polygotdomain (u/polygotdomain)

polygotdomain commented on Health Insurance Costs for Businesses to Rise by Most in 15 Years wsj.com/health/healthcare... · Posted by u/johntfella

bko · 4 months ago

If you think health insurance is expensive now, wait until it's free!

In all seriousness, if a private business with all the incentive in the world can't figure out how to lower healthcare costs, I don't see how punting to the government would somehow be better.

Everyone that proposes a single payer can't explain who makes less money. Will we save money by the doctors getting paid less? The drug companies? Where do these savings come from?

Even if you're able to do everything the health insurance company does and capture 100% of their margin with equal efficiency, you'll capture a profit margin of around 2-6%.

The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better

polygotdomain · 4 months ago

> if a private business with all the incentive in the world can't figure out how to lower healthcare costs

What if their incentives aren't to lower cost? Insurance companies make more when the obfusicate pricing and payout less. That's the opposite of incentive, it's a way to cover up your profits.

> Everyone that proposes a single payer can't explain who makes less money.

If you think the healthcare industry is just doctor-insurance-you, then you're nuts. Look up pharmacy benefit managers. They're basically third parties that are in place to jack up prices.

> Even if you're able to do everything the health insurance company does and capture 100% of their margin with equal efficiency, you'll capture a profit margin of around 2-6%.

Insurance companies have had their profits capped via the ACA for more than a decade now. Where they're making their money is by using more third parties in the middle to jack up pricing and increase costs so that A) their 2-6% is bigger, and B) their "investments" in the third parties are not regulated by the ACA so they can get their massive profits their.

> The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better

Its a very serious argument, you're just happy to dismiss it for some reason. If the entire developed world uses a different system than us, gets better results and for less money, then you'd have to be insane to insist that mimic those systems is not a serious alternative.

polygotdomain commented on Health Insurance Costs for Businesses to Rise by Most in 15 Years wsj.com/health/healthcare... · Posted by u/johntfella

TuringNYC · 4 months ago

>> Some companies look at it as a way to compete by offering better benefits than their competitors.

Do they really? I've see only select hedge funds actually advertise their health plans. Even that is usually that "we pay 100% of premiums." Most plans are impossible to assess until you actually get to the job and see the tiers available and support available. The devil is in the details -- network coverage for your specific state, co-insurance, co-pays, deductibles, % premium paid, support like QoS/tier.

polygotdomain · 4 months ago

Competition based on benefits really comes in at the low end and the top end of employment.

If you're a tradesperson, just having insurance coverage is a big thing. It doesn't matter if it's not great, it's better than nothing. Leaving a job with insurance for one without insurance is likely going to cost you thousands of dollars out of pocket for the same coverage.

At the top end, companies will have plans that cover so many things at very high percentages, meaning that your out of pocket for health insurance will be surprisingly small. Less competitive companies simply can't offer that.

It's only in the middle where the details of a plan matter, and those are going to be the hardest details to find.

polygotdomain commented on Health Insurance Costs for Businesses to Rise by Most in 15 Years wsj.com/health/healthcare... · Posted by u/johntfella

lapetitejort · 4 months ago

Imagine if businesses did not have to worry about their employee's healthcare. Instead they could focus on the business at hand. Maybe this is just a crazy idea.

polygotdomain · 4 months ago

I completely agree. While it's counter intuitive, many businesses want to maintain control of employee's healthcare. Some companies look at it as a way to compete by offering better benefits than their competitors. A lot of companies like controlling healthcare because it keeps employees tied to their employer. If you temporarily lose your insurance when you switch a job, all of the sudden switching doesn't look as good. When you get to really larger companies, then they have the ability to self-insure, which means they can control the costs a hell of a lot more.

Of course, since many companies prefer less regulation, the last thing they'd want to do is hand over the keys to what they do for the healthcare for their employees over to the government. With things how they are now, they can always cut or pair back their plans if they want to cut costs. That lever would be gone with single payer.

Like many things, the system is set up to benefit those in charge rather than those who it's meant to serve. You can look just about anywhere outside the US and see that universal healthcare is a much better system, but better for who? Not much of a benefit for those who make the decisions, so we keep the flawed system we have.

polygotdomain commented on Doge Developed Error-Prone AI Tool to "Munch" Veterans Affairs Contracts propublica.org/article/tr... · Posted by u/afavour

smackay · 7 months ago

I'd be very interested in learning more about how DOGE got staffed.

