
We’re Getting Ripped Off - TheAlchemist
https://slate.com/business/2019/09/health-insurance-us-kaiser-study.html
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dang
[https://news.ycombinator.com/item?id=21073443](https://news.ycombinator.com/item?id=21073443)

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theandrewbailey
Is this a repost? Because that one doesn't look like this one.

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TheAlchemist
Not a repost, but indeed the same topic and data

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d--b
I just moved from the US to France, and thought that I would get ripped off by
the taxes here. But I did the exact same calculation. If you factor in Health
insurance I'm much better off here (even without factoring the $4000
deductible I had in the US).

If you add free school and free university, there is no comparison, France is
way cheaper.

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Sam_Odio
I wish conversations about public healthcare in the US included discussions
about innovation in the healthcare industry.

We don't need to argue that consolidating buyers (e.g. single payer) has more
market power and can negotiate prices down. This is an accepted principle
among economists.

I am very curious about what affects single-payer in the US would have on
global healthcare innovation. E.g. concepts like:

> the high spending of health care consumers in the United States is arguably
> funding not only global pharmaceutical innovation but is also facilitating
> the availability of new medicines to other countries at much lower prices
> than domestic consumers pay.

[https://arcdigital.media/u-s-health-care-reality-
check-1-pha...](https://arcdigital.media/u-s-health-care-reality-
check-1-pharmaceutical-innovation-574241fb80ba)

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henrikschroder
Is there any serious research that shows this to be true?

In America, the Big Lie that all Americans tell about themselves and their
country, is that the US is #1 in everything. And, if statistics happen to show
that the US isn't #1, there's always a reason, an excuse, as to why in this
instance the US isn't #1, but it totally could be, it just doesn't want to, or
it has to deal with some exceptional circumstance that lesser countries just
don't have to deal with.

To me, the idea that the US subsidizes global healthcare innovation feels just
like such an excuse. It gives Americans an opportunity to martyr themselves.
"We could have cheaper healthcare, but we bear this burden, for you."

Come on. It's a load of horseshit.

And even if it were true, why would you accept it? America hates altruism,
deriding it as socialism, so much so that "socialized" healthcare is seen as a
horrible thing. It's not ok for Americans to pay for each other's healthcare,
but it's suddenly perfectly ok to pay for the development of healthcare for
other countries?!? You're happily spending healthcare money for the benefit of
other countries, but not your own population?

This makes no sense. This can't be true. It's a bad excuse to cover up failed
exceptionalism, because the truth is simply that a lot of people with money to
pay for lobbyists are benefiting from the current system.

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colinmhayes
1\. American culture may be anti-altruism, but I can still argue that altruism
is a good thing. Developing life saving drugs is a good thing. I'd like to
think that on this forum everyone can agree that technological innovation is
incredibly important. Of course I would prefer everyone contributes to drug
research costs, but if others aren't willing to pick up the slack I am.

2\. Drugs cost upwards of a billion dollars to develop. Plenty of failed drugs
cost a billion dollars before they fail. If drug companies don't make money
they will stop developing drugs.

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WalterSear
> 9 of 10 top drugmakers spend more on marketing than research

> These spending numbers are at odds with a common claim by pharmaceutical
> companies that they need to patent drugs for extraordinary amounts of time
> to justify the massive amounts of money spent on research. Not only do many
> top drugmakers appear to spend more on advertising, but their profit
> margins, the BBC noted, are often larger than their research spending.

[https://www.vox.com/2015/2/11/8018691/big-pharma-research-
ad...](https://www.vox.com/2015/2/11/8018691/big-pharma-research-advertising)

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sharemywin
Another thing to point out. We pay for the un/under-insured through high
medical prices.

And as for high deductible plans. People tend to put off routine procedures
and tests which then compound into more expensive procedures and care.

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ASalazarMX
I can't force myself to understand this Ferengi-like mindset.

Paying for the un/under-insured through for-profit intermediaries is what lead
to high medical prices. If it's a social service, if should be funded through
taxes.

And people putting off routine procedures and tests, which then compound into
more expensive procedures and care, can be explained not just by apathy, but
by the high cost of doing routine medical care.

My dad slightly burned his forearm opening the radiator cap of his car. He
drove to the hospital, where they washed his arm, put gauze, tape and sent him
home with a non-negotiable $600 USD bill. He's Mexican, but they can collect
in Mexico too. As a side note, this would have cost him $0 in Mexico, because
taxes.

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thinkingkong
Let's just say people could agree that a public system or option was actually
the right course of action. I think the most interesting / challenging part
would be the transition into that system from what we currently have. To me,
that would be more interesting to read about than arguments about how to
change peoples minds.

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nugget
I support Medicare for all but I’m also realistic that it will result in a
two-tiered public/private system, similar to what the UK has with the NHS and
separate cash pay services and private insurance. The key is to disconnect the
private system from employment where the costs and purchase decisions are
obfuscated from the end consumer. When a critical mass of consumers pay out of
pocket for services, the market will drive down prices and increase
transparency. At least that’s the best shot at it, based on what I’ve seen.

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ameister14
I would be careful likening that system to the NHS - the NHS is much more
fully nationalized than a medicare for all system would be

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nugget
It would be at first. But if almost all of a hospital’s revenue comes from
CMS, why wouldn’t CMS simply run the hospital? If it can run provider networks
more efficiently, why not hospitals? At least that’s how I predict the
political discussion will evolve.

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colinmhayes
Government programs will never be as efficient as private ones unless they
utilize market power to make themselves price setters. Nationalized health
insurance is a great idea, but nationalized health care would be much more
difficult to implement, and would likely not be as good as the system we
currently have.

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ordinaryradical
This is a useful way to discuss the cost of healthcare. Premiums are a silent
tax we pay out of our paychecks.

I actually think the most capitalist solution is to remove this burden from
businesses entirely and create some public alternative to live alongside the
private system. There should not be some magic number of employees where your
startup suddenly has to put together a benefits package for everyone. That's
not good for growth or competition.

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kgwxd
I can't even image who would argue against it. What was the point of tying
health insurance to work in the first place? I'm finally in a situation where
I'm managing my own insurance and being compensated for the "lack of benefits"
directly. I got a plan way better than my last one, for $5 more than what my
side of the cost was. And I no longer feel chained to my employer. Even if you
like where you work, that's not a good situation to be in. Companies get the
worst options, and it still cost both parties a horrible amount, and now the
employee is stuck with that crappy plan when they could have shopped around
for a much better deal directly.

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cannonedhamster
The current system is because of wage fixing by the government during WW2. It
was a way for employers to differentiate at a time when wages weren't
available as an option. I agree that the free market is the place to do this.

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purplezooey
"Americans are already paying enough to fund a European-style welfare state."
Why do we tolerate this. Vote next time.

