Public service announcement: you can't COBRA on companies that go bankrupt. COBRA allows you to keep your group plan from your former employer. If that plan goes away, since the company goes away, you will be unable to COBRA. May have changed with Obamacare but this is how it was in the past.
I prefer insurance only for emergency, and everything else to be shopped. When you're bleeding to death, you don't care about if emergency care cost a lot of money, just that you get to the closest hospital possible.
We need shopping anyway, as people with insurance are quite insensitive to the cost of care. There's no need for hospitals to break someone's leg if competition can lower the price of service to a reasonable level.
I have never met a person who suggests comparison shopping for health care who has actually been seriously ill.
If you have had a major illness requiring serious care (e.g., heart disease, cancer, organ failure, stroke), please talk about exactly how you would have comparison shopped for the best bargain in hospitals.
And just in case my implication isn't clear, I think the notion of comparison shopping for treatment is insane. My mother was seriously ill last year, and the last thing we had time to do was get a serious of estimates and do a cost-benefit analysis on treating her brain tumor. Just understanding the treatment options was plenty. And, of course, picking the right doctors, because this actually was brain surgery. Oh, and we had to deal with the a loved one having a brain tumor. Little thing, that.
I believe surgery can be made cheaper through scaling surgery operation. This will in turn increase the reliability of surgeons as they become more experienced in surgery.
In some case, cheaper actually means better surgeon. Obviously, this won't work as well for surgery procedure that are more exotic.
Interesting, but irrelevant. There are all sorts of good approaches to cost containment in medicine. The blog "The Incidental Economist" covers them regularly. None of them rely on seriously ill people pulling out the Sunday supplement and seeing who has the best deal this week on heart bypass surgery.
I have never met a person who suggests comparison shopping for health care who has actually been seriously ill.
I had required emergency care 3 times before the age of 21.
If you have had a major illness requiring serious care (e.g., heart disease, cancer, organ failure, stroke), please talk about exactly how you would have comparison shopped for the best bargain in hospitals.
If somebody isn't immediately dying and mentally unable, the relatives or caretaker can take care of comparison shopping or they can just buy the service from the nearest hospital.
Whatever they choose, will determine the price of the service that they pay for. If everyone is provided insurance, we will all pay an arm and a leg and the hospital get to make extravagant profit due to price insensitivity.
The healthcare system anywhere in the world can't save everybody or care for everybody. There will be some rationing of some kind. It could be long waiting line, denial of care for certain individuals, or based on ability to pay. This is the reality of all systems in the world. The only alternative is to be ruthless in improving efficiency, reliability and cost of a healthcare system so that those dilemma can't happen.
Apparently reading comprehension is not one of your skills.
Have you had a major illness requiring serious care? Apparently not. But you still answered the question. You know why that's relevant? Because you quite literally have no idea what you're talking about. Because you didn't and can't talk about how you would have fit comparison shopping in the busy schedule that goes with not dying.
The notion that somebody is going to say, "Hey, I'm going to see if I can get a discount on dealing with my impending kidney failure" is so far from the reality of what's reasonable in a hospital setting that I don't know where to begin. Other than saying that I should have learned by now not to try to have rational conversations with fundamentalists, be they biblical, Freudian, Marxist, or free-market fundamentalists.
Have you had a major illness requiring serious care? Apparently not. But you still answered the question. You know why that's relevant? Because you quite literally have no idea what you're talking about. Because you didn't and can't talk about how you would have fit comparison shopping in the busy schedule that goes with not dying.
Emergency care is serious care. I was rushed to the hospital. Is that's not "serious care"?
The notion that somebody is going to say, "Hey, I'm going to see if I can get a discount on dealing with my impending kidney failure" is so far from the reality of what's reasonable in a hospital setting that I don't know where to begin. Other than saying that I should have learned by now not to try to have rational conversations with fundamentalists, be they biblical, Freudian, Marxist, or free-market fundamentalists
Never mind. I guess you're right. In some circumstance, when you're healthy, you could comparison shop. When you're very ill, you can't comparison shop as well, due to mental state of mind. Still, I think my economic reasoning is not entirely without merit.
<strike>You obviously felt that your anecdote have more weight than my economic reasoning. Just because you don't comparison shop in your situation doesn't mean other people won't. Ever heard of medical tourism?</strike>
In some circumstance, when you're healthy, you could comparison shop.
