At its very core, an insurance company operates by: 1) pooling policyholder’s risks together and 2) collecting premiums from the policyholders based on actuarial data, to pay claims and maybe make a small profit. But looking broader, an insurance market exists when: a) policyholders voluntarily or are obliged to obtain policies, b) insurers are willing and able to accept the risks in exchange for a premium expected to support the insurance pool, and c) the actuarial risks are calculable and prove true, on average.
The loss of any of A, B, or C will substantially impact a healthy insurance market, or can prevent the insurance market from ever getting started. For some examples of market failures, the ongoing California homeowner insurance crisis shows how losing B (starting with insurers refusing to renew policies near the wildland-rural interface) and C (increase in insured losses due to climate change) results in policies becoming unaffordable or impossible to obtain.
As a broader nationwide example, an established business sector that operates wholly without insurance availability is cannabis. A majority of US States have decriminalized marijuana for medical use, and a near-majority have legalized recreational consumption. Yet due to unyielding federal law, no insurer will issue policies for marijuana businesses, to protect from risks that any business would face, such as losses from fire, due to a product recall or product liability, or for liability to employees. These risks are calculable and there’s a clear need for such policies – thus meeting criteria A and C – but no commercial insurer is willing to issue. Accordingly, the formal market for cannabis business insurance is virtually non-existent in the USA.
With these examples, we can see that the automobile insurance market meets all three criteria for a healthy market, but it’s how these criteria are met which is noteworthy. Motorists in the USA are obliged to insure in every state except New Hampshire and Virginia: it is a criminal offense to drive a car without third-party liability insurance, meaning the motorist might spend time in jail. Note: NH and VA won’t send a motorist to jail, but they do have administrative penalties for driving without “financial responsibility”, which includes insurance or a bond at the DMV.
The exact requirement varies per state, with some requiring very low amounts of coverage and others requiring extra coverage like Personal Injury Protection (PIP, aka no-fault insurance). The point is that criteria A is easily met: motorists want to avoid jail, but also want to avoid the indignity of being sued after having caused a road incident, in addition to protecting their apparently only viable mode of transportation.
Insurers can take into account the overall trends in national risks trends for automobiles (eg new car safety, through the Insurance Institute for Highway Safety, IIHS) as well as local or hyper-local risks (eg hail damage in the southeast, property crime in a particular zip code). And as a large country with nearly as many cars as people, many insurers are willing to meet the demand. This satisfies criteria B and C.
So well-organized is the automobile insurance market that you could almost say that it’s vertically integrated: the largest nationwide insurers have contracts in place with every dealership network, auto collision chain, new and used parts dealers, as well as automatic data sharing with state DMVs, plus with firms like CarFax that buy information. Despite each state being slightly different, the insurers have overcome and achieved a level of near uniformity that allows an efficient market to exist.
Things are drastically different for the American healthcare system and for American health insurance companies. While most think of their healthcare provider as a national name like Anthem Blue Cross or Kaiser Permanente, the reality is that each state is an island, and sometimes counties in a state are enclaves. Even federal programs like Medicaid and Medicare are subject to state-level non-uniformities. For example, hospitals can be either privately operated (eg religion-affiliated, or for-profit) or run by a public entity (eg county or state), and can exist as a single entity or form part of a regional hospital network. Some entities operate both the insurance pool as well as providing the health care (eg HMOs like Kaiser Permanente) while others dispatch to a list of contracted providers, usually being doctor’s own private practices or specialist offices.
With so many disparate entities, and where healthcare is a heavily-regulated activity by each state, the cost of insurable risks – that is, for routine healthcare services – is already kinda difficult to compute. Hospitals and doctors go through intense negotiations with insurers to come to an agreement on reimbursement rates, but the reality is that neither has sufficient actuarial data to price based on what can be borne by the market. So they just pass their costs on, whatever those may be, and insurers either accept it into their calculations, or drop the provider.
Suffice it to say, there are fewer pressure to push the total cost of healthcare down, given this reality, and more likely prices will continue to climb. This fails criteria C.
Briefly speaking, it’s fairly self explanatory why people would want health insurance, since the alternative is either death or serious health repercussions, paying out-of-pocket rates for service, or going to the ER and being burdened by medical debt that will somehow haunt even after death. Criteria A is present.
As for Criteria B, that was actually resolved as part of the Affordable Care Act (ACA). During discussions with the drafters, insurers bargained for an obligation for everyone to have insurance (aka the individual mandate, bolstering criteria A), in exchange for an obligation to issue policies for anyone who applies, irrespective of pre-existing health conditions. Thus, Criteria B is present for all ACA-compliant policies in the USA, even though the individual mandate was later legislatively repealed.
So to answer your question directly, the costs for healthcare in the USA continue to spiral so far out of control that it causes distortions in the health insurance market, to everyone’s detriment. Specific issues such as open-enrollment periods, employer subsidies, and incomprehensible coverage levels all stem from – and are attempts to reduce – costs.