If your goal was to dramatically cut government spending, then hiring bright, young people, with no prior experience, who axed first, and asked questions later would be the way to do it, otherwise you'd get bogged down in details since there was probably a good reason, at least initially for the said spending.

However, if you really, wanted to make a spectacular mess then hiring bright, young people, with no prior experience, who axed first, and asked questions later would be the way to do it.

Somebody, somewhere, thought this was a good approach. How could they not know it would turn into a massive clusterfuck. Hubris?

polygotdomain · 7 months ago

To start, it was clear that many were Musk fan boys. I don't think "bright" was a driving force, but "young, with no prior experience" would be great if you wanted people to make decisions that have the potential to negatively impact millions of lives. You need people with a lack of context to realize those are the stakes at hand. Since it was also clear they were going to "throw AI at it", I also doubt they were looking for anyone who acknowledged the shortcomings and pitfalls of an all AI approach.

I think this approach got them exactly what they wanted. Musk clearly wanted access to as much data as he could get his hands onto; legally or not. There were contracts and investigations into Musk's interest that he wanted control over, and got. Overall, chaos is not seen as an issue for those in this administration. The attitude from the top was clearly that these agencies and contractors "deserved it" for some reason, even though they have no idea what they really do or why they're doing it.

polygotdomain commented on Do Lake Names Reflect Their Properties? ivanludvig.dev/tech/lake-... · Posted by u/IvanLudvig

polygotdomain · 10 months ago

I'm sorry, but I can't help myself with this one... https://youtu.be/dalNQF8NmIs?si=lHyKeTiCLDFczZk6

polygotdomain commented on How to grow professional relationships tej.as/blog/how-to-grow-p... · Posted by u/Liriel

blitzar · a year ago

> bit strange when you only hear from people once every few years, just as they need an intro or career advice or whatever

This might out me as a psycopath, however, cut to the f'ing chase. If it is a transactional conversation don't insult my intelligence by pretending that it isn't. Obvioulsy this can create a problem as I tend towards "Do unto others as you would have them do unto you".

If something is within my means and the person hasn't made it onto my shit list I love to help out, it's what makes getting up in the morning worth while. Unfortunately we are all far more powerless than anyone can imagine and actually being able to do more than point people in the right direction, offer advice or just talk to someone is incredibly rare.

polygotdomain · a year ago

Psychopath? No. But it's also not insulting their intelligence by having that little catch up. You're asking someone for something that they don't have to do for you. Showing up in their inbox saying "Give me something" might seem to you like you're being concise and to the point, but to the person reading it, there's not much motivation for why they should give you that thing you need.

The catchup, as mundane and obvious as it is, at least signals to the person that you see some value in them and value your relationship, even if it's transactional in nature. Does it need to go on for paragraphs or multiple emails back and forth? Absolutely not, but having some lead in makes it less like you're only concerned about what you can get from the person.

Would you rather a waiter just come up to your table and say "Order!?" or have a little bit of pleasantries before asking what you'd like to eat. There's no more transactional relationship than a diner and a waiter, but most people would prefer the latter.

polygotdomain commented on Using AI to fight insurance claim denials sfstandard.com/2024/08/23... · Posted by u/jpmattia

Buttons840 · a year ago

> Health insurance is such a weird thing. It shouldn't exist. You insure yourself against exceptional things. Yet we use insurance for our yearly flu-shot, hardly exceptional.

I knew this in theory, but never really thought much about it.

I need a flu shot, so the company that makes the flu shot needs to be compensated (paid), and the nurse that knows how to inject it into my arm needs to be compensated, and that's it. The manufacturer and nurses provided a sufficient infrastructure to administer flu shots.

But in America, I also have to pay a bunch of insurance companies. I used to make 6 figures as a programmer in the insurance industry. I knew my salary ultimately came from the high medical bills everyone pays, and while I didn't blame myself personally for a nation wide problem, I would have been happy to see my job and my company rendered obsolete and all of us move onto more useful jobs.

I want to see a political cartoon where someone gets a flu shot and then does their patriotic duty, opens their wallet, and starts handing out money to half the nation. In the end, there's even a few bucks left for the nurse.

I exaggerate a bit. In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries (if I remember correctly). I really do have to pay all those people every time I have a medical bill.

Fixing healthcare costs will require a lot of people losing their job, and that wont be popular.

polygotdomain · a year ago

> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular.

