[HN Gopher] Financial lessons from my family's experience with l...
___________________________________________________________________
Financial lessons from my family's experience with long-term care
insurance
Author : wallflower
Score : 96 points
Date : 2025-08-02 14:00 UTC (9 hours ago)
(HTM) web link (www.whitecoatinvestor.com)
(TXT) w3m dump (www.whitecoatinvestor.com)
| jqpabc123 wrote:
| Delay, deny, defend --- this is the insurance industry's modus
| operandi.
|
| Insurance is the only industry where customers are the enemy.
| toomuchtodo wrote:
| There seems to be no will to replace this dysfunctional
| arrangement with a social safety net unfortunately.
| zackmorris wrote:
| Because injustice is corruption.
|
| So every area of our lives that feels like it doesn't work
| like it used to - cost of living, healthcare, education,
| antitrust enforcement, journalism, accountability at the
| highest levels - represents a segment of the economy which
| has been corrupted.
|
| Through this lens, socioeconomic policies start to make
| sense. For example, if your goal is to skim a fraction of the
| income from everyone in an economy and redirect those funds
| to specific goals/organizations/individuals, you could put
| tariffs on common goods and pass the funds collected on to
| companies granted large government contracts. Then the
| largest companies like GM and Ford see their profits reduced
| or even show a loss, while Grok and Palantir have all the
| money they need for mass surveillance.
|
| Explanations for regulatory capture aren't normally this
| reductive, but wealth inequality has reached such monumental
| proportions that the simplest answer tends to be the right
| one when the needs of the few outweigh the needs of the many.
| drstewart wrote:
| So through that lens how do you explain the healthcare
| situation before the start of tariffs, or is your entire
| worldview shaped based only on the news you read in the
| last three days?
| TuringNYC wrote:
| >> There seems to be no will to replace this dysfunctional
| arrangement with a social safety net unfortunately.
|
| I think one problem is that healthcare in many cases is meant
| to tackle the 1.5-2 sigma problems -- so naturally few people
| really encounter bad healthcare. The others _thing_ they have
| good healthcare, until they are unlucky enough to encounter
| an issue.
|
| I'm shocked how many people on my exact same health plan at
| work think it is a great plan.
| wwweston wrote:
| The crucial understanding is that incentives are cross aligned
| because the product is risk coverage.
|
| The more immediate/pressing your need for risk coverage, the
| worse it is for them to sell it to you. The less you need it,
| the better it is for them to sell it to you and the worse for
| you to buy it.
|
| Pretty different than ice cream or cars or housing. Too many
| people just think "oh corporate greed" without thinking about
| the underlying economics (partly because of how us culture
| pretends markets are magic).
| pyuser583 wrote:
| This is why state's have insurance commissions.
|
| In the past, insurance companies (think: liability, fire,
| life, shipping) responded to a claim by hiring a lawyer and
| negotiating down. Like most contracts.
|
| So states began creating insurance commissions, which serve
| as law firms that defend consumers from insurance companies.
| In practice, their existence forces insurance companies to
| pay what they are owed.
|
| We need insurance commissions for health insurance. If there
| is a reason why the policy shouldn't pay (services received
| after policy expired, for example), the insurance commission
| has to sign off.
|
| This is how normal insurance works. Health insurance, of
| course, is not normal insurance.
| lazyasciiart wrote:
| LTC insurance is covered by insurance commissions.
| mjevans wrote:
| We need to just nationalize these things as basic civic
| infrastructure that everyone funds as part of the social
| contract.
| mixmastamyk wrote:
| Yes indeed. Part of the problem is having "insurance"
| draining part of the resources. Long term care means it isn't
| an "accident," but a constant recurring cost. Saving the
| money up front, producing income, and paying directly for
| what you need is often a better strategy.
| esseph wrote:
| I think this underestimates the "cost" of LTC.
|
| And also doesn't consider when the LTC starts. It could
| start at any time, even before working age.
| mixmastamyk wrote:
| Companies are not in business to lose money, and you have
| to fight them to collect. That there are some low
| probability exceptions is not enough in their favor imho.
| Workaccount2 wrote:
| People need to stop looking at it like this.
|
| Healthcare is a triangle. There are three players. You,
| Insurance, and Doctor.
|
| All three are adversaries and allies in different ways.
