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.
I’m no expert, but I might be able to help. Generally and historically in the U.S. one electric company (often called power companies) would handle the entire operation for a local area. They own the generators, long distance transmission lines, and the “last mile” connection to consumers, whether residential, commercial, or industrial. These are expensive systems to build so it doesn’t really make sense to have more than one company providing this service to an area. The power companies are granted a monopoly for whatever area they serve by the state, but in return they are also closely regulated by the state for the business side of the operation, such as how much they can charge for electricity but also making sure they have enough generation capacity and that the distribution system is adequately maintained. They are also regulated by the federal government to make sure they meet technical standards for compatibility. The regulation ensures the companies make a profit by try to keep it relatively small since electricity is a basic necessity. Power company stocks are generally considered a stable, reliable investment. They won’t necessarily grow much, but they should always make a profit.
Each power company is responsible for their own area and the network they operate, often called a grid. However, for resilience they’re usually connected to neighboring grids so that they can get extra electricity if needed. This isn’t free; they will have to buy the electricity from the neighboring grid but it will probably be at a discounted rate. They might also sell electricity to a neighboring grid, of course. I don’t know why they aren’t all just connected to each other in one big grid, though.
Historically, yes. But the prices are generally not bad compared to what I’ve heard in other countries. For instance, the main power utility near me for residential service charges a base fee of $14/month to be connected to the grid and 11.661¢/kWh ($0.11661/kWh). There are some exceptions to this, of course. I actually live in a small town that for whatever reason has historically operated its own electric utility. They maintain the local grid and connections to homes but don’t have generators. They buy the electricity from the previously mentioned utility at a wholesale rate of around 6.5¢/kWh and we as customers pay 10.4¢/kWh. Our base connection fee is closer to $25/month but that also covers our water and sewer connection and trash (including yard waste) and recycling collection. Our town has a good solar energy program, though, so a lot of homes have put solar panels on their roof and there have been days where the town has generated 100% of its electricity from solar panels in the town.
There are some areas that have gone for a more “deregulated” approach where customers have a choice of who they pay for their electricity. I’m not sure how that really works, though, since I don’t think companies are out there building additional electric lines for their customers. Texas is one of the main places I can think that has done this but it seems like the companies have made higher profits for themselves while lowering prices by not maintaining the grid. I have a friend who lives in Texas and he’s always complaining about losing power randomly. I think California was trying to do something similar a long time ago but I’m not sure they’re doing that anymore. That was tied to the whole Enron debacle. I can recommend a book called Conspiracy of Fools by Kurt Eichenwald for more on Enron; it’s not Explain Like I’m Five but still pretty easy to follow even if you don’t understand the accounting concepts they ignored.
I’m not a Linux admin, but I think there are certifications you can get and exams you can take to show you understand stuff about shell scripting and related topics, if that’s what you’re interested in.
I think they have questions like “Make it so a welcome message and the time display when someone logs into your Linux server”, among other, harder things.
I don’t know a huge amount about the job market, but just saying you have those kinds of skills on your CV along with a bit of experience in some other tech/coding/data stuff might even be enough.
Been using Linux for 25 years so i don’t know if it’s comparable to today but ironically it was setting up game servers for fun. Then i applied for a game sever hosting provider. i think they have mostly died out now. Then just kinda jumped over to web hosting this was before cloud was a thing. Then kinda moved into internal IT running corporate IT. The nice thing being 100% Linux admin i don’t have to mess with AD and FSMO. Even though I know how to i keep quiet about that.
I work with two guys named “Brayden”. One of them is a ginger. Both of them are nasty assholes and pissed off all the time. I guess I would be too if I were cursed with that name.
But lots of people have gotten past unfortunate given names. “Rich” for example.
I’ve gotta rep one of my all time favorite party games to this day (ported to PC) Worms Armageddon. They’ve had several sequels, but I believe that was the last one to use that particular physics engine, and every game since has just felt a bit… Hollow?
Also +1 to Paper Mario - S-Tier RPG, best of the whole series IMHO, tho the GameCube sequel TTYD is deserving of a very close second. I wish so bad they’d make a return to badges and acquiring new buddies and buddy upgrades throughout the game. The oragami king battle mechanics did not do it for me, and with it being the core mechanic of the game just soured my whole experience despite the rest of the game being pretty solid.
Reactions and side effects are dependent on the person. I’m healthy so I don’t typically take medications but this was my experience on Strattera, which you’re supposed to take with food. That warning was no joke. I had to take it with a meal, because I’d risk feeling queasy with only a snack. But at low doses, it was fine. Very manageable.
As my dose was increased, the nausea started becoming constant. I couldn’t do anything to relieve it. At one point I was at a restaurant and had to go throw up in the restroom. After that I decided to stop taking Strattera, because the nausea made for a miserable experience and was not worth it at all. I was instantly better once I stopped.
Like the idea of the comic, but the order of the panels is kinda meh. I think the chimney from the inside de house should be first, then Santa’s face with a reaction like this 😣, then inside again maybe leaving aa present like a larva leave an egg, then to Santa 🤤 and finish with the entire Santa’s image climbing on his ride.
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