Precisely so. If you think that this is a bad thing, then you should be advocating for non-insurance medical coverage, not for insurance reform. As you say, it's the nature of the beast. The current attempt to force insurers to cover people who they know will cost them more than the premiums will take in just makes everything more expensive for everybody and does not really do a very good job of covering people who need it.
As shown elsethread, medical malpractice adds up to about 1% of the total cost of the US health care industry, so it cannot come anywhere close to telling the full story of why these things are so costly.
Health insurance plays a big part. When everybody has full coverage, nobody pays the doctor directly. The entity paying the money is separate from the entity using the service. If the doctor raises his rates a bit, the customer doesn't pay. Of course if too many doctors do this, the insurance will have to raise their premiums, but what are you going to do, go without? Thus it all spirals out of control because there are no effective economic controls on prices.
Malpractice liability is certainly part of the picture, insurance is as well, and there are other problems such as our unwillingness to pay for poor people's care but also not to let them go without. But the massive over-insurance in the health care industry is a big part of the problem.
Massive numbers, but it's a massive industry. Your numbers do not in fact support your claim.
The page you link to quotes an $845/person "tort tax" in the US, and says that medical malpractice constitutes "over 10%" of this, which I'll assume to mean is close to 10%. Taking $845 times 300 million and then dividing by ten, we arrive at $25 billion/year total cost for medical malpractice lawsuits.
Wikipedia claims that US health care costs are were about $2.26 trillion in 2007. Thus we can see that medical malpractice liability is approximately 1% of the total cost of US health care.
If you don't have the ability to put $1000-5000 of extra money into health care in the event that something bad happens to you then, yes, this is a bad option for you. However I would say that in this event you are doing something wrong with your life in general, if you can otherwise afford health coverage. Take some time to save up that money, then keep it in the bank somewhere so you can use it when you need it. If you're in a position where a sudden $1000 charge will sink you financially then you really need to attain a better financial position. I know a lot of people are actually in that position, but that doesn't make this any less true. Furthermore, if you can't afford that, then you probably can't afford "full" health coverage either, so you're screwed either way. If your employer is buying it for you then they can pay you the savings they get from using the cheaper health plan which should allow you to survive in the event that you need to pay the deductible.
Costs related to litigation go beyond actual litigation. For example, if the hospital runs a bunch of "unnecessary" tests so that they can show due diligence in the event of a lawsuit, those costs would rightfully be placed in the "related to litigation" category.
But of course you're right overall that the current insane cost of health care is due to many complex reasons. One of the big ones is that we try to have a private system that still cares for everybody. One way this is done is by not allowing hospitals to refuse care to someone just because they can't pay. So guess what, all of those poor people out there who can't afford to see a doctor just go to their local emergency room when they need something. Of course this is extremely expensive, but they don't pay for it. You and I pay for it when we go to the hospital, though. Why do you think they charge you $10 for an over-the-counter pain pill? It's to offset charges caused by people who can't pay. And of course poor people don't like to do this either, but they also can't generally afford visits to the doctor. So instead of seeing the doctor when something feels funny and paying $100 to get it fixed, they visit the hospital after it's burst open, hatched, or whatever, and the hospital is then out $5,000 for their care. And there's much more like this.
Ultimately, the problem is that the US system is this crazy hodgepodge. We're so against socialized medicine, but we don't really want privatized medicine either. The result is this stupid middle ground where we get the worst of both worlds in many ways. The system is very good when you have enough money for it, but the costs are incredibly high compared to other developed countries.
Denial for pre-existing conditions would be if you got into an accident and then tried to obtain insurance to cover it. Obviously this would never be allowed.
I don't. Logically speaking, the companies only sell those things if they make money on them. That means that, on average, you'll pay more for the warranty than you'd pay for the repairs. As long as you're financially capable of absorbing the occasional large repair, you'll most likely come out ahead in the long run.
How about giving a discount for regular doctor visits, or even making them mandatory for coverage? If your car insurance covered major repairs as well as accidents then I'm sure they'll include a clause that requires you to get your oil changed according to the manufacturer's recommendations, and health insurance should be no different.
Health insurance ought to be the same way. You buy what you feel you need. Realistically, you should only buy insurance for events which would be impossible or extremely painful to pay for on your own. If you can afford to pay for the treatment for your torn ligaments yourself then you shouldn't buy insurance to cover them.
