from whatever bracket you feel is right to take from.

davidf182• 9 years ago

Most of the healthcare costs come from lifestyle choices of smoking, overeating and lack of exercise, alcohol and drug abuse, guns. Other costs are from air pollution (asthma) and depression.

Interestingly, people complain when CDC tries to implement public health programs that help to reduce unhealthy lifestyle choices (some call it nanny-state). But you can't complain about high healthcare costs and then not support the public health efforts meant to prevent it.

Specifically, to lower health care costs from tobacco use, tax tobacco (which has over half the effect to get people to quit), ban smoking in public places, spend $1 or $2 per capita for hard-hitting, scary anti-smoking ads. Yet, the Federal Govt. has a roughly $1 tobacco tax. Many states have very low tobacco taxes.

Why is medicine so expensive?

Medicine for most people with chronic hypertension and most people with high cholesterol is generic in the $100 per year cost range.

thephyber3• 9 years ago

Why is medicine so expensive?

  - There is an artificial limit on the number of medical student openings at US accredited medical schools ("rent-seeking")
  - US medical licensing organizations don't recognize almost any overseas schools
  - The cost of US education has skyrocketed in the past few decades, along with health care costs (probably somewhat correlated due to the university degree needed to practice medicine)
  - The Constitution gives Congress the authority to create Intellectual Property laws and regulate patents, which then become the focus of lobbying (@see Disney lobbying to extend copyright TTLs)
  - The US is wealthy and US consumers end up subsidizing medical R&D costs because most other wealthy countries have centralized pharma purchasing contracts
  - 68% of all health care spending in the US is done by governments (think MediCare, MedicAid, VA, government employee contracts), but those governments are largely prevented from using their size to negotiate better drug prices
  - Something like 50% of medical costs are currently spent in the last year of life. @see "How Doctors Die", a famous article where a Doctor describes how doctors and civilians handle their wishes / medical proxy decisions very differently
  - We, as a society, don't want to to die. We have unrealistic expectations of what doctors can do and our quality of life.
  - Medical consumers (err, humans) very much undervalue preventative care investing in {healthy food, exercise, mental stimulation, mental health}. We Americans are generally too arrogant when it comes to our bodies and stigmatize people with physical/mental abnormalities, thus we reject reality when we are confronted with the possibility of becoming "abnormal".
  - We very much overvalue doctors, hospital rooms, and drugs / pills that do the equivalent of "magic"
  - There is no shortage of medical need. Medicare only pays ~60% of the market price for many procedures, so many doctors simply won't see MediCare patients as they can make more by charging the wealthy
  - Recent consolidation in hospitals and health insurance leads to even less competition
  - Hospital pricing is opaque. The cost to get most procedures can't be compared apples-to-apples with other hospitals.
  - Health care in the US is charged by the cost to attempt a procedure, not to fix an ailment
  - The principal–agent problem occurs when {health insurers, hospital admins, doctors, and patients} are at odds when it comes to unnecessary procedures. I just heard a podcast where a man tried to interview doctors to see if he wanted to change and a doctor tried to give him a CAT scan to be able to charge for his interview time
  - Employer-sponsored health insurance is tax-deductable for the company in the US, so there is a huge bias away from individual plans which reduce wasteful premium spending
  - FDA doesn't rubberstamp approvals and actually requires new drugs to perform better than the placebo effect
  - The public stock market is currently biased towards short-term profits
  - The cost of sterilized equipment made to exacting standards is far higher than in countries where exacting standards aren't required
  - Entrenched interests always throw a wrench in any proposed legislation that might aim to change the status quo
  - Opportunity costs: many entrepreneurs are turned off by the heavily-regulated nature of health systems (EHR, apps, software updates, etc) and many other industries (apps, games, social media, finance) can be much more profitable
  - Regulation drives up price and it tends to "mission-creep" over time in the US.
  - Lots of people complain that medical litigation is out of hand and tort-reform could lower costs, but the impact of tort reform varied by whom you talk to

johnwatson112182• 9 years ago

I am about half way through this book

https://www.amazon.com/dp/B00957T4QK/ref=cm_sw_r_cp_awdb_CEV...

And I think it makes many good points about our health care system. Thinking about why I don't use geico insurance for routine maintenance on my car was a very interesting thought experiment.

TuringNYC• 9 years ago

I see what you are getting at (i.e., health insurance should be for catastrophic events rather than routine visits.)

The problem is that in the US, routine visit costs are wildly inflated. Try going in to get a vaccine or a cold and you get wildly dispersed and large quotes. This is because the insurance system is two things in one: a real insurance plan + a negotiated ratecard. When you go for routine/preventative care with insurance, you get fairly reasonable values on the rate card -- without it, they can (and usually do) charge you anything, and often you don't even know the cost until afterwards.

Until there are realistic rates for simple/routine/preventative needs, I don't see how insurance can be restricted to catastrophic cases only.

michaelchisari9• 9 years ago

health insurance should be for catastrophic events rather than routine visits

But routine visits often severely reduce the rate of catastrophic events. Catching cancers early, assessing risk factors, etc.