| Synthetic7346 wrote:
| In reality the triangle is Doctors, Insurance, Hospitals, and
| you in the middle.
| frankharv wrote:
| In reality what the article says is they needed adult-
| sitters.
|
| Family at first but USE PROFESSIONALS. Due to scummy ins
| company wanting docs.
|
| How is that health care? Babysitting is now health care???
|
| We need a better way to deal with dementia. Not health
| care.
|
| A literal babysitter to make sure they eat and don't run
| into the street.
|
| I don't see dementia as sickness. Brain illness maybe.
|
| So we have to warehouse these feeble folk. That is the
| problem.
|
| We need a more humane way rather than Doctor K's method..
|
| What about the poor old guys girlfriend?
| SoftTalker wrote:
| I wrote a longer response but deleted it as it was just a
| personal anecdote. Suffice it to say I'll never buy LTC
| insurance or participate in any elder care such as "assisted
| living" or "nursing care." It's all (IMO) engineered to drain
| old people of their assets before they die. Providing care is
| nowhere on the list of motivations of anyone involved.
| thepryz wrote:
| I could not agree more. My father has a neurodegenerative
| disorder that requires 24 hour care. He did tons of research
| and purchased LTC insurance decades before he was diagnosed.
| Experiencing first hand how difficult and predatory both the
| insurance company and the care facilities are has made it so
| I will never put my own children through it. My plan is to
| just euthanize myself when the time comes.
| tiahura wrote:
| I disagree. Getting a $3800/mo payment for up to 3 years sure
| was nice when I had to put mom in a $4000/mo assisted living
| facility.
|
| There's a reason companies got away from offering these
| policies, they were losing money on them.
| SoftTalker wrote:
| In my case they never paid. According to the lawyers I had
| involved, this isn't uncommon.
| SilverElfin wrote:
| Some states are forcing you to buy LTC insurance. I've heard
| Washington does this through some convoluted laws.
| lazyasciiart wrote:
| Yea, just like the country forces you to buy Medicare,
| except convoluted because people hate social safety nets.
| seanmcdirmid wrote:
| Medicare provides a long term benefit as well, anyways
| the LTC is insolvent and is mostly a ploy to get everyone
| to pay for expensive unhoused neighbor care (well, the
| homeless industrial complex gets most of the money, it
| probably isn't being used to help many). It doesn't
| transfer if you ever leave the state, and doesn't pay out
| very much if you ever need it.
| qwerpy wrote:
| It's a stealth income tax. Most high income people saw
| through it and opted out by buying their own LTC (which
| isn't indexed to income) and then canceling it once their
| exemption was recorded.
| hawaiianbrah wrote:
| I only know a couple people who have since canceled their
| private policies due to a fear the laws will be amended
| requiring periodic attestation. I'm still holding my
| policy, though I am eager to cancel it.
| hawaiianbrah wrote:
| Washington imposed a LTC tax where some percentage of your
| income is taxed and goes into a fund for LTC. At the time
| they implemented it, you could opt out by procuring private
| LTC insurance. Most tech people I know did, because it was
| cheaper than the tax imposed. We're still waiting to see if
| it's safe to cancel our private policies.
| SilverElfin wrote:
| I've heard from many recent moms that Aetna regularly denies
| normal labor and delivery charges that are explicitly covered
| in their plans. That then forces you through a months long
| process of calling them repeatedly, tolerating hold times of
| 1-2 hours each time, and getting virtually no help. And maybe
| at the end of it, when your child is almost one year old, they
| may pay out. That's for a _normal_ delivery with no
| complications.
|
| Aetna knows exhausted and stressed moms are less likely to
| persist. It is blatantly fraudulent but they get away with it
| because no one has the time or money to get their executives
| thrown in jail.
| ta555555 wrote:
| The alternative is to depose them.
|
| It's a massive shame how he is treated right now. Right after
| the deposition of one mass murderer CEO, another would-be mass
| murderer insurer backtracked their plans to limit time under
| anesthesia.
|
| Deposition works.
|
| Even those who believe human lives are equal (they are not)
| have to admit the price of one dead (bad) person outweighs the
| number of people who would have died or had serious
| complications from rushed procedures.