Except: you can't. Try to find out how much a major medical procedure will cost you -- if you can find anyone who gives you any numbers at all, you'll be lucky if that's what you actually get charged. (And then try to find out how much your insurance, if you have any, will pay for! And then try to complain when the final bill is different!)
Don't let it get you upset. I'm on your side on this. I've found that on HN there's a large number of 20-something geeks who are book-smart but life-dumb, as well as a large percentage folks who are frankly very close to being sociopaths, if not outright sociopaths. So yeah, a lot of HN readers are going to be utter pinheads when it comes to debating about healthcare. The reality of people's health experiences is very messy, very random, extremely stressful and utterly terrifying and unfair at times. It's not about simply shopping for the lowest price on some commodity at a local store. It's about a loved one who is vomiting blood and you don't know why and it's 2am. It's about being told you need medical insurance then getting denied because you have a pre-existing health imperfection on some long list of terms -- no shit, sherlock, right? It's about the primary breadwinner of a family being diagnosed with cancer at age 30. It's about an expecting couple being told that based on tests of their fetus that the baby is very likely to have Down's syndrome.
So fuck shopping around. Fuck the market. Fuck economics. Fuck capitalism. Fuck the Republican and really the Libertarian outlook. Fuck everyone who thinks it's every man for himself, I got mine, everyone else can go fuck themselves. Until they wake up one day to find they've got some horrible problem and need help too.
You know when it makes sense for everyone to compete and not give a rat's ass about anyone else? Say you're running a 100-yard dash. Or playing a video game contest. Those are true competitions, may the best man wins. But when you're sick, your family, a neighbor, a fellow citizen, that is precisely the time when it is NOT okay and NOT humane or civilized to think like that.
Don't let it get you upset. I'm on your side on this. I've found that on HN there's a large number of 20-something geeks who are book-smart but life-dumb, as well as a large percentage folks who are frankly very close to being sociopaths, if not outright sociopaths. So yeah, a lot of HN readers are going to be utter pinheads when it comes to debating about healthcare. The reality of people's health experiences is very messy, very random, extremely stressful and utterly terrifying and unfair at times. It's not about simply shopping for the lowest price on some commodity at a local store. It's about a loved one who is vomiting blood and you don't know why and it's 2am. It's about being told you need medical insurance then getting denied because you have a pre-existing health imperfection on some long list of terms -- no shit, sherlock, right? It's about the primary breadwinner of a family being diagnosed with cancer at age 30. It's about an expecting couple being told that based on tests of their fetus that the baby is very likely to have Down's syndrome.
Guess what? Not too long ago, I had a random, extremely stressful, and utterly terrifying healthcare situation and it involves me, bleeding lot of blood and not knowing why. It just so that I have a different perspective.
So fuck shopping around. Fuck the market. Fuck economics. Fuck capitalism. Fuck the Republican and really the Libertarian outlook. Fuck everyone who thinks it's every man for himself, I got mine, everyone else can go fuck themselves. Until they wake up one day to find they've got some horrible problem and need help too.
You know when it makes sense for everyone to compete and not give a rat's ass about anyone else? Say you're running a 100-yard dash. Or playing a video game contest. Those are true competitions, may the best man wins. But when you're sick, your family, a neighbor, a fellow citizen, that is precisely the time when it is NOT okay and NOT humane or civilized to think like that.
I don't give a rat ass about capitalism, socialism, or any political ideology, just that the healthcare system works esave as many lives as possible and preferably without charging an arm and a leg for said medical care.
So either show why I am wrong or don't comment at all.
In the words of Pauli, you aren't even wrong. If you work hard, you could get to the point of being wrong. But first you'd have to understand enough about health care economics to know what the actual problems are, and enough about health care consumption and delivery to frame a reasonable proposal.
Nobody's going to take the time to educate you on all that just to drag you up to the level so that you can understand why your proposal, once you got around to making it, would be wrong. That's your job.
