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Notes -
Some quick hits:
A) Cremieux argues that much of the gap in life expectancy between America and Europe is due to obesity. But America is good at one thing at least – spending money on health care. Combine high spending with effective weight loss drugs, and the U.S. is on track to significantly narrow its life expectancy gap with Europe.
Self-driving cars will close the gap further.
B) Drug overdose deaths are down in King County (Seattle area) this year after more the tripling between 2019–2023. This is probably because fentanyl has already killed a significant percentage of the junky population. There has also been some modest progress in cracking down on open air drug markets. In the last 2 years, about 1 in 1000 King County residents died of a drug overdose.
C) Health insurance companies have a terrible reputation. But it's hard to fix. It's a viscious cycle which goes something like this:
Company has bad reputation
Due to bad reputation, the company has trouble getting talent, so they compensate by paying a lot
This selects for people who care more about money than reputation
Money-grubbing behavior leads to bad reputation
If you were next in line at United Health, how would you fix the problem?
Note: Many societies in the past (India, Japan) created special undercastes to do necessary but unsavory work such as working with dead bodies. Should we do likewise and create a special caste of health insurance workers that are not allowed to work in other fields and we can treat like shit with impunity? Reddit probably thinks so.
D) Epistemic status: uncertain.
Many people in the China tariff post said that China is "not expansionist".
But what is today China was, 2500 years ago, just a small collection of states along the Yellow River. Gradually, over the millenia, they absorbed more and more territory into their country.
It's as if the Roman Empire still existed today and controlled all of Europe.
Genetically speaking, the Han people seem to have done much better than Rome. The Romans, the people who lived in the city of Rome circa 500 BC, essentially all died out. For centuries, Rome's population could only be sustained from continual influxes of people from the countryside, and later, far flung areas of the Roman sphere. This doesn't seem to be the case in China. Even today, there are people who can trace direct male lineage to Confucius who lived around 500 BC.
If I'm in a car accident, my auto insurance company pretty much just pays for my accident (or at least that was my limited experience and the experience of others I know). There are occasional disputes about the amounts and autobody companies do have to deal with those disputes, but I am not aware of any auto insurance companies that attempt to just delay approval of repairs until their customers give up or die. In principle, it seems like they could do that - the insured party may decide they can't afford to wait and argue, they just need their car fixed, and then the insurance company can refuse to pay. I'm sure that does happen from time-to-time, but it doesn't really seem like a going concern.
My infinitely naïve solution is to just offer insurance products that you intend to actually make good on rather than deceiving people into believing they're covered in order to create additional profit margins. I'm sure many people would still be bitter about actual facts, but it seems clear that health insurance companies aren't simply dealing with cold actuarial facts and communicating costs clearly, they're lying to people, they're fighting legitimate medical care, and they profit from figuring out ways to legally avoid paying for treatment.
The auto/medical insurance comparison is a good one to think about. Another distinction between the two is that auto insurance is mostly viewed as an individual thing, where the only real public purpose in getting involved is to make sure people internalize the costs that their decisions may have on others (i.e., basically every jurisdiction requires liability insurance). Whereas in the medical industry, the entire apparatus of the industry and relevant government entities (many of which are entirely captured by the same worldview) is so entirely bound by the view that we must subsidize, that we must transfer incomes via regulation of the medical industry, that they descend into such contorted reasoning along the lines of Everything Not Obligatory Is Forbidden. Those are the only two options once we've decided to implement a system that, instead of being oriented toward individuals internalizing the costs of their choices, is oriented specifically for the purpose of externalizing the cost of every single choice you make, no matter how minor, so long as it pushes around some mathematically-computable risk factor in a PubMed article somewhere. This is why such folks literally think that the only option other than strictly making things with some medical risk forbidden (unless you pay someone with a special government license to give you permission) is to literally put a bullet in the heads of anyone who does anything with computable medical risk. This sort of thing would be unthinkable to even express in the automotive world, because the entire mindset is starting from a completely different frame.
Unsurprisingly, this sort of reasoning is incoherent on its own terms. As mentioned in the other topic in the OP, the vastly dominant risk factor driving obscene amounts of medical spending is obesity. Why doesn't the exact same logic work? Why are we not forced to put a bullet in the head of anyone who uses food irresponsibly (perhaps anyone who attempts to purchase some food that hasn't been prescribed by a government-licensed dietitian)? Why wouldn't we have to put a bullet in the head of anyone who works on or drives their own car, rather than having it serviced by a government-licensed mechanic and be chauffeured around by a government-licensed driver? But this is truly the type of reasoning that has infected anyone who is remotely influential in medical policy. Transferring incomes via medical policy is in their bones, like a sacred value. From this core flows most of the ridiculous policy choices we've made, which have built up hack upon hack, ultimately resulting in messed up incentives for insurance companies. Insurance companies are basically not allowed to be honest and provide an honest product at this point, but that's only one of the many effects of a complete error in mindset.