| GnarfGnarf wrote:
| There are three things a nation needs to accept about universal
| health care:
|
| (1) It's expensive (2) Everybody has to pay (3) The government's
| gotta run it
| cowcity wrote:
| Americans are perfectly conditioned to instinctively and
| aggressively deny all three. :(
| dayjah wrote:
| Hey now. America is a broad spectrum of people -- some of us
| are heretical and believe governments have a role in everyday
| life, some of us believe the opposite.
| cowcity wrote:
| Nitpick all you want, but what I said is exactly right and
| you probably know that.
| gruez wrote:
| >The government's gotta run it
|
| But there are plenty of countries with functioning healthcare
| systems that are private? The Swiss, for instance. Moreover
| depending on what counts as "government's gotta run it" (paying
| for it? administering it? actually providing care?) you can
| argue that the German or even Canadian systems aren't
| government run, at least to some degree.
| olddustytrail wrote:
| So why don't we see Republican Americans advocating to adopt
| the Swiss system which provides universal coverage at a lower
| per capita cost?
| Loughla wrote:
| Because it's any amount of government spending for one. And
| for two (this one is more of my opinion than the last one)
| the US has a problem where we, as a culture, view poor
| people as somehow morally or ethically broken, which is
| what causes them to be poor. Therefore, we shouldn't spend
| money that could positively impact them, regardless of its
| overall benefit. I got mine, so anyone can, but as the
| cultural zeitgeist.
| LocalH wrote:
| Because Republican Americans tend to overwhelmingly think
| "government bad, private business good". Even the "small-c
| conservatives".
| vjvjvjvjghv wrote:
| Although they think government is good at controlling
| their version of morality.
| dayjah wrote:
| If you only ever look at the way a system works at a
| specific point in time you only observe it at that point in
| time.
|
| America has had multiple attempts at solutions for
| healthcare over the years, each started with good intent
| and then waylaid by various causes to produce what we have
| right now.
|
| A sibling comment mentions political compromise to pass the
| ACA, as an example of this.
|
| Another example is that HMOs were started with inherent
| goodness, but got "corrupted" (in my mind) by profit
| seeking.
|
| To directly answer your question: a core tenet of the
| Republican tent is minimal government involvement in day to
| day lives of the citizenry. Ergo, the Swiss system won't
| work because it involves a lot of bureaucracy. Republicans
| link bureaucracy to cost, and feel this is not an
| appropriate use of tax payers dollars.
|
| The holes in this political doctrine are not part of my
| answer here fwiw. Please no "but..." comments to that end
| :)
| fnordpiglet wrote:
| To be fair the tenet is minimal involvement in the day to
| day operations of the economy and maximal involvement in
| the day to day lives of the citizenry.
| dayjah wrote:
| I do find the ironies in political platforms quite
| beautiful. I also love how they provides endless fodder
| for largely fruitless internet discussion ^_^
| Spooky23 wrote:
| Obamacare was a replica of Romneycare, which was
| implemented in Massachusetts. It was the republican
| approach of leveraging private enterprise and encouraging
| consolidated medical networks.
|
| The difference now is the republicans have changed, and
| nuanced issues are just not welcome on the platform of a
| party following a cult of personality.
| daveguy wrote:
| They were advocating for it before Obama tried to get it
| done. It was implemented in Massachusetts and termed
| "Romneycare" as Mitt Romney was the governor. Once Obama
| tried to implement it, it was government overreach and had
| to be watered down to get consensus. Personally I think we
| should have a govt option along side others, but all
| healthcare should be nonprofit (as in the Swiss model).
| Profit extraction is antithetical to healthcare.
| MontgomeryPy wrote:
| In speaking with my republican father in law on his
| opposition to universal healthcare, it dawned on me that he
| views it as a sort of zero sum game. If he has healthcare
| today, and then universal healthcare offers it to folks
| that don't have it today, it is a loss for him.
| wredcoll wrote:
| Something I've run into in similar situations is the
| "moral necessity of punishment", sort of a reverse just-
| world fallacy.
|
| "There are people not good enough for health care and
| helping them would violate this natural order".
| fnordpiglet wrote:
| This is going to be the ultimate issue if we do achieve
| some sort of post scarcity world where human labor is
| redundant. The idea that it's not someone's fault their
| indenture is unnecessary let alone a moral failing
| deserving of punishment is foreign to a lot of American
| thinking. The puritanical labor is godly mentality
| combined with the long term warping of anti Soviet
| propaganda is going to lead to some serious wide spread
| suffering that would take what should be the greatest
| achievement of man kind and turn it into a scourge.