Agreed, but I also don't think it _has_ to be this way. First and foremost, a switch to single payer would mean that a lot of the infrastructure that's currently in medical insurance industry would need to shift towards being government employees. While there'd be massive administrative savings with single payer, there wouldn't be zero administration at all.

I'd also posture that the US would never go full single payer, and that there'd be supplemental plans similar to the German model (and Medicare, to be fair), so while private insurers would still exist, the administrative burden would significantly lower.

In the end, you'd still end up with a lot of people losing their job, but it wouldn't be a complete wipe out of the industry. Certain areas would get hit harder than others with the insurance brokers likely getting cut out big time.

> In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries

That seems pretty high to me. I wonder what made you come up with those numbers.

polygotdomain commented on the US government has to start paying for things again vox.com/policy/367278/us-... · Posted by u/rntn

eigenspace · a year ago

> Lastly, debt only matters in comparison to rates. If you're borrowing lower than growth of GDP, then that borrowing is generally considered a net positive. Artificially deflating rates in the late 2010s and the rapid increase in rates post-COVID is not going to do well for government debt because we can't shift our budgets quickly enough to adjust. Of course that also assumes a functioning congress, which we certainly don't have.

The USA's debt-to-GDP ratio has been increasing for a very long time. Every once in a while, GDP growth starts to overtake debt growth for a few years and then the debt load ratchets up further. So if the plan is to outgrow the debt, that doesn't appear to really be working so far.

polygotdomain · a year ago

The thing that debt to GDP misses is the rates which need to be paid on that debt. For a while those rates were so low, it meant there was little reason to focus on paying down the debt, which is only going to keep that ratio relatively stagnant.

What is far more telling is the debt servicing to GDP ratio, which is far more useful in telling us how much our debt is costing us. This winds up looking wildly different than debt to GDP and has been a lot less concerning up until we've seen the latest spike in rates.

Debt to GDP - https://fred.stlouisfed.org/series/GFDEGDQ188S

Interest to GDP - https://fred.stlouisfed.org/series/FYOIGDA188S

polygotdomain commented on the US government has to start paying for things again vox.com/policy/367278/us-... · Posted by u/rntn

lumb63 · a year ago

> There’s no magic number at which the debt load becomes a full-on crisis.

When the US loses its AAA borrowing status and countless funds are required to sell all US Bonds, you will see that statement is incorrect.

polygotdomain · a year ago

But why did the US lose their AAA rating? It has nothing to do with how much debt we have. It has far more to do with a non-functioning congress that simply decided it wasn't going to pay it. As has been said several times in this thread, it's political, not about the numbers themselves.

polygotdomain commented on the US government has to start paying for things again vox.com/policy/367278/us-... · Posted by u/rntn

polygotdomain · a year ago

This story is incredibly frustrating because it seems to throw a lot of numbers at things (which isn't a bad thing, it's just not super useful) as if that's going to change things politically. Debt is political and the fundamentals of government debt have not changed at all.

Government debt is a red herring that many fiscal conservatives wave to say we're spending too much. Unfortunately those same conservatives don't actually want "fiscal responsibility", they want to cut programs they don't agree with and continue handing out lucrative military contracts that we arguably don't need.

Government debt has always been about borrowing today to fund growth for tomorrow. However, that's not what we're actually doing at all. Much of our current debt is due to COVID stimulous, which was an incredibly exceptional event. Of course that was more to "keeping things going" than fund growth initiatives. That's not to say that debt was "bad" or that we shouldn't have done it, but that much of the debt we're taking on is not going to fund infrastructure, education, or health which are all things that have significant long term benefits to society.

Lastly, debt only matters in comparison to rates. If you're borrowing lower than growth of GDP, then that borrowing is generally considered a net positive. Artificially deflating rates in the late 2010s and the rapid increase in rates post-COVID is not going to do well for government debt because we can't shift our budgets quickly enough to adjust. Of course that also assumes a functioning congress, which we certainly don't have.

Since it is a political issue, it will be a football and a dog whistle. Cut programs for minorities from the right, and raise taxes on the rich from the left. While one party is likely to be more irresponsible with this than the other, it's still not going to go away because it's never supposed to. Government debt is all about the cost to borrow compared to growth. The challenge we're at is that the cost is no longer cheap and we haven't been truly focusing on growth as much as we should. Instead we've just had political distractions.