> For me it’s just the fact I cannot state any opinion at all because of the controversy it might cause.
Years ago I would have rolled my eyes at this comment. As someone who is liberal and runs in liberal circles, it seems ludicrous to me that any sane person would get called out for anything not overtly racist or mean spirited.
Then one time I asked in a group chat — with people I thought were my friends — about where I could read about trans kids getting hormone blockers, because I wasn’t really sure about giving kids (who generally don’t know what they want) the kinds of drugs that alter their bodies.
The rebuke I got was swift and severe. For reference… I’m a mid-30s gay man who lives in the Bay Area, and I wasn’t even expressing an opinion.
I mean, isn’t that always the case though? That lots of people don’t belong there? It’s just the law of large numbers + the ever shifting lives of people.
There is no hiring process that is perfect. Plus, people burn out, organizations shift focus, etc. People who shouldn’t have been hired in the first place make it in, and people whose skills no longer match the job hang on.
Medicare and Medicaid pay some of the lowest rates. Private insurance from employers and individual policy holders subsidizes the cost for the elderly and poor. Charging the same price would disrupt that, creating all kinds of political fallout.
Hospital is free to determine their prices, but they cannot give steep discounts to one channel of sales over other. They have to be consistent.
Healthcare pricing should be based on cost+plus models for the hospitals rather than on value driven approach you see every else in any sales.
We are not questioning their costs whatever they maybe, if the costs logically remain roughly same no matter how a particular patient came to them, then there is no reason for price to be different depending on type/ nature of insurance or lack thereof.
Only if there is no competition and no free market[1]
If you are locked into "choosing" the one in-network service provider in your area who can price very differently for your insurance than for others yes there is room for perverse incentives as is today.
If you and I can choose freely from any service provider in the area and everyone has to price the same way( i.e. not change basis who the customer is) then they will have to be competitive, people are very price sensitive and will tend to move towards the ones which are cheaper.
See how the airlines all slowly have moved towards the low-cost models: more economy/less first class even if they were full service. Sure you will have some Frontier/Spirit type organizations eventually but if they get the job done(Moving you from A to B) at lowest price then that is all that matters[3], similarly if a hospital is no-frills and gets your cataract operation[2] or do regular checkup faster and cheaper they will do so and plenty of people benefit from that.
Force hospitals to compete, not lock into monopolistic preferential contracts with some buyers and force users to now be exhorted crazy premiums to avoid the possibility being charged even more. Price regulation does not mean government fixes the prices, it should just mean that service provider have to charge the same for anyone without knowing their source (which insurance plan/company or self-funded and income level).
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[1] While there are some cases where two hospitals / doctors are not equivalent and cannot be compared, vast majority of care is fungible, i.e. you can replace one hospital / doctor with another without material impact to outcome of care.
[3] This assumes robust regulation, which we already have in healthcare, probably more so than required, there is no systemic regulatory oversight problems in the industry today.
But what's the cost? Complex hospital services have so many inputs that it's impossible to do cost accounting in a completely consistent way. Hospitals literally don't know what their costs are.
Come on. We can put a price on a house, that has thousands of materials, contractors, and other variables like property taxes and mortgage rates. But we can’t put a price on a medical procedure? Give me a break.
It is not only possible as the sibling post compares, they already do it today.
If your claim is hospital management and administration does not have a clue like a early stage start-up founder on VC money what their per-unit costs are, I am not sure you have negotiated a bill between insurance, hospital and you in the U.S, it is laughably false.
Even doctors are acutely aware of how tagging their services under which SKU is covered how by which insurance and by how much, and also how much they make from the hospital for that as well.
I don't think it would work well. Hospitals are not a free market in most of the US. You have to get a Certificate of Need to set up a new one. Given the near monopoly they have in the local area, regulation is probably going to be required if nobody gets to negotiate.
Why can't a hospital charge the same price for the same procedure? I can see that different hospitals may charge different prices from each other. But a single hospital should charge the same no matter if uninsured, insured or whatever.
What is to stop the local hospital from deciding that an appendectomy costs a million dollars? You pay, insurance pays, no matter, is is a million bucks.
The only business that works that way is retail. And even then most will negotiate on bulk orders. Almost everyone else will have a price list they negotiate off of.
I would think that hospitals could create price schedules similarly to how other businesses do.
Although I imagine this gets really messy when dealing with Medicare and with the mandate to treat everyone regardless of their ability to pay. I'd expect those arrangements would need to change to make this work.
I feel a bit silly pontificating about this. Hopefully someone who really understands the topic will weigh in.
This would be true if there were a reasonable amount of market understanding by customers and the friction to switching were low. Neither are the case. Most of the time, it takes a qualifying life event or open enrollment (once a year) to switch. And then, understanding the trade offs between plans, which are difficult to understand on a good day, is another barrier.
Then why are insurance company profit margins so low? Why wouldn’t they just jack up premiums irrelevant to their competitors and ignore negotiating pricing and see increasing margins?
Low profit margins/multiple sellers indicates a highly competitive field, which means the businesses must be doing something stay in business.
Yeah, but "something" could be advertising, kickbacks, cherry picking, lemon dropping, making comparison difficult, selectively optimizing visible metrics while balancing with dirtbag fine print, etc etc.
Then the competition who does not do that crap would offer lower premiums and steal business. Just like any other business that wasted money cannot compete with a business that does not waste money.
