

Public Fried Chicken (by Scott Banister) - sachinag
http://dustincurtis.com/public-fried-chicken.html

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patio11
A ridiculous portion of the pain of health care costs goes away if you use
catastrophic insurance for catastrophes and cash for everything else.

Example: I am covered under national insurance for dentistry in Japan, but
Japanese dentistry is a nightmare (in no small part due to the fact that it is
covered by national insurance), so I get it done when I go back to the US to
visit family. Since I have no American insurance, I pay cash. And its _so
easy_. After spending literally 15 minutes explaining to my dentist's office
that I would be paying cash (and was not unwilling to pay cash, a concept they
found almost mystifying), it was simplicity it self. They told me it cost
$225, I passed over the credit card, _done_. See you next year.

No need to send paper back and forth between a massive paper-munching machine
at the insurance company and a department at the dentist devoted solely to
moving paper through that machine. No complicated contracts or regulations.
Full pricing transparency -- I know I consumed $225 worth of services, and if
that number actually mattered to me I could shop it around fairly effectively.

~~~
ubernostrum
Well, in theory this is how insurance is supposed to work, and is how it works
in other fields. The general idea of insurance is risk management: I have a
huge unpredictable risk which worries me, so I transform it into a small,
predictable risk by purchasing insurance.

And, true to form, with other types of insurance I pay "routine" types of
costs myself; for example, I have auto insurance, but I don't expect it to pay
for a tank of gas or an oil change. I pay those myself, and have the insurance
available for things like accidents, which are unpredictable and far too
expensive for me to pay for all in one go.

And yet... health insurance tends overwhelmingly to pay for predictable
routine treatments (yearly checkups, for example) while balking at paying for
precisely the sorts of large unpredictable costs it's meant to help manage.
How'd we end up with that system?

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stevenbedrick
Well, first of all, many health insurance plans _don't_ cover routine care
(annual physicals, etc.).

Second of all, those plans that do cover routine care generally do so under
the theory that, by paying a small amount of money for routine care, they're
avoiding paying much more down the road when the cheap problems that would
have been caught at a routine physical turn into big, expensive problems.

~~~
ubernostrum
Increasingly, health insurance plans cover routine care under the banner of
"wellness" (there's a reason why there are specialized procedure codes to
identify them). Unfortunately, they often take the form of "sure, we'll cover
that prostate screening, but if it turns out you actually have cancer, um,
tough luck."

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neilk
Wow, it's obvious. Health care is exactly like every other commodity. Why
didn't we think of that before?

<http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf>

~~~
gabrielroth
I just logged on to post the exact same paper.

To anyone who doesn't want to download the pdf linked above: it's Kenneth
Arrow's economics paper "Uncertainty and the Welfare Economics of Medical
Care." It launched the field of health-care economics. It demonstrates that
health care is not like fried chicken. It was published in _1963._

Of course, there are counter-arguments to be made. But an argument comparing
health care to fried chicken _without taking Arrow's work into account_ is a
worthless argument.

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misuba
"If you have an FCP, they pay your bill for you. If you don’t, you eat free."

I've paid massive emergency-room bills. The author and publisher (apparently
not the same person) are morons if they believe it.

~~~
dcurtis
I don't mean to endorse the ideas. I will be publishing an article arguing the
opposite position as well.

~~~
sanj
But it is poorly written and a bad analogy.

I can't think of a situation where I needed fried chicken to prevent my child
from dying.

~~~
jbooth
Yeah, what's the opposite position, an even less coherent analogy?

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there
vertical and horizontal scrolling to read an article?

~~~
davidu
The vertical scrolling is not likely to be deliberate. The horizontal most
certainly is.

~~~
rms
The vertical scrolling is definitely deliberate for the people running a
resolution that requires it -- note that once you scroll down all the way to
read the article, you don't need to vertically scroll again.

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rms
Is this the pro or anti article?

~~~
patio11
Here's the thesis: Routine health care, like routine food purchases, should be
paid for directly by the consumer rather than paid for through indirections
like insurance/employment benefits/government.