FLGMwt• 9 years ago

I just finished "An American Sickness" (https://www.amazon.com/dp/1594206759) that does a good job of targeting all the specific points of inefficiency, with a little bit of explanatory history and exemplary anecdote sprinkled in.

skywhopper3• 9 years ago

Overheard on Twitter: What if... we had this one giant GoFundMe for all medical bills that everyone paid into?

hippich8• 9 years ago

it would be treated exactly like people want universal healthcare - everyone just accepted they deserve one, without being grateful for it. Unlike such funds GoFundMe recipients know exactly who gave them life. This is very powerful distinction.

skywhopper3• 9 years ago

What about the people who don't have a network of friends and acquaintances with enough extra money to help pay their bills? What about chronic problems that require thousands or more dollars each year to address and never end? Should those people just keep begging? Eventually that will destroy their relationships if they kept trying it year after year.

But I'm confused why you think gratefulness and knowing how "gave them life" is key. If my work-provided insurance plan pays for medicine I need to survive, who should I be supplicating myself to to satisfy your moral demands for appropriate gratefulness? Do I have less value as a human being in your eyes because I accepted payment from a faceless remote corporation instead of by begging my social network to give me the money?

hkmurakami8• 9 years ago

I'd go do every medical test and examination I'd be entitled to since I no longer have a cost associated with it.

I.e. What CA Single payer is proposing.

michaelchisari9• 9 years ago

every medical test and examination

You would be a statistical outlier. People don't go to the hospital for fun.

xxSparkleSxx2• 9 years ago

How often do your docs suggest tests that you think are not worthwhile? I'm young, but have never had a physician want to run tests on me where I thought they were a bad idea. If anything they normally say "that's not a big deal, we don't need to do anything for that."

The only exceptions have been dentists and dermatologists - where I'm largely paying out of pocket anyway.

clamprecht• 9 years ago

What about medical tourism? Seems like a possible solution for non-emergency care. Paul Buchheit tweeted a few years ago that he wanted to fund the "Uber of medical tourism". The tweet seems to be gone (not sure why?), but here's my previous comment about it:

https://news.ycombinator.com/item?id=10731415

hkmurakami8• 9 years ago

It's considered politically insensitive these days.

sumeno• 9 years ago

Seems like a really bad solution for people who are poor

michaelchisari9• 9 years ago

Or those who need emergency care.

cpr• 9 years ago

Health sharing co-ops have been at this for some time, based on Christian principles.

Samaritan Ministries, e.g., is $500/month for family and generally pays 100% of medical expenses, though no guarantees.

Our monthly check goes directly to someone else in the group. Minimal overhead for admin.

Also grandfathered in the ACA.

awalton• 9 years ago

Go with me here, what if instead of paying into a crowdfunding campaign, these people paid into a central pool of money, and then when they had exceptional health care costs, they could dip into this pool and pay off their bill?

Imagine what kind of revolution that'd make.

jklein11• 9 years ago

I understand you are being sarcastic, but this is how both single payer systems and private insurance market places work. The only difference is, in one system people are elected to determine how the central pool of money is collected and distributed and in the other decisions are driven by shareholders.

davidf182• 9 years ago

Cities are states are free to work the the Federal Government to set up healthcare for their citizens.

For example, where I live in NYC (at least prior to Obamacare) 450,000 New Yorkers without health insurance could go to one of many Community Health Centers funded by Feds, State and other sources as well as go to one of 11 public hospitals.

Interestingly, ObamaCare cut the DSH funding to these and similar public hospitals throughout the country. [1]

Part of the funding in NY State / NY City comes from $4.35 state and an additional $1.50 city tax per pack on cigarettes. The tax revenues are then put into Medicaid funding which in the case of NY State is matched 1:1 by the Federal Govt.

Trumpcare should restore the DSH funding that ObamaCare unwisely cut and increase the funding for Community Health Centers. States should increase tobacco taxes and use those funds to help pay for healthcare for their residents.

[1] https://en.wikipedia.org/wiki/Disproportionate_share_hospita...

cmurf• 9 years ago

This is both market failure and government failure. And the reason why we're arguing is the politics demands fighting for government or for the free market.

Health care industry in the U.S. includes hospitals, doctors, R&D, pharmaceuticals, insurance. All of those things are for-profit, but are also anti-competitive because they don't voluntarily, or by law, publish prices; they have conglomerated (mergers) more than banks; we confuse insurance with payment plans, a fair chunk of insurance cost is a payment plan for predictable procedures colds, annual checkups, pregnancy, aging. Aging is probably the biggest part of the payment plan because almost everyone is going to have problems related to it eventually.

My main criticism with ACA and proposed AHCA is that it effectively subsidizes a busted system. The U.S. spends 3x per capita for healthcare that does not cover everyone, compared to OECD countries who do cover everyone. U.S. pays more money to cover fewer people. It's an inherently classist system.

To really solve this we have to be willing to merge private insurance, Medicare, Medicaid, FEHB, military and veterans medicine, into one system. All of the conglomeration says is this is a natural monopoly but we keep trying to force something that's inherently anti-competitive to be competitive. It'd still be unfair but metric tons better than what we have, to just hand over the whole mess to a team made up of epistomologists and economists and then adopt their recommendation.

naaaaak• 9 years ago

America's Health-Care Crisis???

You mean Obamacare didn't end skyrocketing costs and fix what it purported to? You mean the sole accomplishment of a corrupt President didn't accomplish anything? Say it isn't so!

Now explain why Marxist idiots "need" to "save" it.

sctb• 9 years ago

You're not welcome to start flamewars like this, and you've been using this account primarily to post ideological comments, which counts as an abuse of the site. Please post civilly and substantively or not at all.

https://news.ycombinator.com/newsguidelines.html

America’s Health-Care Crisis Is a Gold Mine for Crowdfunding

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