I don’t understand American healthcare – doesn’t mean I shouldn’t provide it

http://pandodaily.com/2013/05/04/screw-you-papa-john-i-dont-understand-american-healthcare-but-thats-no-excuse/

by pavel_lishin • 13 years ago

77 137 13 years ago

jaibot• 13 years ago

One important takeaway from this piece is that putting employers in charge of providing health insurance is a terrible idea. Paul Carr shouldn't need to _make an effort_ to make sure his employees have basic health protections - that should be a solved problem.

walshemj• 13 years ago

yes unfortunately back in the 50's the big auto companies did a deal to include healthcare as part of wage negotiations. Which derailed the USA's progression to a German style model of healthcare.

If you talk to Alan Mulally and any on the AFL-CIO off the record they would agree - that in hind sight it was a bad deal both for the workers and the employers.

claudius• 13 years ago

> German style model of healthcare.

Which has the curious drawback that those most able to contribute to it (i.e. those earning more than X €/month) are allowed to opt-out of it. I never quite understood why this would have to be the case, and the various attempts to introduce an actual public health insurance system failed so far.

jgrahamc• 13 years ago

Maybe it’s because I’m a Brit, and we have the national health service. Every man, woman and child in the UK is entitled to free healthcare from cradle to grave. [...] America is a bigger country so free healthcare is off the table. I get that.

I don't understand this argument at all. The NHS in the UK doesn't appear magically free from the sky because we've only got 60 million people. We pay for it through general taxation. This year it will cost about £110B.

Is it really the case that there's an argument that this can't work in the US because there are more people?

TruthElixirX3• 13 years ago

http://en.wikipedia.org/wiki/Economic_calculation_problem

The federal government can't control healthcare because of this. It would probably work better on a state level (See: http://en.wikipedia.org/wiki/Massachusetts_health_care_refor...).

On top of that I don't think the U.S. economy can handle another massive government program on top of existing ones. I am mostly referring to the wars over seas. No other country spends so much on military. The U.S. spends a ton of money on military (and locking people up for drugs).

If the U.S. stopped those two things I think healthcare will be fine, but it won't. So more shit is just being added to an already inefficient and corrupt government.

Then there is the problem of people deciding that since they pay for your healthcare, they should be telling you how to live. There will be more bands on sugary drinks like in New York (though that was struck down). Or what extreme sports you can play, etc. That really bothers me because it will mean more shit that people aren't allowed to do that only harms themselves.

m0th874• 13 years ago

We can discuss Austrian economics until the cows come home, but in the mean time, the US spends nearly twice as much as the UK on healthcare (as a percent of GDP) [1] and 45,000 Americans die every year due to lack of coverage [2]. I'm glad reform is happening. I wish it were more aggressive.

1: http://www.pbs.org/newshour/rundown/2012/10/health-costs-how...

2: http://news.harvard.edu/gazette/story/2009/09/new-study-find...

ryguytilidie2• 13 years ago

I'd actually be quite interested to see polling data on this. I wonder if, given the choice, most Americans would choose to continue funding wars/national security or fund healthcare for all. I would actually imagine wars would win in a landslide unfortunately.

Vivtek• 13 years ago

No. Of course not. We have one person here per capita, just like the UK. If anything we'd get more economies of scale. But it would be socialism, and therefore inherently antithetical to the desires of every right-thinking American.

protomyth7• 13 years ago

Since we cannot even fund IHS for a full year at a time with significantly less people than the entire US population, I think you might want to look at what the actual funding versus cost would be.

http://richheape.com/american-indian-healthcare.htm

laumars4• 13 years ago

I really don't get this attitude some Americans have that any kind of public service designed to make the lives of your less fortunate peers just that little bit easier is some how a bad thing. It's as if 70 years of brainwashing that all "commies" are evil has irreparably warped their brains and now any piece of legislation that doesn't propose proverbially kicking struggling families in the "nuts" is seen as socialism and, by extension, wrong.

Capitalism is all well and good so long as peoples lives are not put in danger; and I'm not talking about luxuries here, I'm talking about whether people live or die. But what we have happening instead is a closed market dominated by a small number of monopolistic drug companies who abuse patent systems and extort their customers just because they can. Surely at some point, even the right-wings have to appreciate that neither closed markets nor putting peoples lives put in danger because of the greed of the few is neither in the spirit of capitalism nor the Christian thing to do (and I only reference the last part because of the emphasis that many right-wings place on religion).

glenra4• 13 years ago

> If anything we'd get more economies of scale.

No, because there are also diseconomies of scale. Some services are best provided by smaller-scale organizations than an entire nation, much less one the size of the US. It is perfectly plausible that a service that worked well for the UK might not work at the scale of the US. Making an organization bigger means adding more layers of bureaucracy, which puts the ultimate decision makers farther away from the problems they are trying to solve. It also creates more room for resources to be absorbed by political infighting within the organization.

dasil0032• 13 years ago

There's no real argument, but he had to say that in order to not be sidelined as an extremist.