Of course if they happen that often then you couldn't afford the insurance to cover them either. And here we come to the fundamental unfairness of private medicine; unhealthy people pay a lot more than healthy people, insured or not! Back to cars, if you buy some sort of comprehensive repair insurance and your car is extremely unreliable, that insurance is going to cost a lot of money! Unlike cars, you can't choose the body you're in, but the insurance is going to work the same.
So far the "answer" to this problem has been to restrict insurance companies. Prevent them from testing for this, or asking about that, or denying your coverage because of the other thing. The trouble is that this just increases overhead and pushes the cost to healthy insurance customers. This then changes their cost-benefit analysis, causing them to buy less insurance for themselves, thus subsidizing the rest less, and it all spirals into the insanity we have today.
I think that as a society we should provide for people with chronic medical conditions without forcing them to put all of their money into medical care, but these half-assed restrictions on insurance companies aren't the way to accomplish it. Either socialize the system outright, or make private coverage mandatory.
You're right. I have a high-deductible insurance plan and a HSA and I get to keep the money in it forever. I can even take it back out and spend it on anything I want for a 10% penalty.
I really think this is the way to go. You get to pay for medical activities with pre-tax money, and that's any medical activities, not just things your insurance would cover. But if something really expensive happens, the pre-tax money covers your deductible and then the insurance kicks in.
Also, working for a small company, I don't get company-provided health insurance. And stupidly enough, I cannot deduct the cost of providing my own. So in fact while the routine procedures are pre-tax money, the insurance premiums are post-tax.
Shoe size can be trivially shown to correlate strongly with better reading comprehension in children.
Because children with bigger shoes are also older.
Finding correlation in a large population tells you nothing about an individual. Large waist sizes could very well be highly correlated with risk for heart disease but an individual could still be healthy with a large waist due to his natural body shape.
That's what happens when you buy "insurance" to cover every little thing.
Insurance should cover catastrophic, unforseeable events. You buy car insurance so that you have coverage if you get t-boned by a semi. You don't buy insurance to cover your oil changes. It would be absurd, and if everybody bought oil-change insurance it would drive the cost through the roof. Yet this is what everybody expects from health "insurance", and guess what happened, the costs got driven through the roof.
Sounds reasonable to me. I think a lot of these ISPs are doing poor jobs and need to reform. It's just not due to overselling, which is necessary and reasonable.
But it would be even cheaper and simpler to drop excess packets on the floor than to buffer them, so you'd think the the effect of cheap and simple hardware would be to have smaller queues.
How would the computer know that Buffy Complete Series contained Buffy Season One? That question is more interesting than you might realize. Any human who is familiar with basic concepts of television could tell you this, even if they don't know anything about Buffy or these two items. But computers can't know this even with all the specialized knowledge they have access to. This sort of common-sense reasoning is one of the big things separating "true AI" from what currently exists.
One thing I don't understand is why modern routers have such gigantic packet queues.
The internet is not meant to be a reliable medium. Packets are supposed to be dropped when corrupted or when things are too congested. But many routers seem to go through heroics to drop as few packets as possible, and as a side effect they send latency through the roof.
Uploading at the maximum rate from my home broadband connection sends the connection's latency skyrocketing from the normal 10ms to about 300ms. If I do several uploads simultaneously, like from an unthrottled bittorrent client, it gets even worse. On most connections it's easy to build up a couple of seconds of latency in this way, which makes it nearly unusable for a lot of tasks.
I occasionally tether my cell phone to my computer. When I do this I have to be really careful not to overload it, because it queues essentially without limit. I've seen ping times up to 120 seconds (yes, two-minute round trips) when I try to push too much traffic through it. It's absurd, and makes it much more difficult to use than it otherwise would be.
So why do they do this? If they'd have short packet queues then you'd just drop packets on the floor when things got congested and latencies would stay sane. TCP connections would automatically throttle to adjust for the congestion, as would most reasonable UDP protocols. Why isn't this done?
Put it this way, I do agree you might be right, but I have no evidence - and lots of people here seem to say they download 24 hours a day. Slashdot is not exactly a random sample of the population. Those lots of people here who say they download 24 hours a day are in the top 10%, quite probably the top 1%, of the user population. For every slashdot user you have 10 or 100 people who just read e-mail and look at their friends' pictures, and who of course never visit slashdot because there's nothing for them here.