Someone losing a benefit on short notice does not constitute an argument for tax-payer subsidization of that benefit. There are other options for these people, like individual plans that aren't provided by their employer. If such plans aren't available to these people in the state they live in it's most likely due to the regulatory environment of that state. In the states I'm familiar with (CA, WA, AZ) individual health insurance plans are cheap and readily available. (People with serious, chronic pre-existing conditions are another matter entirely)
The people who will be adversely affected by this layoff in this domain will be those who get catastrophically ill, requiring huge hospital bills, who aren't otherwise individually covered and who don't find employment before they get sick. I expect that number to be really, really low. Insuring this entire population against that event seems silly.
Ultimately, relying on your employer for these things is a ticking time bomb.
People who have serious, chronic pre-existing conditions (or less serious, say, an impending birth...or acne, or asthma, or are a little overweight, or are merely a middle-aged female--insurance companies can and will deny you for any of these things) are the most important matter...and good luck getting stopgap insurance or retroactively-dated insurance. In a lot of states, there's a single insurance provider who does the 'at-risk' stuff and has to cover you (for usurious prices), but you've first got to be denied coverage by a non-State insurance plan before you can go for the state's high-risk stuff (typically and hilariously, it's often the same company - they deny you the cheap 200/month insurance knowing you'll then be forced to fall back on the 1k/month policy from the state). This all takes time...if you're in the middle of, say, cancer treatments or something, damn, this is a nightmare you don't want to have to deal with. Especially on top of losing your income.
There are a lot of things I can sympathize with when a business goes under, but defaulting on your employees' health insurance with a 2-day notice in the US in our current climate (and not really even a real notice, from what I read, someone's doctor told them about it before the company did!) is pretty crappy.
(People with serious, chronic pre-existing conditions are another matter entirely)
They may be another matter, but does that mean they don't matter?
I expect that number to be really, really low.
Insuring this entire population against that event seems silly.
That is sort of the definition of insurance: Trading a small regular payment in exchange for being protected against very unlikely events. The argument, "it's ok if some people fall through the cracks because it is so unlikely," in the case of insurance doesn't make a lot sense.
"They may be another matter, but does that mean they don't matter?"
I was actually in that sort of position. Do I spend 80k+ on medicine or just let it be because that's a ridiculous amount that my insurance wouldn't cover because of my pre-existing condition (that really only sidelines me now and then)? If I was still working at a corporation, I wouldn't have had an issue. Alas, bootstrapping and freelancing are different ball-games altogether.
Thankfully, I had the choice of moving back to Canada. In exchange for tax-payers taking the burden of my medical costs for a month or two, I recovered as a productive member of society, i.e. paying taxes, contribute to the economy, and started a business here of my own. As much as I loved living in the U.S., I feel a responsibility to return something positive back to Canada for giving a shit about me instead of trying to gouge me with fees.
Someone losing a benefit on short notice does not constitute an argument for tax-payer subsidization of that benefit.
You know there is a whole continent where most people think of healthcare as a right, not a benefit.
And the Hippocratic Oath doesn't mention anything like "only if they have money". And people in the wast majority of other professions don't usually take oaths.
Healthcare and medicine are treated specially around the world.
Isn't it odd how the US mandates car insurance but not health insurance?
Which part of the hippocratic oath mentions working for free? It only talks about what behavior is appropriate when rendering service, and the life debt to teachers.
Car insurance is liability insurance. It is completely different. Doctors do carry liability insurance, for example.
Doctors in Europe do not work for free, what kind of, er, uninformed question is that?
Europe does not have free healthcare, it has universal healthcare. It is only free for those who can't pay for it - and believe me, nobody remotely sane envies them for that privilege.
May be they found a perfect balance. I'm from the country where medical help is either free (covered by the government mandatory insurance) or pretty cheap. First thing we (me and my family) did when we came to US - maxed out our dental plans (and put a sizable chunk on top of it) to fix what THEY did.
Don't forget that US spends more money on healthcare than any other country. (2009 they spent 17.4% GDP, or $7960 per person.)
Despite spending that money you have an unhealthy population (obesity especially a problem); not many doctors (2.4 per 1000 population, fewer than anywhere else except Japan).
Brand name meds are more expensive. The top 30 drugs are more than twice the price in the US than in the UK.
The US does a lousy job of handling long term illness. Preventable mortality among asthma sufferers between 5 and 39 are high, as are lower limb amputations for diabetics. (And diabetes is a considerable problem because of the amount of obesity.)