I know it sounds insane, but the average American's idea of nationalized healthcare is something akin to waiting in Soviet Union breadlines just to get an aspirin. There's a whole cadre of talking heads employed full-time to make the rounds on Fox News et al promoting this sort of willfully ignorant line of thought.

dantheman6• 13 years ago

There are lots of reasons to be against nationalized healthcare. Some for practical reasons, others for legal reasons -- just because you want something doesn't mean it can skip the legal process which is what obamacare tries to do in a lot of places.

One simple reason to be against it is that the current implementation is crazy bad and has no way of dealing with costs and is anti-democratic. It creates outside bodies that don't answer to congress, etc.

ams6110• 13 years ago

Ever been to an ER full of Medicaid patients? Soviet breadline is not far off.

bconway• 13 years ago

Not at all. We've seen it first-hand and up-close with our neighbors to the north. Taxes through the roof, and the only way to get good care is to "go private."

eterm• 13 years ago

Health costs per capita are actually lower in the uk than the us, even after paying for all the treatment.

The problem is that pur current government are privatising the actual provision of care away from the NHS. Large chunks are already privatised and much more will follow.

We're heading to a situation where the NHS will be more like an insurer picking up the tab.

glenra4• 13 years ago

> Is it really the case that there's an argument that this can't work in the US because there are more people?

The simplest such argument would be that there are diseconomies of scale - it's conceivable that the bigger you make a bureaucracy the less responsive/effective/efficient it gets. That certainly could be true - whether it actually is is an empirical question.

Another possibility is that our federal system is ill-suited to the task. There's nothing really preventing individual US states from providing such services. And if most states haven't done so thus far - and in the few that have tried, it hasn't worked out very well - there might be reasons for that which we should try to understand.

nijk9• 13 years ago

Interstate immigration guarantees is a factor against single-statd healthcare.

yoster• 13 years ago

The problem with the states on health insurance is that unless you are part of the 1%, you need it. Healthcare industries are huge corporations that are in it for the almighty dollar. If you go to the emergency room and do not have health insurance, you can bet you will have a bill that will run a couple grand minimum. I wish we were like other countries where we can have a national healthcare system. This is one of the most basic human needs that should be available to everyone. I am very thankful that my company offers an excellent healthcare plan, and I think everyone should have access to a healthcare plan.

m0th874• 13 years ago

I don't understand why he's playing himself up so much for providing healthcare to employees. Of the 3 startups I've worked at, 2 provided healthcare and 1 provided a healthy allowance toward private coverage. All of them I suspect were smaller than NSFWCORP.

I thought this was the default, even for startups. If it's not, it should be.

kenjackson2• 13 years ago

I don't think he's playing himself up so much as he is presenting a struggle of whether or not to provide it and the realization that he must (not from a legal, but from a moral perspective).

And while it may be common in the tech industry (where VC money can make it easier -- and frankly its hard to recruit w/o it), it's less common outside of the tech industry.

I still think it is odd to tie health insurance to employment, but given that this is the case today, I do think that I'd do the same as a small business owner. If I couldn't afford it (at least by the medium-term), I think I'd have to question the feasibility of my business.

kmfrk• 13 years ago

Just as soon as yesterday, I read about a guy on Something Awful who had a stroke and no employer-provided healthcare.

Maybe if you only assume the audience to be a very narrow demographic, you could be right statistically, but this is an issue that extends far beyond just the Valley, Alley, etc.

mgkimsal10• 13 years ago

Employer-provided health insurance is one of the worst things to emerge from the US in the past... what? 70 years? It gives far too much power in the marketplace to employers and very little to the actual users of the insurance - the insured.

Why don't employers provide auto insurance too? They'd get a much better deal via group rates, and we'd be 'better off' because we'd all 'pay less' for auto insurance, right?

The idea of 'benefits' in general being 'expected' from employers is, in itself, a bit crazy - just pay people well, and let them make their own decisions. I'd have thought 'free market' supporters would be all over that concept. Company 401K plans? Generally limit you to high-fee and substandard mutual fund options. Company health insurance plans? One or two options, not something which always fit people very well.

Employer funds in to an employee-controlled HSA was/is a decent middle ground, but HSAs in general seem like they're going to be going away or more limited in availability in the next few years under the Affordable Care Act, which is a real shame.

jmspring• 13 years ago

While I agree that benefits tied to employment, rather than the individual, is a very big problem, it is also the only economical path currently for medical insurance. Scale and contracts that a company can negotiate aren't there for individuals. Every year for the last decade, you hear about insurance companies raising individual and small business rates.

For profit companies managing what ostensibly a shared risk pool is another bone of contention for me. I can't find the actual reference at the moment (typing on iPhone) but legislation has been put in place requiring minimum percentages of premiums that must be spent on coverage rather than "overhead".

