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A comment on Interview with Jeff Atwood, Co-Founder of Stack Overflow. Parent comment

Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by g8oz on Wednesday January 22, 2025 @01:06PM (#42795714)
I think if the health insurance situation was as rosy in the U.S as you make out there would not have been as much support for the killer of the United Healthcare CEO. The figure for the average out of pocket expenses hides a lot of pain.
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by epistasis on Wednesday January 22, 2025 @01:34PM (#42796009)
People have lots of anger about healthcare for many many reasons. I can't tell you how many people I've met who are angry about "Obamacare" but don't realize how it helped them compared to the prior situation. There's also lots of anger at the prices for healthcare that we sometimes see, and that anger gets directed at insurance too, even if it's a hospital or other provider setting the prices. And then there's the anxiety of "will this be covered."

Even without out of pocket costs there's lots of reasons to be angry at insurers.

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by MrBrobot on Wednesday January 22, 2025 @04:59PM (#42797970)
Whether you agree with the Affordable Healthcare Act or not, I feel like nobody remembers “lifetime maximums.” I have some relatively minor (but massively impactful) pre-existing conditions, and I would have exceeded my lifetime maximum by age 30 due to testing, procedures, hospital stays, etc. I have family members that would have exceeded theirs before age 1.
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by MichaelZuo on Wednesday January 22, 2025 @06:25PM (#42798616)
How does the concept of health insurance, risk pooling, etc., make sense if there are no lifetime maximums…?

Eventually 100% of the population will need healthcare of some type.

And without maximums to plan and set prices against, wouldn’t it just be a wealth transfer scheme from the relatively young and healthy to the particularly old and sick…? (With those in the middle roughly neutral)

At least I can’t see any credible way to insure against something 100% of all possible customers will need.

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by wahern on Wednesday January 22, 2025 @07:00PM (#42798921)
> How does the concept of health insurance, risk pooling, etc., make sense if there are no lifetime maximums…?

You're right, it doesn't make literal sense. Though we use the term, health insurance, everybody is really talking about medical coverage, period, except for those trying to play semantic games (not pointing to you). Concepts like risk pooling can still be useful, but at the end of the day we're not really talking about insurance, but how to equitably spread the costs and benefits of rapidly advancing medicine.

Social Security is closer to an insurance scheme. Social Security is a deferred life annuity (a type of insurance instrument) that everybody is required to buy, except there's no middleman. Unfortunately, the last time we extended the deferral period to properly account for risk and cost was 1983. When Social Security originally passed it was assumed Congress would regularly change retirement ages; people in the 1930s knew how insurance worked, and knew full well that lifespans would continue increasing, but they failed to account for political friction in having to explicitly update the terms of the program. Other than military pensions, we didn't have much political experience with large entitlement programs (though it's possible the reason they didn't build in an inflation mechanism then is the same we can't do it today).

Medicare was patterned after Social Security, however like SS we don't properly adjust the age nor pay-in as lifespans have increased and medical costs soared; and advances in medicine and expectations of care evolve so quickly these days that I'm not sure its even possible as a practical matter, not while pretending it's truly any kind of insurance.

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by epistasis on Wednesday January 22, 2025 @08:32PM (#42799624)
Health insurance is already a huge transfer to older generations (not that that's a bad thing). Medicare pays for older folks but it doesn't pay anywhere near the cost of the services that older folks receive. Prices are higher for everyone else to fill the gap at health care providers.

Health insurance is in many ways not even insurance, it's in many ways a price negotiation mechanism.

Anyway the whole system is overly complex, based off a tax credit from the 1950s, but the transition to a new scheme is nearly impossible while one political party is dead set against any improvement, especially if it might be perceived as a positive for the other political party, and also they have become so hyper partisan that they are not allowed to work with the other party in a bipartisan manner.

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by MichaelZuo on Wednesday January 22, 2025 @09:07PM (#42799841)
Huh I didn’t know that. I thought those on Medicare only got the bare minimum service that stayed within cost.

In that case, the upstream sources of why Americans accept this huge charade is going to keep on messing with even the best laid plans.

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by MrBrobot on Thursday January 23, 2025 @09:53AM (#42804603)
It isn’t a simple money in, money out system. You’re taking higher value money in one year, and paying out some money that’s worth less later (inflation)… while at the same time, you’re investing the pool of money you collected, and earning returns on that before you pay out claims - claims that you’ve already negotiated down in price. But by the time the healthier customers need to start making large claims, they’ve already both subsidized the claims of other customers, and made the insurance company more money than they’ll draw in claims.
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by nradov on Thursday January 23, 2025 @10:28AM (#42804941)
It's a simple money in, money out system. Health insurance isn't like homeowner's insurance where the insurer accumulates and invests a pool of money in anticipation of occasional rare events like natural disasters that cause a spike in claims. Medical expenses across a large patient population are very predictable and there is no significant carry over of premiums from year to year. In fact, under the Affordable Care Act (Obamacare), it is actually illegal for most health insurers to do that. Any excess premiums collected must be returned to customers at the end of the year.
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by bko on Wednesday January 22, 2025 @01:37PM (#42796046)
75% of Americans with employer-provided health coverage are satisfied with their current plans

For Americans overall, 71% rate the quality of healthcare they personally receive as excellent or good. Similarly, 72% give excellent or good marks to the quality of care they receive personally.