The more I think about it, the more the auto/medical insurance comparison is driving me up a wall.
I mean, imagine if auto insurance worked like health insurance. For starters, it would be the equivalent of accident insurance plus a maintenance contract. If they had to accept "pre-existing conditions" people would be driving their cars around until fumes were filling the cabin for unknown reasons, get insurance during an open enrollment period, and then dumping their clunker on the nearest garage with entitled demands to "just fix it". Further, imagine car mechanics had some sort of "duty of care" to these cars, and couldn't just turn them away. Imagine of mechanics had to fix cars, regardless of cost, of anyone who could tow them to the garage. And then a bunch of these people just took their cars and drove off into the sunset without paying a dime.
Suddenly car insurance companies would be desperate for anything they could possibly due to stay solvent. And garages would just be making prices up out of thin air to stay solvent. They'd both have virtually uncapped and unavoidable liabilities, and limited means of income. Absolutely every single interaction with a "customer" would be an arms race where they need to either fleece this person as thoroughly as possible, lest they risk getting taken by this person for as much as possible.
Conversely, if health insurance were just like car insurance, they'd pay for traumatic injuries and sudden illness and that would be it. Chronic issues are on you, lifestyle issues are on you. Furthermore, they'd probably calculate your estimated years of life left, versus cost of treatment, to render a decision about whether you are "totaled" or not. They'd probably be a lot more like life insurance too, where they go over you with a fine toothed comb in deciding what the cost to insure you should be. Hospitals and doctors would expect payment for services up front, but hopefully would drop the arms race and just have generally consistent pricing for x-rays, casts, stitches, etc.
Now, things get thorny, in both directions, when you consider the state requiring you to have car or health insurance. Many states do currently require car insurance, and many states are also experiencing the effects of society shifting towards low trust defect-bots where illegal immigrants without insurance are crashing left, right and center ruining things for everyone, and despite breaking all the laws, nobody does jack or shit about it. Likewise when the ACA attempted to make having health insurance mandatory, the cost of plans was so ruinous many people just ate the penalty, and the whole scheme was so unpopular Trump got the mandate revoked.
But maybe we could pretend we still lived in a functional high trust society where everyone bought health insurance and the prices were reasonable, with all of the above. I still don't think people would accept the tradeoffs of health insurance being "just like" car insurance.
Yeah… ultimately, a lot of Americans view health insurance as a general paypig for health-related expenditures, in a way they don’t when it comes to car or home insurance (not yet, at least, as they’re getting there with regard to uninsured motorists [a Noticer might ask: and who are these "uninsured motorists"?]). From their point of view, health insurance companies exist just to approve claims and send money.
They’re not entirely blameworthy in that view, descriptively-speaking. Where the US government does its usual subsidization of demand and restriction of supply, and turning intrapersonal reallocation of risk into stealth interpersonal redistribution of wealth (another example would be Social Security).
However, prescriptively, it’s also an ought for many Americans—not just an is—that Someone Else should pay for their healthcare (especially if they’re frequent flyers due to some meme “diseases”/”disabilities”), that Someone Else should pay for their parents’ end-of-life care to eke out a few more months (lest they have to do a cost-benefit analysis using their parents’ estate—or heaven forbid—their own net-worth), that Someone Else should pay for the healthcare of Vulnerable Communities such as women, non-Asian minorities, and Persons of Under-documented Citizenship.
The notion that health insurance companies might perform actuarial risk/reward assessments is out of their personal Overton Windows. On DataSecretsLox (where I’m but a humble, occasional lurker), there were two back-to-back comments that I thought summarized the situation nicely:
Lumifer:
EchoChaos:
Illegals, who everyone just bluntly refers to as illegals or ‘Venezuelans’ when they’re around them. It’s not some big secret; when I went to driving school they straight up told us it was a good idea to have uninsured motorist protection in case you got into an accident with an illegal.
This isn’t some kind of politically incorrect knowledge that everyone pretends not to have like 13/52 or drunk driving rates by ethnicity.
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