Also, a minor nit, not all companies offer up bad 401k plans. As an early employee at a couple of startups, I've helped hr pick the better options given rather than the first one peddled.

mgkimsal10• 13 years ago

This is a social and financial engineering problem - change the tax structure to encourage people to get private insurance. Make the cost of private insurance 150% deductible for one year, then 140% deductible the second year, etc. for 5 years to encourage more people to do it. As more people have private insurance vs employer provided, the market economics would shift.

Sure, not all companies offer bad 401k plans. Enough do that it's not something that we should continue to encourage though - pay people more and let them make their own decisions. That money for 'benefits' isn't freely coming from nowhere - it's the cost of employing you, and it could just as easily go in to your pocket vs the pockets of plan administrators that you didn't get to choose.

pessimizer3• 13 years ago

>benefits tied to employment [...] is also the only economical path currently for medical insurance.

It's the least economical path ever come up with for the financing of health care. No one has ever come up with a more expensive way. All other ways that have ever been implemented have been cheaper.

kenjackson2• 13 years ago

Why don't employers provide auto insurance too? They'd get a much better deal via group rates, and we'd be 'better off' because we'd all 'pay less' for auto insurance, right?

Would we pay lower rates? Auto insurance is mandatory if you want to drive. Everyone has it (well a very high percentage of drivers). There's a relatively competitive market for auto insurance. I'm not sure moving it to employers would change things all that much.

I do think that employer provided health insurance is odd, but I don't think the alternative is "free market". We have to incentivize healthy people to get insurance too, just as we have good drivers that get auto insurance. It seems like we need to make health insurance mandatory or move to universal health care. Neither are very likely in my lifetime.

Also most employers give employees the option to opt out of health insurance, and you get some amount of the money back as additional pay. Virtually no one takes this option.

mgkimsal10• 13 years ago

I've not had that option - it was either "take the insurance or don't".

TruthElixirX3• 13 years ago

>Auto insurance is mandatory if you want to drive.

No, it isn't. Unlike almost every other state, New Hampshire does not automatically require motorists to carry an auto liability insurance policy or provide some of financial backing in order to drive a vehicle within its boundaries.

http://www.dmv.org/nh-new-hampshire/car-insurance.php

Further more, you can avoid auto insurance by not driving in most places. You cannot leave your body at home.

UnoriginalGuy• 13 years ago

> Auto insurance is mandatory if you want to drive. Everyone has it (well a very high percentage of drivers).

As is health insurance in the US. Or at least it will be soon.

a3n• 13 years ago

https://en.wikipedia.org/wiki/Employer-sponsored_health_insu...

We get our health care through insurance companies in the US because wages and prices were government controlled during and just after WWII. The labor market was very tight during the war, and during the expansion after. The govt declared that health insurance wasn't wages, so employers were able to compete for workers with health insurance.

As a result, today, the only practical way to get health insurance in the US for most people is through an employer's health insurance company. Which makes for a more inefficient labor market, since it's harder for people to change jobs and be sure of needed coverage. Sucks to be us.

As for whether an employer should offer health insurance: it's like tipping in restaurants. You may not like the tipping system in the US, but that is the system we have, so if you don't want to tip the person working for you for the duration of your meal, don't go in the restaurant. As an employer, if you don't want to offer health insurance to your employees for the duration that they work for you, don't go into business. Differences in scale, complexity and starting a business issues notwithstanding.

mgkimsal10• 13 years ago

"The govt declared that health insurance wasn't wages"

And at some point they likely will reverse that, and premiums will be counted as wages (or at least taxable), and we'll be stuck with an even worse situation.

Symmetry• 13 years ago

Well, that and not allowing competition between hospitals[1]. And remunerating doctors based on the labor theory of value[2]. But Employer-provided health insurance is certainly in the top 3. Given those, I'm sort of amazed that our healthcare system works so well, with us only spending twice as much to achieve similar health outcomes to other countries.

[1]http://en.wikipedia.org/wiki/Certificate_of_need The theory at the time was that competition was intrinsically wasteful and so should be prevented.

[2]http://www.slate.com/articles/news_and_politics/prescription... I believe that the reason that insurance companies followed suit is that hospitals can't offer lower rates to anyone than the offer to Medicare, the same reason free birth control to college students disappeared.

jws• 13 years ago

gives far too much power in the marketplace to employers

Having been on the employer side, it also puts distortions on their decision making. Some examples I had to deal with…

• You have an employee who is not working out, you aren't happy with his work, he has been unable to improve, and he isn't particularly happy failing day in and day out either, you'd like to terminate his employment, but you also know he has a dependent with mind bogglingly expensive health care issues that will take long term treatment and won't be eligible for coverage anywhere else because they are now pre-existing conditions. (Also know that whatever that dependent costs is going to get added to your next year's "insurance" premium in the negotiations.)