Regarding health insurance coverage, 65% of Americans rate their own coverage as excellent or good. Another poll found 63% rated their own health care coverage as excellent or good.

You have to get offline

https://www.ahip.org/news/articles/new-poll-strong-majority-...

https://news.gallup.com/poll/654044/view-healthcare-quality-...

https://news.gallup.com/poll/468176/americans-sour-healthcar...

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by sympil on Wednesday January 22, 2025 @02:09PM (#42796338)
You have to get offline

Perhaps. But if I weren’t online I wouldn’t know how widespread the support of Luigi is.

Only 75% of people on employer healthcare plans are satisfied? A great many people aren’t on employer plans.

From the third link you provided:

For the first time in Gallup’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% -- a new high -- calling it “poor.”

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by bko on Wednesday January 22, 2025 @03:14PM (#42796991)
> The poll by CloudResearch found that 27% of U.S. adults expressed “moderate” or “a lot” of sympathy for Mangione.

> A smaller but significant share of adults, 12%, said they were supportive of the decision to murder Brian Thompson, 50, who was shot in New York on Dec. 4.

12% is basically zero in this country. To give you a frame of reference, 14% of people think Obama is antichrist

https://www.msn.com/en-us/news/us/1-in-4-americans-sympathiz...

https://www.yahoo.com/news/12-million-americans-believe-liza...

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by sympil on Wednesday January 22, 2025 @04:57PM (#42797958)
The former DHS head seems to think it’s a lot of people. Don’t know any other murderers who have 27% of the population having sympathy for them.

12% is not basically zero.

https://www.thewrap.com/luigi-mangione-discourse-alarms-home...

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by epistasis on Wednesday January 22, 2025 @02:39PM (#42796657)
Is the support that widespread, or is it a bubble created by social media?

I think there's great dissatisfaction with healthcare in general, but social media is not a good way of judging social attitudes across the US. It's great for finding a small niche, however.

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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by sympil on Wednesday January 22, 2025 @02:45PM (#42796725)
He’s got a lot more support than any other murderer I know about.
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by vkou on Wednesday January 22, 2025 @03:06PM (#42796929)
Not to mention, they are satisfied compared to what? The situation they'd be in if they were unemployed and had to pay for the entire overpriced thing themselves?
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by sir0010010 on Thursday January 23, 2025 @04:52AM (#42802473)
The thing about insurance is that the reason you purchase it is for managing tail events. And the only way to know if you are satisfied with your insurance company is to experience a tail event and see how your insurance company behaves. If you develop an expensive to manage chronic illness, is your insurance company prompt in paying claims? Does it try to deny all of them and require you to hire an attorney to get them to pay anything at all? Does it turn out that much of the treatments you need for recovery were never covered by insurance at all? And even if it is paying - how many hours a week do they expect you to spend submitting and resubmitting claims and calling various doctors to collect more information and submit more and more paperwork?
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Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow by glenngillen on Wednesday January 22, 2025 @10:34PM (#42800430)
I've lived in the UK, the USA, and Australia. I've had excellent employer funded/subsidised health insurance in the latter two. The moment my wife & learned we were having our first child it focussed our priorities in an incredibly clear and sudden way, and healthcare was a huge component of that. It was immediately clear we did not want to have a raise a family with the US healthcare system given the other alternatives we had available to us. We saw out the pregnancy in the USA and moved home to Australia shortly after. Our second child was born in Australia. The out of pocket cost difference between the two countries was negligible. My wife would subjectively say the quality of care we got in the USA was slightly higher, though there was nothing wrong with the care we got in Australia either so it's almost splitting hairs just to declare a winner. The most obvious difference is how little planning or effort needs to be made around healthcare decisions in Australia. No worrying about if we're in network or not. No worrying about if the pathology lab that's doing the testing is in network. Is some out of network surgeon going to be attending/observing on the day? What are the financial impacts if there are complications? Do we need to pre-agree a plan of what's acceptable financially? Is the bill we receive at the end accurate? Are there risks of signification on-going medication or other costs for medications if there's a complication in surgery?

Just a whole swathe of anxiety and stress that doesn't exist anymore. I'm not sure I can put a price on how valuable that is for our family. I clearly priced it higher than the higher income and lower tax I'd be paying if I'd stayed in the Bay Area though.

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