People often mention excessive spending in US hospitals - lots of high tech equipment, good doctors, many tests, etc. US hospitals are more expensive than many other countries. US doctors get paid more than non-US colleagues (but this is the same for other high-paid workers in different industries.) US hospitals are more expensive even though the stays are shorter. What do you get for this money?
The US does do a good job with some cancers - survival rates for breast cancer are very good. Expensive hospitals don't seem to be working in other areas - people with heart attacks are more than twice as likely to have bypass surgery or angioplasty if they're in the US than in Canada; but there's little evidence that US patients live longer. And some cancers (cervical) have poor outcomes in the US compared to other countries.
Of course, collecting the money that people have to pay also costs money. The US has a high number of admin workers (2.2 per office based doctor). Collecting revenue was estimated to cost 12% of revenue by one doctor group.
The US spends 50% more per person than the next highest spending countries, and more than double of most countries.
I'm not saying that US healthcare is great. I'm saying that having a weak economy and spending 30% of GDP is the definite way to disaster. See, the difference is not in the quality, but in the fact that US (inefficiently) spends money that it has (well, borrowed from China, but who cares, China doesn't), while Greece spends money which it hasn't. While having an overall (from the glance of the beholder) better health "climate" (obesity seems to be a nonissue in Southern Europe, red wine and olive oil makes wonders compared to HFCS, chips and beer).
I live in Bay Area, buy organic food and all that, but still can't get used to how sweet is everything sweet is in the US.
I owe you a million dollars, is it my problem? Yes, it is, you can sue me, you can take my home, my car, etc. I can go bankrupt, I will never see the light of the credit card again in 7 years, etc.
Who can sue US of A and send it to bankruptcy? Make it sell the 5th fleet to Iran to cover the portion of the debt? I'm not saying that 15 trillion debt is good or bad, I'm just saying that dividing it by population and coming up with a $50k figure is a propaganda. If I'm a US citizen and have $5k in credit card debt it doesn't mean that my debt is now $55K. These are two different debts.
For people without serious pre-existing conditions, health insurance is nothing but an extra cost. The insurance industry depends on the healthy to subsidize the sick.
For healthy people, it's usually cheaper to pay your doctor dentist and other specialists in cash...well, if you are healthy, you don't usually need to see any specialists.
The conversion from being a healthy person to a sick person is by and large a random phenomenon. You buy insurance because you have a non-linear utility function. Assuming that you'll be a healthy person is like going all in on a p=0.99 bet repeatedly and then acting surprised when you go bust.
After a government project just fails spectacularly...the response is yet more spending of taxpayer money? Why not just free the health insurance market to operate like the auto insurance market, such that individuals can buy on their own without having to go through their employers, and such that insurers must face competition across state lines?
There are tax breaks to providing health insurance through your employer, so companies are incentivized to compensate you with health insurance instead of more cash.
Coming up with a better way is trivial, yes, but getting it past the entrenched interests of one of the largest sectors of the economy (Healthcare) is ridiculously hard.
Yes, I know this. The solution is to either repeal those tax breaks or provide the same ones to individuals, to put all purchasers on the same playing field. Can't possible be more dislocating than the health care reform bill itself.
So your response to a dysfunctional government that can't even implement something as basic as health care is to say "screw it" and cut everyone loose? Health care is a public good, it belongs in the public domain. Quit electing stupid partisan assholes to run your government and you might get some policy that isn't designed for the sole purpose of benefiting special interests.
Health care is not a public good (in the economic sense of the word). To be a public good it has to be non-rival and non-excludable. It is definitely rival (the surgeon can't operate on two people at once). And, it is only non-excudable to the extent that society won't let people die just because they aren't able to pay.
There are plenty of reasons to think health care will not be efficiently produced by the market (adverse selection in health insurance is one). But, the reason the government will do such a bad job isn't that we have "stupid partisan assholes". It's that the incentives for government bureaucratic are all screwed up (see public choice theory). The problem is deeper than politics.
The first paragraph seems weird. Does the fact that bluedanieru used a term in a sense other than economism jargon change the point? It seemed to have a clear meaning to me; I can't even tell if you disagree with it.
The second has a straightforward answer: universal health care has been implemented successfully in basically every industrial democracy (including the USA, for people over 65). I'd like one of those, please.