• You hire a guy that has been an independent consultant around town for many years. A few months later he needs expensive heart surgery, so you carry him for a while during recovery (and pay for all the health bills in next years "insurance" negotiation), after which time he stops producing work until you figure it out and fire him. He then goes back to his independent consulting work after using you for an expensive surgery and recovery. Now, remember that the next time you think about hiring a pudgy 40 year old man who currently does not have insurance.

mgkimsal10• 13 years ago

Excellent point. Leaving insurance decisions to the individual would take these issues out of your hands, and let you operate more efficiently. And to elaborate on the employee side, employees wouldn't have to feel so tied down to particular employment situations simply because of health issues.

pavedwalden• 13 years ago

I think HSAs are overrated. My biggest problem purchasing healthcare isn't that I can't scrape up the funds, it's that as an uninsured individual I'm charged a much higher price for services than the insurance companies will pay. So $1000 of my money in an HSA doesn't go as far as $1000 from Kaiser Permenante. Not nearly as far.

mgkimsal10• 13 years ago

They sort of go hand-in-hand. Right now I've got a Blue Cross plan with an HSA. I pay for the majority of stuff from the HSA, but I'm generally paying a 'Blue Cross negotiated' rate for things.

nijk9• 13 years ago

One issue is that the govt can relativelt easily ban you from driving without insurance. banning you from existing without health insurance is harder. ACA oa trying, though (by forcing coverage, not by killing people)

antidaily• 13 years ago

Ive done a bit of research on the subject, and it seems like if you do want to offer your employees insurance and you're a biz or startup of less than 25 people, it's going to be cheaper and better incentivized than it used to be.

bmelton6• 13 years ago

Color me critical, but it seems like, basically, the point of this article was to show off exactly how informed in her 'hard-nosed' critiques, and how that is proffered as justification for the obvious bias present in the article.

I also find it interesting that despite the apparent mountains of reading, the author cannot determine any good reason why one might oppose the Affordable Care Act, which tells me that either her bias refused to allow her to accept posed oppositions as valid, or that she simply doesn't care that other people do object.

I think there are plenty of valid reasons for opposing it, just as there are plenty of reasons to support it, and frankly, I think all of major justifications on either side of the argument fall into the category of fairly obvious.

That said, kudos on choosing to provide health care immediately. It is a tough decision, and it will affect the company's bottom line, but despite that, if you're an employer who believes that everybody should have affordable health care, it is the obviously correct choice.

onli2• 13 years ago

That was one of his points: There are no good reasons to be against the Act. I can't really judge if that is true, but basically, the idea that it is absolutely right to try to get as many people as possible insured is pretty powerful. And most of the opposition one noted was on the level of "that is socialism!" (which it isnt, and socialism isn't bad).

niggler2• 13 years ago

There are many americans working at medical device companies that will be affected by the 2.3% medical device tax. Zimmer, for example, cited the medical device tax as the reason for firing a thousand workers a few years ago.

dantheman6• 13 years ago

There are lot's of good reasons to be against the Act. How about it forcing the young and relatively poor to subsidize the old and relatively rich -- it's a giant intergenerational wealth transfer mechanism.

Young adults will pay higher premiums under Obamacare because of its age rating system. The law stipulates that the maximum variation allowed in adult premiums is a cost ratio of 3 to 1. But as Heritage research shows, “The natural variation by age in medical costs is about 5 to 1—meaning that the oldest group of (non-Medicare) adults normally consumes about five times as much medical care as the youngest group.” Obamacare’s “rate compression” causes insurers to charge artificially low premiums for older adults and higher premiums for younger adults. Moreover, “Actuaries estimate that the effect will be to increase premiums for those ages 18–24 by 45 percent and those ages 25–29 by 35 percent while decreasing premiums for those ages 55–59 by 12 percent and those ages 60–64 by 13 percent.”

http://blog.heritage.org/2012/03/21/obamacares-2nd-anniversa...

johndavidback• 13 years ago

I'm genuinely interested in your positions of opposition to the Affordable Care Act, if any. You're right in saying the OP did not provide any, and I'd be curious to hear some cohesive argument against it that doesn't necessarily tow a party line.

As far as the general timbre of the article, I would say it's pretty plainly stating that 'whether to provide healthcare?' offers no moral gray area whatsoever, and that it's a plain obligation on behalf of the employer.

bmelton6• 13 years ago

Since you asked for points of opposition, I'll assume you have arguments in support readily available. The most obvious ones I can think of are:

1) The health care system is really broken, very expensive, and should be fixed outright. Letting the government foot the bill isn't a fix, and is just a waste of citizen tax dollars.

2) It isn't the American way. Instead of taxing Americans for health care, cut taxes, give them more money back, and let them spend it how they want, whether on health care or on preventative care. Create legislation that puts reasonable caps on health care expenses instead, and actually make health care affordable.

