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These problems are all a result of the huge tax benefit given to employer-provided healthcare; if we got rid of that or extended it to apply to individual plans

by nickff 10y ago

These problems are all a result of the huge tax benefit given to employer-provided healthcare; if we got rid of that or extended it to apply to individual plans as well (and hopefully allowed people to purchase out-of-state insurance), it would reduce costs, and allow for more job freedom. I would also personally rather have health insurance actually act as insurance, where you are granted the coverage at the time of diagnosis, rather than having the insurer gradually pay for treatment, but this is unlikely to come to pass.

lsiebert 10y ago
A tax benefit works only if the person has income to offset. If you are a freelance developer and you get sick with a life threatening or chronic illness or even just injured, you may not be able to work while you are getting treatment. If you want more job freedom, a needs based subsidy based on tax income allows cost shifting from years of productive work and tax earnings to years where you can't work, even if your productive work comes later in life, after treatment. It also provides for those who may never be able to earn enough working to pay for current health insurance, those who are retraining latter in life, and those starting a company.
- nickff 10y ago
  If I were campaigning for something similar to what you describe, I might sell it as a refundable tax credit, which would be no change for people with employer-provided healthcare, and a benefit for the unemployed or self-employed.
  - khuey 10y ago
    This is essentially what the ACA's Premium Tax Credit is.
cookiecaper 10y ago
Insurance is a terrible model for health care. Everyone needs health care. Insurance only works when you have a large pool of persons paying premiums against an at-least-relatively unlikely risk. That might work for things like cancer, but it doesn't really work for anything else. We should not have to have an insurance policy for a doctor check out that weird lump on our thigh or come in and spend 10 seconds pretending to talk to us before scribbling out a prescription for something that vaguely sounds appropriate and walking out. Insurance is what distorts these markets. Patients need to pay doctors directly again. Real competition needs to be returned. Right now, the doctor inflates their bill 5x because they know the insurance is going to talk them down, the insurance talks them down because they know they're going to inflate the bill and not worry about it since it's an insurance company paying out, and round and round we go. There's no reason the market for medical care needs to be different than the market for food, which is cheap and abundant. People often say that you can't can have an efficient medical marketplace because medical care is emergent, but that's usually not true; most medical care, like most meal times, can wait long enough to allow the patient to make a choice between competitors, and providers who charge more than the average demographic in their area can afford will go out of business. The incentive to overcharge for emergent care is countered by the incentive to compete, which has already lead to many "urgent care centers" arising throughout the U.S. Good government regulations that prevent cartels from organizing and causing the markets to freeze up/fail can help. These regulations should include outlawing medical insurance. Whatever the solution is, the current situation is an abject failure. ACA band-aids a couple of warts but it gave us new wounds in the process. Whole thing needs to be torn down and rebooted based on sound market principles.

by nickff 10y ago

lsiebert 10y ago

A tax benefit works only if the person has income to offset. If you are a freelance developer and you get sick with a life threatening or chronic illness or even just injured, you may not be able to work while you are getting treatment. If you want more job freedom, a needs based subsidy based on tax income allows cost shifting from years of productive work and tax earnings to years where you can't work, even if your productive work comes later in life, after treatment. It also provides for those who may never be able to earn enough working to pay for current health insurance, those who are retraining latter in life, and those starting a company.

nickff 10y ago
If I were campaigning for something similar to what you describe, I might sell it as a refundable tax credit, which would be no change for people with employer-provided healthcare, and a benefit for the unemployed or self-employed.
- khuey 10y ago
  This is essentially what the ACA's Premium Tax Credit is.

cookiecaper 10y ago

Insurance is a terrible model for health care. Everyone needs health care. Insurance only works when you have a large pool of persons paying premiums against an at-least-relatively unlikely risk. That might work for things like cancer, but it doesn't really work for anything else. We should not have to have an insurance policy for a doctor check out that weird lump on our thigh or come in and spend 10 seconds pretending to talk to us before scribbling out a prescription for something that vaguely sounds appropriate and walking out. Insurance is what distorts these markets. Patients need to pay doctors directly again. Real competition needs to be returned. Right now, the doctor inflates their bill 5x because they know the insurance is going to talk them down, the insurance talks them down because they know they're going to inflate the bill and not worry about it since it's an insurance company paying out, and round and round we go. There's no reason the market for medical care needs to be different than the market for food, which is cheap and abundant. People often say that you can't can have an efficient medical marketplace because medical care is emergent, but that's usually not true; most medical care, like most meal times, can wait long enough to allow the patient to make a choice between competitors, and providers who charge more than the average demographic in their area can afford will go out of business. The incentive to overcharge for emergent care is countered by the incentive to compete, which has already lead to many "urgent care centers" arising throughout the U.S. Good government regulations that prevent cartels from organizing and causing the markets to freeze up/fail can help. These regulations should include outlawing medical insurance. Whatever the solution is, the current situation is an abject failure. ACA band-aids a couple of warts but it gave us new wounds in the process. Whole thing needs to be torn down and rebooted based on sound market principles.