As for shifting the top 10% to other ISPs or to a higher pricing structure, there's nothing wrong with that. What's wrong is doing it with underhanded tactics.
It would be perfectly reasonable to have, say, a 50GB/month plan for most people, then an extra fee per gigabyte, or a true unlimited subscription that costs more. I believe AT&T proposed this, and it seems to me like a fine idea. The problem is that a lot of these ISPs want to have a 50GB/month plan for everybody but they keep calling it "unlimited".
I have no problem with controlling the amount of traffic on the network as long as it's done honestly. Forging TCP RST packets and cutting people off of their "unlimited" connections after they cross the hidden limit is not OK.
Not my experience at all. Both sides seem to end up with jobs which are similarly desirably. The French get way more stressed out due to being out of work for a long time first, though.
You seriously need a citation to tell you that 90% of broadband users are light users and do not, in fact, use bittorrent running full blast all the time during peak hours?
If you really do need a citation for this, go around to all of your neighbors. Ask them if they have broadband, and if they do ask them about their use habits. You'll find that the vast majority use it for e-mail, web browsing, occasional youtubing. (And keep in mind that while youtube is intensive while you're downloading, you still spend most of the time watching the videos and not downloading them, so overall the pipe is not very heavily used.)
And while you're totaling up these statistics, you can put me in the 90% category as well. I use my broadband connection mostly for e-mail, web browsing, youtubing, uploading photos and videos, etc. I occasionally download large files and, yes, use bittorrent on occasion. It sits idle well over 90% of the time and that includes peak hours.
Nonsensical. It's like paying for one loaf of bread and taking two. The problem is not taking bread, the problem is that you take more than you pay for.
The problem is not that you don't have 90% unused capacity sitting around doing no good for you whatsoever. The problem is that your actual capacity is below actual demand.
How is it that an otherwise intelligent crowd is so incapable of understanding the basic economic and statistical principles behind overselling?
Which must be why my French friends often go over a year between jobs, whereas my American friends tend to simply jump straight from one job to the next. Must be that wonderful European idea of non-commoditized labor.
With the exclusion of Silicon Valley, Metro Boston is the #1 startup hotbed in the United States. I have no objection to the general content of your post, but it struck me that this is a really weird and long-winded way to say "Metro Boston is the #2 startup hotbed in the United States."
Slashdot Mirror
Precisely so. If you think that this is a bad thing, then you should be advocating for non-insurance medical coverage, not for insurance reform. As you say, it's the nature of the beast. The current attempt to force insurers to cover people who they know will cost them more than the premiums will take in just makes everything more expensive for everybody and does not really do a very good job of covering people who need it.
As shown elsethread, medical malpractice adds up to about 1% of the total cost of the US health care industry, so it cannot come anywhere close to telling the full story of why these things are so costly.
Health insurance plays a big part. When everybody has full coverage, nobody pays the doctor directly. The entity paying the money is separate from the entity using the service. If the doctor raises his rates a bit, the customer doesn't pay. Of course if too many doctors do this, the insurance will have to raise their premiums, but what are you going to do, go without? Thus it all spirals out of control because there are no effective economic controls on prices.
Malpractice liability is certainly part of the picture, insurance is as well, and there are other problems such as our unwillingness to pay for poor people's care but also not to let them go without. But the massive over-insurance in the health care industry is a big part of the problem.
Massive numbers, but it's a massive industry. Your numbers do not in fact support your claim.
The page you link to quotes an $845/person "tort tax" in the US, and says that medical malpractice constitutes "over 10%" of this, which I'll assume to mean is close to 10%. Taking $845 times 300 million and then dividing by ten, we arrive at $25 billion/year total cost for medical malpractice lawsuits.
Wikipedia claims that US health care costs are were about $2.26 trillion in 2007. Thus we can see that medical malpractice liability is approximately 1% of the total cost of US health care.
