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Until we disconnect healthcare from a job then pricing will be out of wack and way off market value. Once healthcare is more consumer focused and everyone has

Until we disconnect healthcare from a job then pricing will be out of wack and way off market value. Once healthcare is more consumer focused and everyone has individual plans then pricing can be scrutinized. Currently it is a backdoor game with insurance and health services greatly disconnected from the customer. We don't get auto, life, home or any other insurance from our companies, nor should we, so why do we still do healthcare? It causes all sorts of problems (starting business, stuck in jobs/quitting is more difficult, ageism, etc). Imagine if all your insurance for your auto, home and life ended when you quit a job, it is silly that healthcare does for people without individual plans. Also companies like Aetna and BlueCross are company focused, very different than in auto, home or even life insurance where it has to be mostly individual focused (think Geico, Progressive, Nationwide). We need to disallow getting healthcare from an employer (money can be given to help pay it but as salary). This has to change first otherwise every price control is still set in a closed fantasy market and will never change the game, far disconnected from the user product/service market value.

chimeracoder 10y ago
> We don't get auto, life, home or any other insurance from our companies, nor should we, so why do we still do healthcare? Health insurance isn't like auto or home insurance, because it's not purely insurance. Some part of it is, because you're insuring against the risk of rare and catastrophic conditions, but a good chunk of it is covering routine care, which is by definition predictable. Under an insurance model, the insured price of a routine procedure would always be slightly higher than the out-of-pocket (uninsured) price. The phrase "health insurance" is misleading. Real insurance has a negative expected value - you pay slightly more in expectation in exchange for having a lower variance on your possible outcomes. But people don't want that with health "insurance". They want health insurance to cover things that they otherwise wouldn't be able to afford, both routine and catastrophic. That's not insurance, which is why comparing health insurance to any other form of insurance doesn't really make sense.
- pjc50 10y ago
  > a good chunk of it is covering routine care, which is by definition predictable I'm curious to know what you consider "routine" here? I'm trying to think of what I'd call routine NHS care and the examples I can come up with are childhood vaccinations (not employees), elder care (not employees, medicare in the US), OTC trivia like paracetamol (not exactly covered in either system), and population screening programmes like for breast and other cancers. Then there's chronic conditions such as asthma and diabetes, and the question of whether people who've lost that particular lottery should have a permanently lower standard of living or not.
  - ghaff 10y ago
    Most routine care isn't truly predictable other than vaccinations and preventative medicine (physicals, associated lab tests). However, there's a great deal that's statistically predictable but not chronic/catastrophic such as cuts that need stitches, broken bones, bad flu/high fever, etc. that most people will encounter to greater or lesser degrees throughout their lifetime.
  - chimeracoder 10y ago
    > Then there's chronic conditions such as asthma and diabetes, and the question of whether people who've lost that particular lottery should have a permanently lower standard of living or not. The whole point is that this isn't an insurance question. It's a question of how someone should pay for a chronic condition that may be more expensive to treat than they can afford, in some cases. But that's not an insurance question, because it's not about smoothing risk across states of the world. So talking about how health insurance should solve problems like these is a misuse of the term "insurance", and comparing health insurance to auto and home insurance is misleading.
  - douche 10y ago
    If you have children, it's pretty statistically likely that you'll be in and out of the doctor's office for routine things like ear infections, strep throat, bronchitis, flu. If they play sports, you can tack on sprains, broken bones, x-rays, concussions, and yearly sports physicals. The difference between paying the copays for all those office visits and paying the uninsured-but-not-in-poverty sticker price is massive.
sokoloff 10y ago
> Imagine if all your insurance for your auto, home and life ended when you quit a job This was a massive lightbulb for me. For decades, I've always thought it normal and healthy that employers provided health insurance as a way to compete in the employment market. Your post triggered that lightbulb and now I don't know what to think, but thanks for shaking me awake.
- supster 10y ago
  During WWII the US government set wage controls, so in order to compete for employees, corporations started offering health insurance benefits. Then after WWII, the US government created tax benefits to corporations for providing health insurance. Soon the practice became the de facto way to get insured. source: https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States#The_rise_of_employer-sponsored_coverage https://en.wikipedia.org/wiki/Health_insurance_in_the_United...

chimeracoder 10y ago

> We don't get auto, life, home or any other insurance from our companies, nor should we, so why do we still do healthcare? Health insurance isn't like auto or home insurance, because it's not purely insurance. Some part of it is, because you're insuring against the risk of rare and catastrophic conditions, but a good chunk of it is covering routine care, which is by definition predictable. Under an insurance model, the insured price of a routine procedure would always be slightly higher than the out-of-pocket (uninsured) price. The phrase "health insurance" is misleading. Real insurance has a negative expected value - you pay slightly more in expectation in exchange for having a lower variance on your possible outcomes. But people don't want that with health "insurance". They want health insurance to cover things that they otherwise wouldn't be able to afford, both routine and catastrophic. That's not insurance, which is why comparing health insurance to any other form of insurance doesn't really make sense.

pjc50 10y ago
> a good chunk of it is covering routine care, which is by definition predictable I'm curious to know what you consider "routine" here? I'm trying to think of what I'd call routine NHS care and the examples I can come up with are childhood vaccinations (not employees), elder care (not employees, medicare in the US), OTC trivia like paracetamol (not exactly covered in either system), and population screening programmes like for breast and other cancers. Then there's chronic conditions such as asthma and diabetes, and the question of whether people who've lost that particular lottery should have a permanently lower standard of living or not.
- ghaff 10y ago
  Most routine care isn't truly predictable other than vaccinations and preventative medicine (physicals, associated lab tests). However, there's a great deal that's statistically predictable but not chronic/catastrophic such as cuts that need stitches, broken bones, bad flu/high fever, etc. that most people will encounter to greater or lesser degrees throughout their lifetime.
- chimeracoder 10y ago
  > Then there's chronic conditions such as asthma and diabetes, and the question of whether people who've lost that particular lottery should have a permanently lower standard of living or not. The whole point is that this isn't an insurance question. It's a question of how someone should pay for a chronic condition that may be more expensive to treat than they can afford, in some cases. But that's not an insurance question, because it's not about smoothing risk across states of the world. So talking about how health insurance should solve problems like these is a misuse of the term "insurance", and comparing health insurance to auto and home insurance is misleading.
- douche 10y ago
  If you have children, it's pretty statistically likely that you'll be in and out of the doctor's office for routine things like ear infections, strep throat, bronchitis, flu. If they play sports, you can tack on sprains, broken bones, x-rays, concussions, and yearly sports physicals. The difference between paying the copays for all those office visits and paying the uninsured-but-not-in-poverty sticker price is massive.

sokoloff 10y ago

> Imagine if all your insurance for your auto, home and life ended when you quit a job This was a massive lightbulb for me. For decades, I've always thought it normal and healthy that employers provided health insurance as a way to compete in the employment market. Your post triggered that lightbulb and now I don't know what to think, but thanks for shaking me awake.

supster 10y ago
During WWII the US government set wage controls, so in order to compete for employees, corporations started offering health insurance benefits. Then after WWII, the US government created tax benefits to corporations for providing health insurance. Soon the practice became the de facto way to get insured. source: https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States#The_rise_of_employer-sponsored_coverage https://en.wikipedia.org/wiki/Health_insurance_in_the_United...