Enrollment periods prevent people from changing plans immediately after obtaining an expensive service, like a major surgery. Employer subsidies exist due to a federal tax quirk decades ago, which has now accidentally become an essential part of the health insurance and health care situation. And coverage levels try to provide tiered plans, so people can still afford minimal coverage for “catastrophic” injuries while others can buy coverage for known, recurring medical needs.
But these are all bandaging the bleeding which is unchecked costs. It would take an act of Congress – literally – or of state legislatures to address the structural issues at play. The most prominent solution to nip costs is the bud is to achieve the same near-vertical integration as with automobile insurance. This means a single or very few entities which have contracts in place with every provider (doctors and hospitals), negotiated at once and uniformly, so as to achieve criteria C. The single-payer model – which Medicare already uses – is one such solution.
Going further would be the universal healthcare model, which discards the notion of health insurance entirely and creates an obligation for a government department to provide for the health of the citizens, funded by taxes. This means doctors and hospitals work at the behest of the department for the citizenry, or work privately outside the system entirely, with no guarantee of a steady stream of work. Substantial administrative savings would arise, since the number of players has been reduced and thus simplifies things, including the basic act of billing and getting paid for services rendered.
These models could be approached by individual states or by the nation as a whole, but it’s unclear where the Overton window for that idea currently is.
I find it hard to believe that a far market can exist when everyone is required or effectively required to purchase something. If you think of supply and demand, the demand for something like health insurance or legally mandated car insurance is effectively infinite.
The decision to get car insurance or not is not “is the value this car insurance provides worth the money” it’s “is the value this car provides worth the money”. Similarly, the value of health insurance becomes the value of getting any sort of medical treatment, because it’s generally impossible to get treatment otherwise.
This allows the insurance companies to charge rates far beyond the value they actually provide, because they are legal gatekeepers to far more valuable opportunities.
We use libreNMS. Its docs state that it will do this, but we only use the uptime monitoring feature, so I can’t arrest as to how well it will monitor everything else.
I use this too. When SNMP is set up there are loads of things you can monitor with LibreNMS. Much less of a learning curve than Grafana + Prometheus, although the latter probably has some nice tweaks available that SNMP does not provide.
42TiB (I managed to get about 5TiB back by defining remux to be lower quality as “normal” releases in the arr* apps 😎) Now I can finally add more media
I went to Amsterdam over the weekend. The weather apps said it was gonna rain, did it fuck. I brought my puffer jacket and was almost dying from the heat until I got to the hotel room. Never had to wear it during the trip.
Then for the dramatic take - the BBC version of House of Cards / To Play the King / The Final Cut starring Ian Richardson (Not the US version with Kevin Spacey)
Black Books
…and then Father Ted and IT Crowd
Then I think you have to include the big HBO series: The Wire / The Sopranos / Game of Thrones / House of the Dragon.
NixOS is cool, the whole Linux configuration in one file is convenient but I already found my home and comfort place that’s Arch btw don’t think I switch to other distro anytime soon
Just to clarify, I wouldn’t recommend putting everything in a single file, but rather modularize the configuration.
I also came from Arch, but have since abandoned it, and I don’t think I want to use distributions for myself that use the the classic imperative concept. One you get a better understanding of it, it makes so much more sense.
I’m a centrist but I lean slightly right, and I’ve used Linux for 15 years. There are plenty of conservatives who use Linux for the privacy and security advantages it offers. At least one of the Linux YouTubers I watch is quite conservative. That said, Linux dev communities don’t tend to take kindly to conservative members voicing opinions while many allow left-wing opinions free rein, and some distro devs have openly stated they don’t want conservatives using their software. They should either allow political opinions from everyone or nobody, IMO. I’d say preferably just leave politics out of it altogether, FOSS should be open to be used by anyone regardless of politics or any other factors.
As someone with conservative views, do you believe in conserving the environment through strong environmental regulations, or do you prefer letting these big fancy companies take away our seasons and weather and animals for their own agendas?
I don’t know how to say it in a polite way but you are annoying. Original commenter stated that they want to keep the politics out to which you answered with a political argument that can basically be translated to “You are stupid”.
I guess you come from some internet political circle where the “My idea is the best and everyone else is dumb” is tolerated because generally these “communities” have common views. But this /c/ is not a place for that. People don’t share a singular opinion here so if everyone acted like you, this fun linux forum would no longer be so fun. Everyone would just crap on each other because each would think their opinion is the best and others are dumb.
I personally come here to relax or something, not get tired by arguments.
This is a political post. It even says libertarian in the title. The meme uses the word “liberal” and threatens violence to people based on the political freedom of their operating system. You chose to click on it, you chose to read it and continue reading, and you chose to go to the comments to talk about it. Now you’re complaining that politics are suddenly involved. Sorry buddy, it’s time to take some personal responsibility for your own decisions. You made a choice and now you’re complaining that you have to see what you clicked on this meme to see. There’s nothing I or anyone else can do to protect you from seeing the things you deliberately click on.
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