~~~
clistctrl
That makes sense when you keep it inside the metaphor; however there is a
large difference between providing a chicken dinner, and providing healthcare.
The full costs would be prohibitive for nearly everyone if everyone only paid
for what they use. Meaning the system might be unfair but it is arguably
better than no system at all.

~~~
DanielStraight
I think an important issue is that _life_ isn't fair. Some people need nothing
but routine checkups for 90 years. Some children need a million dollars of
medical care before they're 10 years old. I don't think it's fair to say that
if you happen to get a rare and costly-to-treat disease, you're just screwed.
It makes much more sense to me to balance healthcare costs roughly equally
across the whole population.

What keeps this system fair is that everyone really is recieving the same
thing: the promise of good health care no matter what health issues they
encounter. Health care systems work because most people pay for more than they
"use." Whether it's the goverment or private companies that organize this
system of most people paying a little more so some people can use a lot more
makes no difference to me. I think it's the right system, so the question to
me is just whether it works or not. Current U.S. health care is broken in a
lot of ways, and I'm not sure it can fixed while it stays in the market. If
the government can make a system where everyone pays roughly equally and
everyone recieves all the care they need, then let them take it over. If they
can't, then they should be working to find someone who can.

Or to come back to the analogy, some people need to eat 10 chickens a day and
some people can live on a wing a week. If people pay out of pocket for their
chicken, then some people will just starve to death. There is no avoiding it.
No one can afford the amount of chicken that some people need.

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kevinholesh
There's no such thing as free chicken.

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aresant
The point that I agree with is that running healthcare through the gov't is
going to mean we get 3rd tier care at 1st rate costs.

But at least we'll all be equally screwed.

~~~
nfnaaron
What tier care are we getting now, at what rate costs? Sincerely curious as to
your opinion.

~~~
aresant
Short version I would rate US as tier 1 care, at tier 1 pricing.

I dont know a simpler aggregate measure than life expectancy.

For the way that Americans live, the average life expectancy is nothing short
of a medical miracle.

We don't rate at the top of the scale, but like everything, you have to take
that in context - interesing argument here ->

[http://freakonomics.blogs.nytimes.com/2009/12/10/why-does-
th...](http://freakonomics.blogs.nytimes.com/2009/12/10/why-does-the-us-
rank-29th-in-longevity/)

As for costs, it's not cheap, but it's not out of reach for average working
people - especially when you're solution oriented as commentator above who
notes catastrophic only as a solution.

My fundamental problem with this entire debate is that true national health
care tugs heart strings yet there are clearly much more effecient proposals
than what the gov't is proposing.

In my experience the US gov't - eg the largest employer in the world - has one
interest, and that's expanding their business.

~~~
nfnaaron
I guess for those who can get health care, I'd agree with you. For those who
have no insurance (which is often the same thing as no access, at least to
expensive care) and/or pre-existing conditions, I guess they have either zero
care or infinite pricing.

I think the "average working person" is slowly disappearing, replaced by the
person with one, two or three no-benefit low wage jobs.

I expected nothing but sausage out of the government, particularly since the
administration and the Dems were so set on getting an agreement, any
agreement. It was theoretically possible for the two parties to have an honest
debate and work toward an agreement that's good for citizens and uses taxes
and other money efficiently, but in practice that would be impossible since
their primary concern seems to be not agreeing to whatever the other side
says.

It seems so plausible that we could have a much more rational and accessible
health care system, however because health care is so expensive it can only be
meaningfully underwritten by either or both of the government or insurance
companies. The government is dysfunctional, and the insurance company's
primary objective is to ensure _least_ access to health care while still
convincing people that they're a good buy.

Feh.

~~~
aresant
More reason than ever to work hard, and do your best to inspire, mentor, and
help anybody out there that shows signs of life as an entrepreneur - private
industry CAN negotiate vs. insurance where individuals cannot.