3) The federal government is woefully inefficient at getting things done, and that is by design. Managing this at the federal level just makes it even more expensive than it already is, because now in addition to all the costs associated with the medicine, care, hospitals and doctors, you've also got to pay the government middle-men as well.

4) It's a further abuse of the Commerce Clause of the Constitution. The commerce clause allows the federal government to regulate interstate commerce, not dictate commands to citizens in states. Allow states to implement their own health care acts if they so choose, and let the money stay closer to the people who need it, which should lower the administration costs.

pessimizer3• 13 years ago

Every single objection you have to this article has nothing to do with either its content or form.

Help me to understand why you would post a comment like this:

>Color me critical, but it seems like, basically, the point of this article was to show off exactly how informed in her 'hard-nosed' critiques, and how that is proffered as justification for the obvious bias present in the article.

I'm not sure how to translate this other than "He thinks she's so smart, so he's asserting that he has an opinion worth listening to."

>I also find it interesting that despite the apparent mountains of reading, the author cannot determine any good reason why one might oppose ${THING_THAT_AUTHOR_SUPPORTS}, which tells me that either her bias refused to allow her to accept posed oppositions as valid, or that she simply doesn't care that other people do object.

Translation: "He has an opinion, and he thinks that there are no reasonable arguments against that opinion, so his opinion must be worthless." Remind me never to tell you what I think 3 times 5 equals, because my opinion will not pass this criterion.

>I think there are plenty of valid reasons for opposing it, just as there are plenty of reasons to support it, and frankly, I think all of major justifications on either side of the argument fall into the category of fairly obvious.

Now we know what you think - but you're not considering telling us why because it's "fairly obvious?" The author told us why he thought what he thought, and you attacked him for not telling us why everybody else thought what they thought, too.

>That said, kudos on ${ACTION_OF_AUTHOR_SUPPORTING_THING}. It is a tough decision, and it will ${COST_OF_SUPPORTING_THING}, but despite that, if you're ${WHAT_AUTHOR_IS} who ${HAS_AUTHORS_OPINION}, it is the obviously correct choice.

Do you think the author is searching for your vague tautological approval?

Comments like this trouble me. I don't understand why people take the time to make them. Color me honestly troubled.

bmelton6• 13 years ago

Sorry to have been so troubling. What I meant to point out, and admittedly did a bad job of, is that I sensed a pattern of "thoroughly investigating" both sides of an issue as merely justification for calling someone a dick. I don't think that holds muster, especially as the same thorough investigation into health care reform led to absolutely zero evidence of why anyone could think it's a bad idea?

No matter which you you side on the issue of the Affordable Care Act, there are compelling arguments on both sides of the debate. I don't see how you can do thorough investigation and come up with the conclusion that it is wholly good, unless you're just happy to categorize everybody in opposition as either dumb, naive, uninformed or just wrong.

As for what I think, I did post reasons against in another thread here, which you're of course welcomed to find and/or respond to, but that's just a few of the rather obvious reasons against, and don't necessarily reflect my stance.

My real stance is that it's a complicated issue, and both sides have very compelling truths in support of their stance. The willingness to ignore those compelling truths, even after seeking them out, speaks to a greater bias, in my opinion.

You're correct in that perhaps I was overly harsh. I didn't intend to come off as negatively as my re-reading of my statement affirms that I did, but as there are currently more detractors of Obamacare than supporters, the assertion that the majority simply doesn't have a point at all, smacks of arrogance to me.

There is another argument at play, that I think more accurately reflects the author's viewpoint, which is that there are not any good arguments against universal health care as a concept, and has to ignore the specifics of the particular universal health care bill that's been introduced and enacted.

As a vague example, I'm betting you'd get pretty high poll numbers for a question that asked "Would you support a bill that could eliminate crime?", but would almost certainly be against any particular bill that sought to do exactly that as it would almost certainly entail the restriction of many of our American freedoms.

All that said, yes, I am sorry to have posted a response that didn't more accurately measure how I felt, or at least try to temper that response with more supporting evidence, but at the time I was in a hurry. I don't really see how your response is very different than mine either, so I'll just assume we both responded with too much knee-jerk response and hope to call it a day.

For what it's worth, the proverbial straw that tipped me into a frenzy was the line about Reddit - asserting that Reddit has never been excellent, and that despite this one particular case in which it obviously delivered excellence, the author assures us that it will never reach those heights again. Reddit is a big place, and there are pockets of excellence hidden amongst the mass of everything else. One man's trash being another man's treasure, the likelihood of a particular subreddit being considered universally good is of course slim, but to assume that this one particular thread is the very best that Reddit ever has, ever can, or ever will do just smacked too much of bullshit to me to let the rest go.

mgkimsal10• 13 years ago

Given the US Constitution's "general welfare" clause, I'm not sure why nation health care options are such a hard thing to get passed and put in to place.

http://en.wikipedia.org/wiki/General_Welfare_clause#United_S...

oellegaard2• 13 years ago

In Denmark we have completely free medical treatment - I used to live in Switzerland where they have a system where you have to get a health insurance. I had to visit the doctor once to remove some stitches I got from an accident while travelling. The first thing they asked for when I arrived at my doctor was for me to fill out an insurance form - before that they didn't even ask what kind of medical treatment I would need.