If you don't have the ability to put $1000-5000 of extra money into health care in the event that something bad happens to you then, yes, this is a bad option for you. However I would say that in this event you are doing something wrong with your life in general, if you can otherwise afford health coverage. Take some time to save up that money, then keep it in the bank somewhere so you can use it when you need it. If you're in a position where a sudden $1000 charge will sink you financially then you really need to attain a better financial position. I know a lot of people are actually in that position, but that doesn't make this any less true. Furthermore, if you can't afford that, then you probably can't afford "full" health coverage either, so you're screwed either way. If your employer is buying it for you then they can pay you the savings they get from using the cheaper health plan which should allow you to survive in the event that you need to pay the deductible.
Costs related to litigation go beyond actual litigation. For example, if the hospital runs a bunch of "unnecessary" tests so that they can show due diligence in the event of a lawsuit, those costs would rightfully be placed in the "related to litigation" category.
But of course you're right overall that the current insane cost of health care is due to many complex reasons. One of the big ones is that we try to have a private system that still cares for everybody. One way this is done is by not allowing hospitals to refuse care to someone just because they can't pay. So guess what, all of those poor people out there who can't afford to see a doctor just go to their local emergency room when they need something. Of course this is extremely expensive, but they don't pay for it. You and I pay for it when we go to the hospital, though. Why do you think they charge you $10 for an over-the-counter pain pill? It's to offset charges caused by people who can't pay. And of course poor people don't like to do this either, but they also can't generally afford visits to the doctor. So instead of seeing the doctor when something feels funny and paying $100 to get it fixed, they visit the hospital after it's burst open, hatched, or whatever, and the hospital is then out $5,000 for their care. And there's much more like this.
Ultimately, the problem is that the US system is this crazy hodgepodge. We're so against socialized medicine, but we don't really want privatized medicine either. The result is this stupid middle ground where we get the worst of both worlds in many ways. The system is very good when you have enough money for it, but the costs are incredibly high compared to other developed countries.
Denial for pre-existing conditions would be if you got into an accident and then tried to obtain insurance to cover it. Obviously this would never be allowed.
I don't. Logically speaking, the companies only sell those things if they make money on them. That means that, on average, you'll pay more for the warranty than you'd pay for the repairs. As long as you're financially capable of absorbing the occasional large repair, you'll most likely come out ahead in the long run.
What? I specifically said that this sort of hype-insurance would drive up costs, which it has, and which you say it has. Which part is bogus?
How about giving a discount for regular doctor visits, or even making them mandatory for coverage? If your car insurance covered major repairs as well as accidents then I'm sure they'll include a clause that requires you to get your oil changed according to the manufacturer's recommendations, and health insurance should be no different.
Health insurance ought to be the same way. You buy what you feel you need. Realistically, you should only buy insurance for events which would be impossible or extremely painful to pay for on your own. If you can afford to pay for the treatment for your torn ligaments yourself then you shouldn't buy insurance to cover them.
Of course if they happen that often then you couldn't afford the insurance to cover them either. And here we come to the fundamental unfairness of private medicine; unhealthy people pay a lot more than healthy people, insured or not! Back to cars, if you buy some sort of comprehensive repair insurance and your car is extremely unreliable, that insurance is going to cost a lot of money! Unlike cars, you can't choose the body you're in, but the insurance is going to work the same.
So far the "answer" to this problem has been to restrict insurance companies. Prevent them from testing for this, or asking about that, or denying your coverage because of the other thing. The trouble is that this just increases overhead and pushes the cost to healthy insurance customers. This then changes their cost-benefit analysis, causing them to buy less insurance for themselves, thus subsidizing the rest less, and it all spirals into the insanity we have today.
I think that as a society we should provide for people with chronic medical conditions without forcing them to put all of their money into medical care, but these half-assed restrictions on insurance companies aren't the way to accomplish it. Either socialize the system outright, or make private coverage mandatory.
You're right. I have a high-deductible insurance plan and a HSA and I get to keep the money in it forever. I can even take it back out and spend it on anything I want for a 10% penalty.
I really think this is the way to go. You get to pay for medical activities with pre-tax money, and that's any medical activities, not just things your insurance would cover. But if something really expensive happens, the pre-tax money covers your deductible and then the insurance kicks in.
Also, working for a small company, I don't get company-provided health insurance. And stupidly enough, I cannot deduct the cost of providing my own. So in fact while the routine procedures are pre-tax money, the insurance premiums are post-tax.
Shoe size can be trivially shown to correlate strongly with better reading comprehension in children.