The idea that there are first-principles reasons why this "can't work" when it so clearly can and does is just ridiculous. But I see it again and again. It's like libertarians have never been to Canada (or don't have grandparents).
I was just responding to his "it's a public good so it should be provided by the government". In economics, public goods are automatic things that should be done by the government because the market would fail miserably. I wasn't using jargon for jargon's sake.
Your advocacy for universal health seems to have two parts:
1. It would be nice for someone else to pay for my health care.
2. Universal health care in other countries is better than what we have in the U.S.
My responses would be:
1. Everyone would like this, but it doesn't make us any better off in aggregate. (If you want to redistribute income, it doesn't have to be done via healthcare).
2. Is debatable. There are trade-offs. Look at wait times in Canada. What about innovation over time. Maybe other countries are free riding off of our innovation. Just because costs aren't as visible don't mean they don't exist.
I'm not against all government intervention into healthcare. But, we should understand why the market is failing and how the government is correcting those failures. That is the only way to make good choices about the trade-offs involved. Otherwise, we are just setting ourselves up for failure in the long run.
What about them? Wait times are only an issue for urgent care situations, and you can't assume that wait times are problematic for all cases. The urgent cases usually get shorter wait times than the less urgent ones.
Most Canadians are pretty happy with the health care system and get a good laugh at how US politicians like to point out the flaws in our system. It may not be perfect, but it's pretty damned good.
As a Canadian who has had cancer twice, I can tell you first hand that the time between diagnosis and treatments were never a problem for me. I received excellent care, and have had access to all the diagnostic tests that I've needed.
It is not true that wait times are only an issue for urgent care situations. If my grandmother can not walk without hip replacement surgery, and she is going to wait in a bed in for months, I'm happy to send her to the states for surgery.
Excessive wait times have been an issue for a very long time. Things are getting better, in part because there is a drastic comparison to quality of life health care across the border.
I am not intracately familiar with the services provided in the states, but I believe the answer is Medicare for retirees and Medicare for the uninsured poor. Medicare would cover the cost of many non-elective quality of life procedure.
I'm sure these programs are not all encompassing, and free or reduced cost solutions like Catholic hospitals are not ubiquitous, hence the discussion in the States about reform.
MMO's are fucking money sinks. Investors see the insane profits from selling virtual items and figure "No inventory! No warehouses! Yet they're selling product!" and figure they can just throw money at a game until it's profitable.
Also, after Schilling started, free-to-play became the model. A genuinely doomed company from day one.
US-based AAA MMORPGs have development budgets in the $X00 million range, and only end up profitable if they're World of Warcraft or launched before 2004. They take, minimally, three years to launch. The primary customer acquisition method is a nationwide media buy which costs as much as the development costs do, and if you don't totally saturate the retail channel and then sell all your boxes, you lose.
By comparison, you can launch a social game for five/six figures in two months, your primary acquisition method will be virality backed up by cross-promotions and FB ads, if it doesn't work you shoot it in the head and do another one, and if it does work you double-down on development and quintuple-down on advertising and then print money hats.
League of Legends had budget which was 10x less , and it is profitable , launched 2009/2010 but I agree it is hard to make good hit MMOORG.
Got sold for cca. 500Mil to Tencent years or so ago , so yes you can make money but it is not easy
League of Legends and the other MOBA games are a very different model from AAA MMORPG development. (I'd call it a ridiculously superior model if I had investors who had staked me with $X0 million and told me make a video game, but I sincerely pray that I never offend anyone enough to have them sentence me to that.)
In app development terms it is akin to having to say hit #1 on the app store and hold it for months to get a decent return.
I think Age Of Conan was an interesting case, launched with big publicity and was quiet good. Things outside the introductory areas though weren't fully fleshed out and there were some big bugs. In the first couple of months they lost most of the user base, one you start a decline in an MMO network effects take hold.
They have put an extraordinary amount of work into the game since this point, building a great game, and had success with the free to play model. Still though, the biggest impact on where they are now was these first few weeks.
Why was Rhode Island trying "to jump start a video game industry in Rhode Island" by investing in only one company? Why not fund 3000 smaller videogame companies?
They could have given $250,000 to 300 videogame companies, or $2.5 million each to 30 companies.
Seems more like intentional corruption than failure. Did Curtis have any bona tides or anything to offer besides photo ops with starstruck officials? The failure was in electing or appointing the bureaucrats who spent public funds for personal entertainment.