| kasey_junk wrote:
| It's absolutely the case that public health coverage will
| benefit some people who make bad health decisions at the
| cost to some of those who make good decisions (or the
| decisions themselves must be made by a central
| authority).
|
| That doesn't make it the wrong policy decision. Lots of
| systems we happily manage with similar dynamics. But I
| don't think denying that basic fact is the right path
| forward. The moral hazard is real and worth
| acknowledging.
| AngryData wrote:
| Ironically the people who make bad health decisions are
| often benefiting the medical system by dieing more often
| around retirement age rather than going on to live 20+
| years past retirement with age-related healthcare
| problems that cost WAY more than any other health
| conditions they could encounter when they are younger.
|
| Smokers for example have more lung disease and cancer
| which cost money to treat, but usually not until they are
| in their 60s so they still spend their entire life paying
| into the system, but then they die soon after, saving on
| age related healthcare costs. And that is on top of
| smoking disqualifying someone from many treatments and
| surgeries, making smokers a net-win for healthcare costs
| to society.
|
| Being really fat also seems to have similar effects,
| although the the finances are much closer so perhaps the
| second order effects from being fat cancel them out. But
| on paper they are still a bit cheaper than the average
| person.
|
| Many people will argue against it because it "feels
| wrong" and they think unhealthy people should be punished
| (for example with higher insurance fees) and don't want
| to admit that unhealthy people are subsidizing their own
| healthcare, doubly so if you add in the sin taxes they
| have been paying their whole life that often result in
| more state income than their entire life-time medical
| costs add up to. But there has been numerous studies
| across the decades in Europe and the US showing how much
| cheaper unhealthy people that die earlier are to care for
| compared to the 90 year old granny walking everyday and
| risking broken hips and taking 30 different medications a
| day.
| vjvjvjvjghv wrote:
| Almost nobody in US politics who talks about something
| doesn't understand it or thinks it through. That's for
| people on the left and and on the right. They just repeat
| talking points that are given to them by wealthy party
| donors.
| mike_d wrote:
| In the Swiss system the private insurance companies are
| required to be non-profits. The government sets the standard
| for care and coverage and all the companies can do is compete
| on price.
|
| Basically what Obamacare was originally intended to be before
| they had to compromise to get it passed.
| k4shm0n3y wrote:
| Who were they compromising with? The Congress had large
| Democrat majorities in both houses during the ACA
| legislative process.
| SpicyLemonZest wrote:
| The parties weren't yet ideologically sorted. The
| Democratic majority included dozens of members of the
| Blue Dog coalition, a conservative group who (among other
| things) didn't support healthcare reform.
| Alive-in-2025 wrote:
| Also the us Congress is blocked by the senate needing 60
| votes/supporters to reach cloture on every single bill,
| except the once per year thing that got the bbb passed.
| So it's very easy to block the other side. https://en.wik
| ipedia.org/wiki/Reconciliation_(United_States_...
| zacherates wrote:
| They were trying to get Republican votes so that the law
| would be bipartisan. In the end it passed on a party line
| vote, so maybe the compromises were a mistake...
| phatfish wrote:
| All the Democrats bought by the private health insurance
| companies I assume.
| votepaunchy wrote:
| The 60th vote was Ted Kennedy who died in office and a
| Republican was elected to fill the seat, forcing passage
| of an earlier bill.
|
| https://en.m.wikipedia.org/wiki/2010_United_States_Senate
| _sp...
| vjvjvjvjghv wrote:
| Democrat senators Lieberman and Baucus mainly torpedoed
| it. And Pelosi refused to get republicans on board.
| vondur wrote:
| I've heard good things about the Dutch system of healthcare
| and that it may be adoptable to the US. I'd totally agree
| that healthcare corporations become non profit like Kaiser
| here in the US. They aren't perfect, but they seem to be
| better than the their for profit competitors.
| nothrabannosir wrote:
| Dutch system and original Romney care (and early versions
| of Obama care) had a lot in common. Health care providers
| are private, insurance companies private, gov dictates a
| basic list of treatments which count as "basic care" and
| _must_ be covered by insurance, sets max deductible /
| copay etc, insurance companies are not allowed to refuse
| any customers, everyone must have insurance, if you can't
| afford it gov will pay for your insurance.