Because children with bigger shoes are also older.
Finding correlation in a large population tells you nothing about an individual. Large waist sizes could very well be highly correlated with risk for heart disease but an individual could still be healthy with a large waist due to his natural body shape.
That's what happens when you buy "insurance" to cover every little thing.
Insurance should cover catastrophic, unforseeable events. You buy car insurance so that you have coverage if you get t-boned by a semi. You don't buy insurance to cover your oil changes. It would be absurd, and if everybody bought oil-change insurance it would drive the cost through the roof. Yet this is what everybody expects from health "insurance", and guess what happened, the costs got driven through the roof.
Sounds reasonable to me. I think a lot of these ISPs are doing poor jobs and need to reform. It's just not due to overselling, which is necessary and reasonable.
But it would be even cheaper and simpler to drop excess packets on the floor than to buffer them, so you'd think the the effect of cheap and simple hardware would be to have smaller queues.
Fiberglass and carbon composites also have low tolerance for cracks and sudden failure modes, and they enjoy great success in airplane wings.
One thing I don't understand is why modern routers have such gigantic packet queues.
The internet is not meant to be a reliable medium. Packets are supposed to be dropped when corrupted or when things are too congested. But many routers seem to go through heroics to drop as few packets as possible, and as a side effect they send latency through the roof.
Uploading at the maximum rate from my home broadband connection sends the connection's latency skyrocketing from the normal 10ms to about 300ms. If I do several uploads simultaneously, like from an unthrottled bittorrent client, it gets even worse. On most connections it's easy to build up a couple of seconds of latency in this way, which makes it nearly unusable for a lot of tasks.
I occasionally tether my cell phone to my computer. When I do this I have to be really careful not to overload it, because it queues essentially without limit. I've seen ping times up to 120 seconds (yes, two-minute round trips) when I try to push too much traffic through it. It's absurd, and makes it much more difficult to use than it otherwise would be.
So why do they do this? If they'd have short packet queues then you'd just drop packets on the floor when things got congested and latencies would stay sane. TCP connections would automatically throttle to adjust for the congestion, as would most reasonable UDP protocols. Why isn't this done?
As for shifting the top 10% to other ISPs or to a higher pricing structure, there's nothing wrong with that. What's wrong is doing it with underhanded tactics.
It would be perfectly reasonable to have, say, a 50GB/month plan for most people, then an extra fee per gigabyte, or a true unlimited subscription that costs more. I believe AT&T proposed this, and it seems to me like a fine idea. The problem is that a lot of these ISPs want to have a 50GB/month plan for everybody but they keep calling it "unlimited".
I have no problem with controlling the amount of traffic on the network as long as it's done honestly. Forging TCP RST packets and cutting people off of their "unlimited" connections after they cross the hidden limit is not OK.
Not my experience at all. Both sides seem to end up with jobs which are similarly desirably. The French get way more stressed out due to being out of work for a long time first, though.
You seriously need a citation to tell you that 90% of broadband users are light users and do not, in fact, use bittorrent running full blast all the time during peak hours?
If you really do need a citation for this, go around to all of your neighbors. Ask them if they have broadband, and if they do ask them about their use habits. You'll find that the vast majority use it for e-mail, web browsing, occasional youtubing. (And keep in mind that while youtube is intensive while you're downloading, you still spend most of the time watching the videos and not downloading them, so overall the pipe is not very heavily used.)
And while you're totaling up these statistics, you can put me in the 90% category as well. I use my broadband connection mostly for e-mail, web browsing, youtubing, uploading photos and videos, etc. I occasionally download large files and, yes, use bittorrent on occasion. It sits idle well over 90% of the time and that includes peak hours.
Nonsensical. It's like paying for one loaf of bread and taking two. The problem is not taking bread, the problem is that you take more than you pay for.
The problem is not that you don't have 90% unused capacity sitting around doing no good for you whatsoever. The problem is that your actual capacity is below actual demand.
How is it that an otherwise intelligent crowd is so incapable of understanding the basic economic and statistical principles behind overselling?
Which must be why my French friends often go over a year between jobs, whereas my American friends tend to simply jump straight from one job to the next. Must be that wonderful European idea of non-commoditized labor.
Neither, because NASA only hires smart people.