I have never felt more offended. I consider it a human right to have access to health care. Why would the state not provide this? Everyone needs it, you can't live without it.

ryguytilidie2• 13 years ago

Its pretty hilarious in America. I was in the ER a few months back and I was literally laying on a gurney wincing in pain while the attending nurse gave me an insurance form to fill out. Can someone come up with another example of an industry where such absolute rock bottom service is tolerated as healthcare?

johnnyb92• 13 years ago

If you are really interested in learning why some people think universal health care is not a "right" I encourage you to read this article:

http://www.aynrand.org/site/News2?id=13873

arethuza• 13 years ago

"The American rights impose no obligations on other people"

What about the right to a fair trial by a jury?

summerdown22• 13 years ago

Clearly this is nonsense:

> Your right to anything at others' expense means that they become rightless.

So let me understand this argument ... my right to anything at all removes all other rights from others? Because the UK has universal healthcare, its people have no rights?

I suggest that the truth is not that exercise of one right diminishes all others 100%, but by some fractional percent. And that life, liberty and happiness are best served by a mixture of rights and liberty, not an extreme in one direction.

sultezdukes2• 13 years ago

In Denmark we have completely free medical treatment

For obvious reasons, that's not true.

oellegaard2• 13 years ago

If you don't pay tax you still get free medical treatment - but sure, society pays for it.

wsc9813• 13 years ago

I think an important consideration could be freedom of the employee to spend the money he thinks is best. I think that point of view is part of US culture, but not very much of culture in Western Europe. I understand the writer of the article is from the UK and as such might not understand this point of view.

The so-called social healthcare as pushed by the government will inherently waste a lot of money because government is always wasteful with it's resources. Governments are wasteful because whenever they run out of money they have the option to tax people more. On the other hand companies that waste a lot of money will eventually be removed from the marketplace, as they are unhealthy. This is one reason why healthcare as a government responsibility might be a bad idea, because whenever money is badly used in healthcare, instead of fixing the actual issue the government is more likely to just tax people more.

I think many opponents of social healthcare feel it should be an employees responsibility to spend the money as they think is best. If they want to spend a bigger part of their earnings on healthcare, they should be able to and if they want to spend nothing at all they should be able to as well.

Proponents of social healthcare will argue that some people don't know how to spend their money wisely and as such they will find it's a task of the government to make sure a part of the earnings will be forcibly spend on healthcare. It should be understood that this will inherently remove some (financial) freedom of the employees and perhaps from the employers as well.

Here in the Netherlands social healthcare is financially becoming more and more expensive. One big issue is that people who are forced to spend part of the earnings right now won't be sure they will actually see any of it back in 30+ years when they grow old enough to need healthcare themselves due to our society having more and more ageing population and less young people to support the healthcare for this ageing population. We've pretty much got the same issue with our socialised pension plans.

If young people would be able to save some earnings for their own healthcare, they could have a better guarantee being actually able to use it when they grow older.

The book "The Road to Serfdom" by F.A. Hayek explains why many socialist measures (even with the best of intentions) often risk pushing government into the same dangerous direction that Russia and Germany went in the past: http://www.tiptopwebsite.com/custommusic2/mrsilber2.pdf

drusenko• 13 years ago

The real issue is that uninsured people are an externality to society.

If we actually let people choose to not buy insurance and deal with those consequences, that would be fine. But as a civilized society, we don't find it acceptable to let people die for preventable reasons, so society ends up footing the bill for that person.

Either we need to let those who can afford it and choose not to purchase insurance die of pneumonia if they can't afford the treatment, or everyone needs to buy health insurance if they expect to be treated for life-threatening conditions.

It's not a matter of "spend your money how you see fit". It's "you choose not to buy health insurance and we pay for it anyway", which is patently unfair on the rest of us.

cecilpl4• 13 years ago

> The so-called social healthcare as pushed by the government will inherently waste a lot of money because government is always wasteful with it's resources. Governments are wasteful because whenever they run out of money they have the option to tax people more. On the other hand companies that waste a lot of money will eventually be removed from the marketplace, as they are unhealthy.

Which large companies that sell health insurance have gone bankrupt due to being wasteful with money?

The incentive to "not waste money" in the health insurance industry is "deny coverage when possible". Is that really the best way to provide healthcare for all Americans? Presumably that's the real goal that we all share, and we're just arguing about the best way to do it.

