<story><title>Employees Start to Feel the Squeeze of High-Deductible Health Plans</title><url>https://www.npr.org/sections/health-shots/2019/05/03/719519579/employees-start-to-feel-the-squeeze-of-high-deductible-health-plans</url></story><parent_chain><item><author>rayiner</author><text>By contrast, would the US be able to stomach denying cutting-edge treatment because it’s too expensive, like the UK? &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.theguardian.com&amp;#x2F;science&amp;#x2F;2017&amp;#x2F;dec&amp;#x2F;20&amp;#x2F;drug-giants-hefty-prices-nhs-vital-medication-pharma-profits&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.theguardian.com&amp;#x2F;science&amp;#x2F;2017&amp;#x2F;dec&amp;#x2F;20&amp;#x2F;drug-giants-...&lt;/a&gt;&lt;p&gt;That’s what makes me nervous about socialized medicine in the US. I’m absolutely in favor of universal coverage—a healthcare system that maximizes the health of the average productive person. But I worry that Americans lack the cold realism of Brits, and won’t be able to effectively control costs by denying cost-ineffective treatments.</text></item><item><author>FireBeyond</author><text>Right. And therein lies the rub. The US is quite possibly one of the worst in the world for &amp;quot;Fuck you I got mine&amp;quot; (until you don&amp;#x27;t got yours). And then there&amp;#x27;s the cognitive dissonance of people who might have otherwise screamed about &amp;quot;socialized medicine&amp;quot; who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...).&lt;p&gt;How many other countries in the world consider medical bankruptcy a thing to be accepted and tolerated?</text></item><item><author>cmuguythrow</author><text>To be fair, this perspective does assume that people care about the health of society as a whole. If you&amp;#x27;re willing to let others get substandard care or even die, it may be more optimal for you to have your own smaller, lower-risk pool with better benefits.</text></item><item><author>CptFribble</author><text>Every discussion on healthcare payment structures in this country is completely asinine.&lt;p&gt;Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool.&lt;p&gt;How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed.&lt;p&gt;But as long as we keep ourselves fractured into thousands of different risk pools, all these discussions about deductibles and HSAs and whatnot are just chasing our own tails.</text></item></parent_chain><comment><author>CydeWeys</author><text>Insurers deny expensive or cutting-edge treatments in the US all the time!  You don&amp;#x27;t have to look hard to find sob story after sob story.&lt;p&gt;And it makes sense.  If a treatment is super-expensive and unlikely to be effective anyway, and that money could be put to better use to help more other people ...  It&amp;#x27;s like how someone who smokes isn&amp;#x27;t going to get a lung transplant; there&amp;#x27;s too many others that need transplants and not enough lungs to go around, so give the lungs to the people who will benefit the most from them (generally, people who are young and otherwise healthy).  There aren&amp;#x27;t infinite resources in this world, so in the cases where scarcity comes into play, they should be doled out in the way that creates the greatest good.</text></comment>
<story><title>Employees Start to Feel the Squeeze of High-Deductible Health Plans</title><url>https://www.npr.org/sections/health-shots/2019/05/03/719519579/employees-start-to-feel-the-squeeze-of-high-deductible-health-plans</url></story><parent_chain><item><author>rayiner</author><text>By contrast, would the US be able to stomach denying cutting-edge treatment because it’s too expensive, like the UK? &lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.theguardian.com&amp;#x2F;science&amp;#x2F;2017&amp;#x2F;dec&amp;#x2F;20&amp;#x2F;drug-giants-hefty-prices-nhs-vital-medication-pharma-profits&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.theguardian.com&amp;#x2F;science&amp;#x2F;2017&amp;#x2F;dec&amp;#x2F;20&amp;#x2F;drug-giants-...&lt;/a&gt;&lt;p&gt;That’s what makes me nervous about socialized medicine in the US. I’m absolutely in favor of universal coverage—a healthcare system that maximizes the health of the average productive person. But I worry that Americans lack the cold realism of Brits, and won’t be able to effectively control costs by denying cost-ineffective treatments.</text></item><item><author>FireBeyond</author><text>Right. And therein lies the rub. The US is quite possibly one of the worst in the world for &amp;quot;Fuck you I got mine&amp;quot; (until you don&amp;#x27;t got yours). And then there&amp;#x27;s the cognitive dissonance of people who might have otherwise screamed about &amp;quot;socialized medicine&amp;quot; who find themselves on the unlucky end of a diagnosis and are singing a different tune (or sometimes still singing the same tune, even as they put up a GoFundMe...).&lt;p&gt;How many other countries in the world consider medical bankruptcy a thing to be accepted and tolerated?</text></item><item><author>cmuguythrow</author><text>To be fair, this perspective does assume that people care about the health of society as a whole. If you&amp;#x27;re willing to let others get substandard care or even die, it may be more optimal for you to have your own smaller, lower-risk pool with better benefits.</text></item><item><author>CptFribble</author><text>Every discussion on healthcare payment structures in this country is completely asinine.&lt;p&gt;Healthcare is best managed as a risk pool. The bigger the pool, the cheaper to be in it. The biggest risk pool is everyone. Therefore, we should put everyone in a single pool.&lt;p&gt;How we manage this is a separate discussion. Private, public, maybe a federally chartered non-profit like the Fed.&lt;p&gt;But as long as we keep ourselves fractured into thousands of different risk pools, all these discussions about deductibles and HSAs and whatnot are just chasing our own tails.</text></item></parent_chain><comment><author>FireBeyond</author><text>Well, that article talks about blaming Big Pharma for the costs that make it expensive, not the National Health Service.&lt;p&gt;With the big pool comes big leverage. The NHS effectively said &amp;quot;We&amp;#x27;re not paying that much&amp;quot;, and the pharmaceutical companies decided they&amp;#x27;d rather be paid something. Because if someone is not getting treatment, then they&amp;#x27;re not getting those drugs.&lt;p&gt;Medicare in the US does this. &amp;quot;This is what we are paying for this drug&amp;quot;.&lt;p&gt;The issue isn&amp;#x27;t so much this. It&amp;#x27;s that drug industry lobbies in the US will have far more sway over the politics of this than they would in the UK (or Canada, or Australia, or...).&lt;p&gt;I definitely don&amp;#x27;t claim to be an expert on these things. But I have lived in the UK with the NHS, in Australia with its medical system, and now in the US. In addition to that, I&amp;#x27;ve worked as a healthcare provider, and for a Health Benefits Management software company, so I&amp;#x27;d at least like to think I have something of a varied perspective.</text></comment>