|
| Afaik that's the gist of it. The ACA has been maimed on
| various fronts (e.g. the mandate "everyone must have health
| insurance" is no longer practically in effect), but it
| originally started out very similar. Far more than to,
| e.g., the UK's NHS which is fundamentally quite different.
| bluGill wrote:
| Government does not have to run it. Gokernment needs to ensure
| it is run well but there is no reason they have to run it.
| reactordev wrote:
| Oversight doesn't work, look at the finance markets.
| vjvjvjvjghv wrote:
| It works in other countries
| bradleyjg wrote:
| It's not a matter of acceptance. We can't accept the cost of
| anything consistently growing at a rate faster than GDP. That's
| just math, not ethics or political choice theory or anything
| else. Health care cost growth is going to slow one way or the
| another.
| reactordev wrote:
| Watch what happens to the GDP if they don't tackle the health
| care problem. You think it's expensive now? Negotiating drug
| prices isn't going to solve the problem. Having "health
| insurance" isn't going to work when an AI decides whether
| your illness warrants saving you.
|
| You _all_ need to think about what's going to happen to you
| when you can't move anymore. Will you have enough money?
| Triple it. Maybe 6x it. Only the rich will be able to live
| healthy unless you're diligent about your own health or
| strike it rich in an IPO.
| toomuchtodo wrote:
| But growth is also going to slow due to demographics, and
| this is unavoidable. Are we going to prioritize caring for
| humans? Or line goes up? Because line goes up is going to hit
| the demographic wall eventually.
|
| https://www.mckinsey.com/mgi/our-research/dependency-and-
| dep...
|
| https://www.cato.org/cato-
| journal/spring/summer-2018/demogra...
|
| https://www.cato.org/commentary/clear-eyed-look-our-
| demograp...
|
| https://www.sas.upenn.edu/~jesusfv/Slides_London.pdf
| wredcoll wrote:
| What part of the cost of healthcare involves providing
| profits for middlemen?
| fnordpiglet wrote:
| It has more to do with demand than being anything. Demand for
| healthcare is highly inelastic. If the price of Pokemon's
| grew faster than GDP consistently we would be fine. But if
| the price of a necessity for life does, we will not be fine.
|
| This is why life necessities are often treated as a public
| responsibility. Health care is one of the few that is treated
| as a luxury.
| gosub100 wrote:
| Computers and software used to be extremely expensive about 30
| years ago, yet private industry advanced the state of the art
| and brought the prices down.
|
| There seems to be very little talk about making medical
| education cheaper and more accessible. Why wouldn't it be
| cheaper if we had more MDs and nurses? What if we made it
| easier to become an MD ?
|
| The insurance system is a cartel and they are greedy. However
| the regulations (upheld by the government) enable it.
| throwawayqqq11 wrote:
| Without relgulation, the profit seekers would remain in power
| and the same applies to more medical staff.
|
| The insurance system is a profit seeking institution, that
| functions as intended. Why dont you talk about that BURNING
| aspect?
| gosub100 wrote:
| You didn't address a single thing I said
| Spooky23 wrote:
| Because your congressman gets lots of donations from doctors
| and hospitals. Doctors like to drive fancy cars.
|
| In places with Catholics, you usually get the bishops
| advocating for the local Catholic hospital system.
| gosub100 wrote:
| So government (my congressman) IS the problem! Thanks for
| reinforcing what Reagan said 40 years ago.
| wredcoll wrote:
| Sure, but what these types of people fail to understand
| is that the only way to solve the problem is also
| government.
|
| It turns out the real world is a big complicated messy
| place and there's rarely a simple answer like "delete
| government!"
| esseph wrote:
| This cult of personality in American politics is such a
| curse.
| Spooky23 wrote:
| [delayed]
| aerostable_slug wrote:
| We've done that to some extent via the legal enablement of
| nurse practitioner and physician assistant led care. Of
| course, largely speaking all they do is supervise the
| recording of patient metrics and prescribe drugs in label-
| consistent ways, but that often works out reasonably well for
| the patient. When the patient needs specialty care then the
| NP or PA simply punts them into the winds of referrals and
| insurance justifications.
|
| I'm not sure there's any realistic way to enhance the
| availability of specialists. You can't 'stub' your way
| through providing the care of a skilled gastroenterologist by
| substitution with a NP, though PAs in specialty care are
| becoming common.
