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One advantage most other countries have, with the government being the plan manager, is that the pool of taxes they can utilize for funding is larger. Income ta

One advantage most other countries have, with the government being the plan manager, is that the pool of taxes they can utilize for funding is larger. Income taxes partially fund health care, yes, but so does VAT. But at any rate, if you ignore the "free" point of the original poster, that post was quite correct. America leans heavily on corporations to perform the management of health care, and I don't see that as particularly "sane" to be honest. To me, such is an unnecessary competitive advantage to large corporations that can better manage the bureaucracy and expense. Small business owners often cannot afford the time and expense to offer this (understandably, to be honest). Consequently, employees that are self-employed or working for small companies may have to forgo health insurance. It is very possible that this leads to some talented employees resisting leaving a corporation purely for health insurance reasons, a phenomenon called "job lock" (https://www.jstor.org/stable/2118427?seq=1#page_scan_tab_contents https://www.jstor.org/stable/2118427?seq=1#page_scan_tab_con...).

zaroth 10y ago
At least when corporations search for a health plan, they are intensely competitive in finding the best plan for the price. Every year when their policies renew is another round of searching, comparing, and analyzing the various options in their local market. Health insurance has got to be the most expensive benefit a company offers by far, and I know even at a small startup we spend a lot of time finding the best plan for the money for our group. Compare that to the US government, which isn't even legally allowed to negotiate on drug costs, and look where that has brought us [1,2]. So you could argue companies "waste" an enormous amount of resources having to procure health insurance for their employees year after year, but it also at least helps establish at least some competition in the market, which puts at least some pressure on prices. Companies health insurance budgets are not unlimited (unlike the Fed's) so we don't see quite the same run-away pricing as you do when the purchaser is literally printing the money to pay for it. Obama's famous "you can keep your Doctor" lie is very telling. Different companies will elect for very different levels of coverage. The law requires that whatever level of coverage you chose to offer your employees is offered consistently from management down to your cheapest full-time employee, which is a really smart policy. Large corporations have better negotiating power in almost all respects of their operations, supply chain, and yes, employee benefits. We wouldn't imagine trying to 'level the playing field' in any other aspect of the operation of a company, so I don't think that's a compelling argument for single-payer health insurance? When small businesses chose to forgo even offering health insurance (which is that even legal now?) that is actually a competitive advantage for them; they avoid a huge operating cost, and implicitly are selecting for the type of worker they are looking for -- single, young, and healthy. [1] - https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Drug-Spending/Drug_Spending_Dashboard.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... [2] - http://www.nola.com/politics/index.ssf/2016/07/medicare_price_safeguard_actua.html http://www.nola.com/politics/index.ssf/2016/07/medicare_pric...
- soundwave106 10y ago
  The advantage of a "single payer" system would be to bring the benefits of large corporation negotiating power down to everyone. If there was no competition at all, I'm sure that there is some potential for rising costs. But a lot of "single payer" systems actually do offer a fair bit of wiggle room for private market competition. The mess that is the state of the United States government health care really isn't a compelling argument here against single payer (the statistics for most of the rest of the world's health care systems, which are more integrated, kind of show this). I would expect that any "Medicaid / Medicare for all" system emerge in the United States would be two-tiered, like is the case in several other countries. To be honest, I would almost describe the situation in America as oligopoly-like in many cases (in insurance and hospital networks in particular) depending on where you are, and that would mute the effect of any corporate competition.
- aplummer 10y ago
  You've made a false assumption that "intense competition" (italicised for emphasis!) always makes things cheaper. It doesn't apply with health insurance, which is why health costs are so much higher in the U.S than anywhere else. [1] Fact: the system of private health insurance in the U.S makes it more expensive for everyone. Source: every other western country paying far less. It is possible for the free market to fail when the thing people are buying is something they would pay any amount of money for. [1]http://gamapserver.who.int/gho/interactive_charts/health_financing/atlas.html?indicator=i3 http://gamapserver.who.int/gho/interactive_charts/health_fin...

zaroth 10y ago

At least when corporations search for a health plan, they are intensely competitive in finding the best plan for the price. Every year when their policies renew is another round of searching, comparing, and analyzing the various options in their local market. Health insurance has got to be the most expensive benefit a company offers by far, and I know even at a small startup we spend a lot of time finding the best plan for the money for our group. Compare that to the US government, which isn't even legally allowed to negotiate on drug costs, and look where that has brought us [1,2]. So you could argue companies "waste" an enormous amount of resources having to procure health insurance for their employees year after year, but it also at least helps establish at least some competition in the market, which puts at least some pressure on prices. Companies health insurance budgets are not unlimited (unlike the Fed's) so we don't see quite the same run-away pricing as you do when the purchaser is literally printing the money to pay for it. Obama's famous "you can keep your Doctor" lie is very telling. Different companies will elect for very different levels of coverage. The law requires that whatever level of coverage you chose to offer your employees is offered consistently from management down to your cheapest full-time employee, which is a really smart policy. Large corporations have better negotiating power in almost all respects of their operations, supply chain, and yes, employee benefits. We wouldn't imagine trying to 'level the playing field' in any other aspect of the operation of a company, so I don't think that's a compelling argument for single-payer health insurance? When small businesses chose to forgo even offering health insurance (which is that even legal now?) that is actually a competitive advantage for them; they avoid a huge operating cost, and implicitly are selecting for the type of worker they are looking for -- single, young, and healthy. [1] - https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Drug-Spending/Drug_Spending_Dashboard.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... [2] - http://www.nola.com/politics/index.ssf/2016/07/medicare_price_safeguard_actua.html http://www.nola.com/politics/index.ssf/2016/07/medicare_pric...

soundwave106 10y ago
The advantage of a "single payer" system would be to bring the benefits of large corporation negotiating power down to everyone. If there was no competition at all, I'm sure that there is some potential for rising costs. But a lot of "single payer" systems actually do offer a fair bit of wiggle room for private market competition. The mess that is the state of the United States government health care really isn't a compelling argument here against single payer (the statistics for most of the rest of the world's health care systems, which are more integrated, kind of show this). I would expect that any "Medicaid / Medicare for all" system emerge in the United States would be two-tiered, like is the case in several other countries. To be honest, I would almost describe the situation in America as oligopoly-like in many cases (in insurance and hospital networks in particular) depending on where you are, and that would mute the effect of any corporate competition.
aplummer 10y ago
You've made a false assumption that "intense competition" (italicised for emphasis!) always makes things cheaper. It doesn't apply with health insurance, which is why health costs are so much higher in the U.S than anywhere else. [1] Fact: the system of private health insurance in the U.S makes it more expensive for everyone. Source: every other western country paying far less. It is possible for the free market to fail when the thing people are buying is something they would pay any amount of money for. [1]http://gamapserver.who.int/gho/interactive_charts/health_financing/atlas.html?indicator=i3 http://gamapserver.who.int/gho/interactive_charts/health_fin...