If government-provided health insurance is too wasteful, why does the American federal government spend more money on healthcare than most other countries (not even counting the American private healthcare expenses), with worse outcomes?

wsc9813• 13 years ago

> Which large companies that sell health insurance have gone bankrupt due to being wasteful with money?

Was not necessarily talking about companies in a specific market. But plenty companies have gone bankrupt through bad financial management. I think in the Netherlands some insurance companies might have gone bankrupt if our government allowed them to (because many insurance companies in the Netherlands are linked with banking companies). But instead our government thought it wiser to spend taxpayers money to keep these companies alive.

> The incentive to "not waste money" in the health insurance industry is "deny coverage when possible". Is that really the best way to provide healthcare for all Americans? Presumably that's the real goal that we all share, and we're just arguing about the best way to do it.

I think this is a prime example where government legislation should provide consumer security that insurance companies keep to their end of the contract.

> If government-provided health insurance is too wasteful, why does the American federal government spend more money on healthcare than most other countries (not even counting the American private healthcare expenses), with worse outcomes?

Of course the cause might be in many areas, I'm not sure the US example compared to many other countries is proof that government supplied social healthcare is always cheaper.

Then again, even F.A. Hayek argues in his book "The Road to Serfdom" that perhaps in very few situations government supplied services might be worth the loss in freedom [1]. Perhaps healthcare could be one of these services.

[1]: "In instances like these it is at least possible that we might all be better off, and should prefer the new situation if we had the choice-but that no individual ever gets the choice, because the alternative is that either we should all use the same cheap car (or all should use only electricity), or that we should have the choice between these things with each of them at a much higher price. I do not know whether this is true in either of the instances given. But it must be admitted that it is possible that by compulsory standardisation or the prohibition of variety beyond a certain degree, abundance might be increased in some fields more than sufficiently to compensate for the restriction of the choice of the consumer."

rbehrends• 13 years ago

> The so-called social healthcare as pushed by the government will inherently waste a lot of money because government is always wasteful with it's resources.

This just isn't the case. Healthcare/health insurance, for a number of reasons, is one place where government-provided solutions have traditionally been less wasteful than private market solutions.

One reason is that single-payer systems are monopsonies: The single payer (which need not be the government, and in some countries actually isn't the government) has much greater bargaining power than any individual or company and can negotiate better prices.

Second, the big cost drivers for health insurances are things that happen either way; the 80/20 rule applies, and most actual costs are caused by chronic illnesses, surgery, etc. These costs will occur either way and will have to be paid for. They will eventually come out of your paycheck (or somebody's paycheck), no matter who's being charged and how. There's no taxing people more or less, because most of the costs are fixed. Single-payer systems allow us to structure payment for these costs to minimize inefficiencies, medical debts, etc.; universal healthcare furthermore reduces the risk of treatment for acute conditions being delayed, which drives costs up further.

Third, healthcare/health insurance markets are less efficient than other markets. One reason is that people do not have a desire to shop around when getting sick; evaluating healthcare options takes time, and that's the last thing you have when you need treatment. Another reason is that healthcare and health insurance is simply too complex and time-consuming for patients to fully understand and to appreciate, especially with the arcane complexity of health plans as they tend to develop in a free market. Finally, insurers in a free market will do their darnedest to insure healthy people and avoid insuring sick people. All of this breaks the normal demand and supply constraints in a fairly fundamental fashion.

Health insurance in the Netherlands may be becoming more expensive, but that's because health insurance is becoming more expensive everywhere as a consequence of population aging and advanced treatment options. In the end, your per capita health care expenditures are still 2/3 of that of the United States. Under the US system, you could expect to pay a couple thousand Euro more annually.

mgkimsal10• 13 years ago

"Another reason is that healthcare and health insurance is simply too complex and time-consuming for patients to fully understand and to appreciate, especially with the arcane complexity of health plans as they tend to develop in a free market. "

Yet another reason: it's not like most simple commerce transactions with 'satisfaction guaranteed or your money back". If I choose option A over option B when looking at medical procedures, I may live or die. No going back for a refund. Or I may be permanently scarred, brain-damaged, or otherwise harmed for the rest of my life. Or... I might be cured. There's very little ability to 'shop around' and 'compare' options when talking about life-critical situations.

It's somewhat similar to housing, in that most people only buy a few houses (at most) over several decades - trying to shop around and compare options only goes so far - once you've made a decision, there's rarely ever a quick 'undo and start over' option.

michaelpinto• 13 years ago

I think I've lost count of the number of time on Hacker News (and else where) that I read about a founder that got sick and didn't have health insurance. So on top of a life threatening illness one has to worry about paying for it all. And as one who does pay for health insurance it now costs me the sum of a very good used used car every year.