My bet is a mix of incompetence (on the part of 38 Studios leadership, and government side), plus maybe some under-the-table kickbacks. They could have just started the company the obvious and healthy way, by making a product then selling it, then iterating and scaling up using organic revenue that came from customers. When customers buy your shit, they're voting with your wallet to say, "I want your shit. Take my money", so it solves or derisks the whole "Is there a market for this? Will we burn through this investor cash and ever fail to make payroll?" problem rather neatly. But instead they tried to juice it with investor crash. Which at times is a bit like trying to finish your semester project early by snorting a lot of cocaine so can skip sleeping. It just might work out ok and come to a gentle landing. But all kinds of forces pushing against that happening, and far more risky.
Funny that this degenerated into a discussion about healthcare. I can almost guarantee this will be a business school case study in the very near future.
The thing is, companies are still putting out MMOs. Guild Wars 2 - Not out yet but looks to be an awesome followup to Guild Wars. Tera, just released in North America and getting some praise (was previously in South Korea). Star Wars The Old Republic also just released and had a pretty successful launch even though now it is seeing it's user base decline.
I would be very interested in seeing how these three titles perform over the next 5 years but it's safe to say that you can still produce an MMO as long as you (a Have actual experience in the game industry (b Have some successful titles under your belt or a publisher willing to bankroll your talented studio.
Also, really great followup article that goes over some of the failures:
As a foreigner, I can't understand why the U.S. has no public free healthcare for all. Its one of the basic rights and one of the first obligations of a government. All governments should provide free and public healthcare and education. Here in Brazil we have a pretty bad government and yet we have those. And if you're seriously injured and it is an emergency, you can go to any private hospital and they are forced by law to treat you and payment is decided later. Sometimes U.S. policies scares me...
>And if you're seriously injured and it is an emergency, you can go to any private hospital and they are forced by law to treat you and payment is decided later.
That works exactly the same in the U.S. You can't be denied emergency treatment.
The same is true of most if not all hospitals in the US to my understanding. They cannot turn away patients in the emergency room for ability to pay. Still, the hospital can try to bill excessive amounts. Also, this does not guarantee the highest level of care to everyone, but neither private insurance nor most nationalized healthcare programs provide this.
I find this to be quite sad. I really enjoyed the game and was looking forward to their follow up.
I also don't approve of companies keeping employees in the dark when things are going wrong. I understand why they do it, keeping bad news quite is all the rage apparently, but I can't endorse it.
It's a delusion on the part of everyone involve. Management can't see past the next quarter and hopes beyond hope their company won't collapse. Employees don't see the warning signs and just accept what management is feeding them. Management has bad news but isn't willing to share with employees for fear that the employees will leave, even if that bad news means collapse is imminent and all employees will leave anyway.
> "A complex system that works is invariably found to have evolved from a simple system that worked. The inverse proposition also appears to be true: A complex system designed from scratch never works and cannot be made to work. You have to start over, beginning with a working simple system."
See the MMO game APB and its Scottish developer Realtime Worlds for another debacle. Mad cash was burned, it just managed to get released, then bombed spectacularly, taking the 300+ employee company with it.
One thing that has amazed me since the story first broke a few weeks ago is how little attention has been paid to the actions of 38 Studio's CEO Jennifer MacLean, the CFO, and board of directors. This was an all-star team (see http://blogs.law.harvard.edu/lamont/2012/05/18/38-studios-bo... ). The media attention has been on Schilling, but the senior management and board of directors have some responsibility for this debacle as well.
Good. These are the same assholes who allowed me to preorder KoA in Japan on Steam, saying "it will be released internationally a few days after the US release". It still isn't unlocked.
It sucks that Curt is going to have this failed thing associated with his name now. Because his prior big splash in the game industry is/was with the board wargame Advanced Squad Leader at his company Multi-Man Publishing. They did a stellar job at bringing ASL back to market and back from the dead, especially with the Starter Kit series -- brilliant design, just what ASL needed to bypass the complexity hairball of the full system, which was so intimidating to potential newbies. So perhaps this was a case of a mortal biting off more than he could chew. I also strongly hope that this doesn't somehow indirectly hurt MMP or ASL and they keep on kicking ass.