| gosub100 wrote:
| Why not open more medical schools? And eliminate the
| matching system? If you want to be an ____-ologist, here is
| the list of requirements. Meet the requirements and you are
| the ___ologist. Not whether or not a practice group likes
| you, or your parents knew which colleague to talk to. Don't
| allow the supply of MDs to be constrained.
| tiahura wrote:
| This isn't about health care. Please read the article.
| i80and wrote:
| Elder care and memory care are under the umbrella of
| healthcare.
|
| That they're nonsensically broken out as a separate insurance
| category is intrinsically linked to the problems the article
| describes
| vjvjvjvjghv wrote:
| (1) is not correct. The US spends more than other nation per
| capita on health care
|
| (3) isn't correct either. It needs to be regulated in some way.
| Government doesn't have to run it. I think it should be treated
| more like a utility
| byryan wrote:
| Your first point doesn't mean that universal health care in
| the US would not be expensive. It definitely would, not that
| the USG couldn't afford it, but it wouldn't be cheap.
|
| Agree with your second point.
| bluGill wrote:
| You need to get this long before you need it, but also ensure it
| is good plan that will take care of you. The person in the
| article is lucky to have kids doing that, if you don't have kids
| who care who will care for you.
| vjvjvjvjghv wrote:
| "ensure it is good plan that will take care of you. "
|
| That's basically impossible. You will only know if you made the
| right choice once you are actually starting to use the
| insurance.
| lvl155 wrote:
| Healthcare in the US is broken and they won't let you fix it
| because the money is too good. Think about the fact that PBMs,
| which is there to save and manage on pharma is incentivized to
| promote drug price inflation. That's just one "small" piece of
| this clusterf*k. It's layers and layers of these convoluted
| system of incentives.
|
| As to OP, the simplest solution is to move out of the US early
| enough or become "poor" enough and be in a wealthy blue state by
| the time you get to this predicament.
| wnc3141 wrote:
| I think the broader extrapolation is that the social contract
| has emerged around giving private enterprise wide latitude to
| promote the public welfare. However that does mean that the
| quality of said welfare entirely revolves how profitable you
| are to said enterprise. While great for airline tickets, its a
| tragedy for healthcare.
| silisili wrote:
| Healthcare is little more than a jobs program at this point.
|
| I believe it is the largest industry by employment in every
| single state now.
|
| That compounds the problem even further. Really fixing it would
| put a double digit percentage of people out of work. I'm all
| for it, but I can see why politicians are hesitant.
| Avicebron wrote:
| > Really fixing it would put a double digit percentage of
| people out of work. I'm all for it, but I can see why
| politicians are hesitant.
|
| I'd love to hear what you think "really fixing it" is, please
| share.
|
| I can report that all (almost all?) of the hospitals and
| their networks both big and small in the area I am in have
| had layoffs this year of admin staff and healthcare
| professionals (nurses, doctors, etc). They have reduced bed
| counts, and cut programs and treatment options available. All
| of this was done in the name of the "affordability crisis"
| and is kind of like the 3rd wave of this kind of
| consolidation, belt-tightening behavior. And..prices haven't
| gone down, and they keep cutting.
| silisili wrote:
| I don't know all the answers, but I can tell you that
| cutting doctors and services is not what I had in mind.
| Mainly the behemoth that is everything tangential to that,
| namely insurance and pharma, for two. I worked on the
| insurance side(in tech), and most people wouldn't believe
| the number of people involved between the doctor getting
| money from the patient.
|
| On the contrary of your statement, I would also do
| everything I could to allow more (capable, of course)
| people to become doctors each year, though I'm not sure
| what all that would entail. It feels criminal to me that we
| limit residency while a) every doctor I've ever visited is
| way oversubscribed and in a hurry, and b) specialist
| appointments are months out.
| Avicebron wrote:
| Ok, I pretty much agree with everything you suggest.
|
| Browsing HN has conditioned me to react to sentiment like
| "healthcare...it's a jobs program...solve it by putting
| people out of work (the market will magically fix it)" to
| essentially be code for "I support continued abuse and
| further deprivations against the poor"
| A_D_E_P_T wrote:
| > _I 'd love to hear what you think "really fixing it" is,
| please share._
|
| I'm not that poster, but there's a really easy fix: Just
| model the system after Hong Kong's.