Given this situation I'm frankly amazed that every business leader in this country isn't calling for socialized medicine at this point in time. At this point I see the insurance companies and the surrounding ecosystem as something that hurts us in a global economy.

jusben13693• 13 years ago

Running a startup I've gone through this exact same thought process. My high level bullet points are: 1) It's insane that any business should spend so many cycles on managing this. I would have thought Republicans (pro business) might be more open to a state role in healthcare precisely so business's don't have to manage this burden. 2) Somebody who is 35 or 40 with children fully burdened is around $1200 a month or $14,000 per year. Someone who is 25 and single is $200. You think that differential never goes through our minds when assessing candidate and how much we'll pay them? That totally sucks but is a reality. 3) The wealthiest and most likely to vote Americans get their health insurance via their company. So they're entirely immune to the dysfunctional system. If ALL Americans were procuring health insurance in the private marketplace there'd be a much better system. Much less abuse. If the government (like EU/AUS) was the sole customer there would be a much better system. It's this mixture of employers, too small in aggregate to manage the demand side, + smaller individuals buying it on their own, that drives the spiraling costs here. 4) Having a startup provide your health insurance is really dumb. Startups have a much higher % chance of closing their doors. So one day you get laid off because your startup doesn't make it. Guess what, now you have to go and find a new job AND work out what you're COBRA options are. In the broader context, most people who get laid off in the US lose their job AND now have a $1000 or more (if they're family provider) costs layered on as they now have to start paying for healthcare. Like losing a war you didn't start then being forced to pay repatriation costs when your economy is at its weakest.

Politically, I think we're more likely to get universal healthcare via the state through than to ever get all employers to stop offering it and put everyone into the marketplace. So I support these efforts because the current blend is the worst.

(PS right now we're paying full costs because we lean toward hiring more mature people (read families) who understand what it would cost them in the marketplace to get it so they can balance it against their overall lowered financial compensation.)

wnight2• 13 years ago

Throw in on-site daycare and you'll have a very attractive deal.

Did you find insurance that the employees can keep at the same rate even if the company folds or they're terminated? I heard someone talking about your problem #4 and how they'd helped a bit by at least keeping anyone from having ballooning costs.

justin662• 13 years ago

> It's insane that any business should spend so many cycles on managing this. I would have thought Republicans (pro business) might be more open to a state role in healthcare precisely so business's don't have to manage this burden.

Two things to keep in mind, with this and a lot of other issues: - The cycles spent handling it aren't a big deal to large corporations. - The idea that small-business interests and large corporate business interests are one and the same is one of the Big Lies of the Republican party.

jusben13693• 13 years ago

Hey Justin66. Not true at all! Large corporations have to grapple with this and spend a fortune managing health care for employees. The interesting question is what % more might they pay in payroll type tax to move this onto the state.

sultezdukes2• 13 years ago

What I don’t get is why anyone would oppose a bill that makes affordable healthcare accessible to more people.

Ignoring the philosophical debate for the time being (something as a non-American, he at least tries to understand), his premise seems to be that Obamacare makes affordable healthcare accessible to more people. That (along with the philosophical debate) is the argument.

guylhem• 13 years ago

"This level of diligence is why when I state something on the record, I’m always — always — right."

Warning sign #1

"If there’s anything I can do to protect the health of my employees and their families, shouldn’t I just close the fucking spreadsheet and do it?"

Asking to use emotion instead of reason - check

"And — fuck you, Papa John"

Insult or ad-hominem - check

"I’m going to have to work even harder to raise more money"

Call for self sacrifice. We're done there.

This is at best a populist opinion, and NOT a reasonable analysis, as per the author own suggestion to use emotions instead of reason.

Also, when someone tells you about 100% accuracy, think about Dunning–Kruger cognitive biais.

"If I made the wrong business decision, I’m an idiot but fewer people will get sick. If I made the right decision, I’m a genius and fewer people will get sick"

Hey genius - that's assuming the medical care paid for will have a significant effect. Modern medicine treat all kind of things, but for some we've just not found the right answer yet. And I sleep quite well.

cpdean2• 13 years ago

But... don't you wanna buy like eighteen subscriptions to his startup so he can feed is surrogate family of employees?

hype7• 13 years ago

Thank god someone else pointed that out. I stopped reading at your first warning sign — any doubt I had about Nicholas Carr being a complete dick just went up in a puff of smoke

mcculley• 13 years ago

It's only a debate for organizations that are trying to minimize costs where quality does not matter. See the concurrent discussions about full-time employment becoming rarer for service industry jobs.

If your organization is trying to get and keep the best people and keep them productive, there is no debate. Provide health care and health insurance. I don't understand how a venture capital backed organization could be confused about this, as they should be going after huge value adds with fewer employees instead of grinding out low margin labor.

cpdean2• 13 years ago

http://www.reasonwell.com/:06d4d5/The_Patient_Protection_and...

I have no idea.

I don’t understand American healthcare – doesn’t mean I shouldn’t provide it

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