And this is only true in a markets that are easy to enter. Starting an insurance company isn’t easy.
Why are profit margins only 5%? Could be many reasons, including collusion. Insurance companies have teams of lawyers whose job it is to navigate existing regulation, lobby for new ones and to push for ones that hurt competition.
Given how shady and complex the entire industry is, we don’t really have a reason to believe that 5% is an accurate number.
Stating that SEC filings for an entire industry are fraudulent across 7+ large companies with tens of thousands of employees each is a pretty serious accusation that I cannot entertain without proof. The other option is I stop trusting in the whole system.
People who work at FAANG calibre companies are professionals, perfectly capable of finding new positions that suit their skills and level of commitment. I think it’s infantilizing to take the CEO’s comments and imply that those employees are being mistreated.
The Constitution doesn't say that the Supreme Court is the final say?
Constitution, Article 3
> The judicial Power of the United States, shall be vested in one supreme Court, and in such inferior Courts as the Congress may from time to time ordain and establish. The Judges, both of the supreme and inferior Courts, shall hold their Offices during good Behaviour, and shall, at stated Times, receive for their Services, a Compensation, which shall not be diminished during their Continuance in Office.
If your question was intended to claim that the Article you quoted gives The Supreme Court ‘the final say on legal interpretation,’ I’m interested to know which words in that Article you believe gives that say.
> Supreme Court can just ignore its own precedents
I’m not a fan of the current Court, but stare decisis has never been binding. Landmark rulings are landmarks because the create or break precedent. Courts have been doing that since there were courts.
Stare decides bound Casey, at least. It's never before been ignored when it established a new individual right (Dobbs overturns precedent to remove a right, which has never been done before). This really can't be minimized as "Courts gonna Court".
> If not, then it would seem to imply that we are OK with western powers using their capital (instead of gunboats) to impose their ideology on other cultures in the world.
“impose their ideology” is a disingenuous frame for this situation. They are censoring search results. As in, the customer, who Amazon makes money off by showing them what they want, is not being shown items that relate to what they searched for.
That’s not a pop-up that says “Muhammad was bisexual.”
In any case, cultural relativism is a liberal cop-out. American companies should use their capital to promote American values.
> American companies should use their capital to promote American values
Like how Facebook bans all nudity, even in countries where nudity is much less of a big deal (eg Germany)? Or apple has a blanket ban on “adult” apps in their App Store, because in America violence is ok but sex is bad?
I hear what you’re saying, but as an Australian, exported American cultural values can be pretty odious too. I don’t have any simple answers though.
I wouldn’t consider those “American values,” except in the sense that those companies are trying to protect their interests by having a platform that appeals to a wide variety of people.
Which, come to think of it, is itself a distinct value: compromise of free expression for money.
> They are censoring search results. As in, the customer, who Amazon makes money off by showing them what they want, is not being shown items that relate to what they searched for.
But that happens in the US too, if I want to ISIS's propaganda magazine on Amazon is it censorship that I can't find those? If I look for porn on youtube, is it censorship I can't find it?
youtube doesn't want to. there's plenty of porn sites in the US. there's plenty of money in the porn industry too.
sure, there's a social stigma. but if google/youtube/alphabet wanted to (as in they think there's enough money to be made in that sector) they would do it.
US conservatism does interfere with a lot of personal things (cough), but at least the current status quo is that it does not want to restrict selling data. (though there's a big think-of-the-children scare, and with the same sustained push for banning this or that this could change eventually)
I am not arguing that they are the same, have a look at what I quoted. This is really annoying me with HN, people looking for an easy dismissal of an argument instead of trying to actually talk about the underlying point.
The point that I am trying to make is that the argument I quoted doesn't work, because we already have situations where someone might look for something and can't find it.
I am not agreeing this is good, I am not saying it's the same, I am just trying to interact with a specific argument. This is a complex topic about cultural differences and ethics, let's try to stay curious and not just give shallow dismissals.
The examples you used for that point are bad because they come off as false equivalence, and “porn on YouTube” (age rating) and “ISIS books on Amazon” (murder) already have very legitimate justifications. Banning pride can be just a shirt with the word “gay”, and that’s absurd without needing an explanation.
>Well when 80% of all US Dollars were "printed" / created in the last 2-3 years massive inflation will follow
Be careful. This theory tracks for regular currencies, but gets distorted (note: I didn’t not say that it doesn’t apply, only that it isn’t as strong as you say) when the currency in question is the reserve currency for the world.
Classic Model didn’t predict this, because “this” is a totally bonkers scenario. Inflation is running hot (additionally) because supply chains have been torched (China and Russia) just at the time when demand came roaring back (the world minus China gave up on lockdowns).
You’re not wrong, but I encourage you to resist the temptation to simplify the story down to “classic” vs “MMT.” It’s tempting, but the world is very very complex and it ain’t getting any simpler.
Years ago I would have rolled my eyes at this comment. As someone who is liberal and runs in liberal circles, it seems ludicrous to me that any sane person would get called out for anything not overtly racist or mean spirited.
Then one time I asked in a group chat — with people I thought were my friends — about where I could read about trans kids getting hormone blockers, because I wasn’t really sure about giving kids (who generally don’t know what they want) the kinds of drugs that alter their bodies.
The rebuke I got was swift and severe. For reference… I’m a mid-30s gay man who lives in the Bay Area, and I wasn’t even expressing an opinion.
Yeah; I’m out.