|
| There's a tax-funded public system available to every
| citizen, so that everybody gets treatment. In practice,
| this is mostly utilized by the poor, and for emergencies
| like broken bones. You can see specialists via the public
| system, but there can be a wait of weeks to months. This is
| all effectively free. You'll never see a bill, or the bill
| will be extremely small. (e.g., $100 for four days of
| inpatient care.)
|
| There's a private system for those willing to pay. This is
| unrestrained capitalism with little regulation and no
| parasitic middlemen. Want to see a specialist _right now_
| -- like later this afternoon, or first thing tomorrow
| morning? Sure. It 'll usually be $200 or $300 out of
| pocket. _No insurance necessarily involved._ Diagnostics
| are also super fast -- same day or next day, usually. If
| you want an elective surgery, or if you want a superior
| tier of care (like a nicer hospital room, better food, more
| flexibility re scheduling,) you can pay for it privately...
| And usually without getting insurance companies involved.
|
| There is effectively no "prescription" system. With very
| few exceptions for narcotics and certain stimulants, if you
| need a drug of any kind, you can buy it OTC. This includes
| steroids, weird nootropics, viagra (lol at needing a
| prescription for this), and all kinds of stuff. This vastly
| reduces the burden on the system.
|
| Hong Kong's system is superior in every respect, and it's
| especially better at treating you like an adult. The
| American system is simultaneously complex and
| infantilizing.
| llbbdd wrote:
| Aside from the prescription part, this is exactly 1:1 how
| it works in the US. I say this having myself and my
| family utilize all of it extensively, public tax-funded
| emergency treatment, inpatient coverage, private doctors
| and specialists.
| A_D_E_P_T wrote:
| The public system in Hong Kong doesn't really cost
| anything. It's not that you get costs "waived" if you
| whine hard enough that you ought to be a charity case
| (which, by the way, is degrading,) and it's not that
| costs are passed on to a middleman. Medical treatment is
| transparently priced and simply inexpensive -- so it's
| simply not a cause of bankruptcy in Hong Kong, whereas,
| in the US...
|
| > https://worldpopulationreview.com/country-
| rankings/medical-b...
|
| Also, perhaps because it's a lot more laissez faire, the
| private system in Hong Kong is almost unimaginably
| superior to the private system in the US. It's far
| cheaper because pricing is transparent and most people
| pay cash! (Cutting out that middleman.) It's higher
| quality because there's a lot more competition, rather
| than collusion among a few major providers.
| 2OEH8eoCRo0 wrote:
| My father's doctor says she doesn't want healthcare reform or
| more doctors because then their salaries will tank.
| EvanAnderson wrote:
| This was the reason behind the AMA lobbying for the freeze
| on federally-funded residency slots back in the mid-90s
| (which is still being felt today, even after AMA has
| changed their tune).
| JTbane wrote:
| >Really fixing it would put a double digit percentage of
| people out of work.
|
| Eh, I kind of disagree. It would put a lot of insurance
| people and hospital admins out of a job, but the boots-on-
| the-ground providers would be fine.
| wahern wrote:
| > I believe it is the largest industry by employment in every
| single state now.
|
| This made be curious, so I looked around. FWIW, healthcare
| constitutes ~11% of the workforce in the US. It's ~16% in
| Germany, ~10% in the UK, and ~5% in France.
|
| As a percentage of GDP healthcare is far higher in the US, of
| course.
| silisili wrote:
| It's actually a really hard thing to track, and BLS does a
| poor job of it in my opinion. That 11% covers most but not
| even all people at a clinic or hospital. It counts people
| from doctors to records specialist, but not say, janitors
| or IT, and nothing outside of that like insurance. And
| that's not necessarily wrong to do, but makes it hard to
| grasp the whole size.
|
| If you add in everyone in insurance, pharma, devices, and
| the jobs those support, that number seems to be closer to
| 17% of the workforce from what I could put together.
|
| Not sure if those in Europe do it similarly, but it just
| feels like a huge number of people. Maybe that is the
| result of demographics and a topheavy population, though.
| victorbjorklund wrote:
| Doubt european numbers count insurance (public or
| private) pharmacy etc or all the jobs that support
| healhcare in general (powerplants, construction workers,
| restaurants, etc)
| mjevans wrote:
| It also doesn't count family members providing care for
| loved ones 'unpaid'.
|
| Nor does it count any of the people who really should
| have more or better care but don't get it.
| esseph wrote:
| I'm not so sure.
|
| If we fix healthcare costs we can spend more on hospitals.
| With more hospitals means more jobs and more competitive care
| costs.
|
| In addition, a lot of those insurance jobs are facing
| pressure from "AI".
| elgenie wrote:
| Like 5-10% of the US's _total_ GDP gets wasted annually on the
| layers and layers and layers of healthcare middlemen... for
| worse outcomes.
| emchammer wrote:
| That is crazy. That is more than the defense budget.
| loeg wrote:
| Eh. Most of the US' "worse outcomes" are upstream of the
| healthcare system and would be upstream of it under any other
| country's healthcare model too. (Diet/exercise, and vehicle-
| related injury.) Feel free to criticize the spending, but the
| worse outcomes angle is kind of disingenuous.
| malshe wrote:
| I wonder if moving his father to an assisted living facility at
| some point will be a better option. I have little experience with
| this topic so I am genuinely curious.
| thepryz wrote:
| In my experience, these facilities are all in crisis. They
| can't find people to staff the facilities and provide care and
| when they do, they can't afford to pay them.
|
| My father has a neurodegenerative disorder and we've struggled
| to find a place that will provide consistent care. My mother, a
| retired nurse, is the one who tends to do a significant amount
| of the work to feed, clean, and otherwise care for him despite
| paying over $10k/month. It's infuriating.
| malshe wrote:
| Oh wow, that's frustrating! I hope you find someone to
| provide consistent care at a reasonable price. Btw do your
| parents live in a state with high cost of living or this is a
| general situation across the country?
| thepryz wrote:
| Midwest, so cost of living is relatively low to moderate. I
| don't have firsthand experience elsewhere but it's my
| understanding that what we experience isn't uncommon.
|
| This is the third facility he's been in and options are
| limited because a lot of facilities aren't staffed to
| provide memory care. Unfortunately, there just aren't many
| options unless you're wealthy enough to have in-home care.
| WarOnPrivacy wrote:
| My youngest and I were discussing how removing zoning barriers to
| ADU (in-law suites) can be a big win for families and small win
| for housing in general.
|
| In short, build an efficiency apartment on family property for an
| alone-living relative. Family can better provide support; the
| relative's residence goes back into the housing supply.
|
| The municipality provides usual construction inspections but
| doesn't prevent the construction for non-pragmatic reasons.
|
| ref: https://duckduckgo.com/?t=h_&q=zoning+to+allow+ADU%2C+in-
| law...
| mud_dauber wrote:
| his notes are EXACTLY my experience. bookmark it.
| wrs wrote:
| Same here...three times so far.
| dehrmann wrote:
| > they each paid about $14,000 in annual premiums for 10 years,
| and the daily benefit started at $200 per day.
|
| Insurance companies have to make money, but that's not that good
| of a deal, and the payout isn't that high ($73k annually)
| considering you won't be doing much else.
| SoftTalker wrote:
| Consider also that by the time you need a nursing home or some
| other form of continual skilled care you are probably going to
| die within that year.
|
| "Long-Term" is sort of a scare tactic that is used to get you
| imagining that you're going to be needing expensive skilled
| care for years. That can happen, but isn't normal.
| lazyasciiart wrote:
| Severe dementia id exactly when it does happen, though. Most
| patients die within months of moving into a nursing home.
| Dementia patients average ten years.
| squigz wrote:
| Given that my only experience with such homes is indeed long-
| term, I'd be curious to see actual statistics on this
| forrestthewoods wrote:
| $140,000 in premium and $73,000/year in payout seems like a
| terrible deal for the insurance company.
|
| Two sets of my grandparents have needed daily helpers for
| _years_. And that's just for regular day to day care. Not in
| response to a particular trauma.
| getnormality wrote:
| It _has_ been a terrible deal. These policies have been a
| disaster for the industry. They 're very expensive _and_ they
| 've raised premiums to cover rising costs, which causes
| people to drop the policy unless they're sure they'll need
| it. And then those people often require care for many years,
| generating massive losses.
|
| Insurance is wonderful when it works, but the conditions for
| it to work can be quite fragile.
| dehrmann wrote:
| Certain types of insurance can be funny because of how much
| information asymmetry there is.
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