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Is it technical? There is a reason the US is unique in the world in both its unsocialized healthcare and in its costs. While socialized medicine now may not rev

by zanny 10y ago

Is it technical? There is a reason the US is unique in the world in both its unsocialized healthcare and in its costs. While socialized medicine now may not reverse the out of control spending, we can observe that the lack of it was the most likely cause. In the semi-private market of American healthcare that has been around since the 70s, the incentives structure has been absurdly broken for so long it should be no surprise you pay more for mediocre results. At this point though, going with the known working solution sooner rather than later is the technically most plausible way to stop the cost expansion. It is exactly like people debating about national debt - you can't complain or argue about how to pay it off until you stop adding to it every year, often with an increasing deficit (which is how republican administrations for the last 30 years have governed). It is crazy to argue that in the moment your house is on fire to try this untested strategy of using giant fans to blow the fire out that nobody else has done versus going with the tried and true use a fire truck to extinguish the blaze. Experiment after everything isn't on fire.

mason240 10y ago
The problem isn't necessarily that it's a semi-private market, it's that for the vast majority of people it's tied to their employer. The only for most Americans to have a choice in their health insurance is when they get to pick between the plans from either husband's or the wife's employers. The biggest disappointment of the Republican alternative to Obamacare was not coming up with a way to sever that tie.
- pjc50 10y ago
  > disappointment of the Republican alternative to Obamacare was not coming up with a way to sever that tie. Since that tie is also maintained by large amounts of political donations, it's going to be a hard one to break.
- gph 10y ago
  But tying it to an employer allows for group rate bargaining with the insurance company. I'm no expert in insurance, but I imagine there's very few instances where an individual will be able to negotiate a better rate for comparable coverage than they would get as part of a group. Sure it cuts down on individual choice, but it should theoretically be the most cost efficient method, both for the employees and the insurance company.
  - dv_dt 10y ago
    It's inefficient in the first place that groups are limited to employees within a given employer instead of entire insurance customer bases or broad product based policy groups. It is very much not a cost efficiency to introduce employer sub groupings of customers.
    - slsii 10y ago
      Employer-based plans typically have lower premiums because they are, by definition, groups of working-age and (in most cases) working people. They are younger and less sick, so insurance costs are lower. (Dependents are typically more expensive.) This is the reason that companies, once they reach a sufficient size, self-insure, because they are carving out their younger and healthier population from the broader population. Plus, there are savings gained from administrative costs as well. Selection of plans or providers is not the problem, especially with the current popularity of PPO plans.
      - dv_dt 10y ago
        I have a really hard time believing that somehow companies self-managing healthcare administration is more efficient than a large group consisting of the entirety of an insurers customers let alone vs. nations with universal healthcare or even ones with single payer private healthcare. And that doesn't even address the many small businesses which need to pay for "individual" plans as if there weren't larger groups with which to distribute the risk. Even the marketing act of splitting up all these groups up as you describe is a huge waste. Now you have to shop the differences, the companies have to explain the differences, and everyone (insurance co, health provider, patients) gets to track multiple different groups with different rules. It's all a waste compared to fewer larger distributed risk pools - which is the whole point of insurance.
  - em3rgent0rdr 10y ago
    High marginal tax rates incentivizes employers to offer health care benefits instead of salary. This is a main reason why health care has been so closely tied to insurance. Either tax the benefits at the marginal rate, or reduce the marginal rate to liberate health care from employment.
dalbasal 10y ago
By technical I don't mean unrelated to the question of who pays. It's certainly related. But, I think it's a mistake to spend too much time on the macro-level "medical care as a right" or "free markets." Most medical markets (including the US') have large free market & "social" elements. I don't think moving one way or another along that axis would move the needle in a predictable way. That would be decided by the more detailed points. That's what I mean by technical

by zanny 10y ago

mason240 10y ago

The problem isn't necessarily that it's a semi-private market, it's that for the vast majority of people it's tied to their employer. The only for most Americans to have a choice in their health insurance is when they get to pick between the plans from either husband's or the wife's employers. The biggest disappointment of the Republican alternative to Obamacare was not coming up with a way to sever that tie.

pjc50 10y ago
> disappointment of the Republican alternative to Obamacare was not coming up with a way to sever that tie. Since that tie is also maintained by large amounts of political donations, it's going to be a hard one to break.
gph 10y ago
But tying it to an employer allows for group rate bargaining with the insurance company. I'm no expert in insurance, but I imagine there's very few instances where an individual will be able to negotiate a better rate for comparable coverage than they would get as part of a group. Sure it cuts down on individual choice, but it should theoretically be the most cost efficient method, both for the employees and the insurance company.
- dv_dt 10y ago
  It's inefficient in the first place that groups are limited to employees within a given employer instead of entire insurance customer bases or broad product based policy groups. It is very much not a cost efficiency to introduce employer sub groupings of customers.
  - slsii 10y ago
    Employer-based plans typically have lower premiums because they are, by definition, groups of working-age and (in most cases) working people. They are younger and less sick, so insurance costs are lower. (Dependents are typically more expensive.) This is the reason that companies, once they reach a sufficient size, self-insure, because they are carving out their younger and healthier population from the broader population. Plus, there are savings gained from administrative costs as well. Selection of plans or providers is not the problem, especially with the current popularity of PPO plans.
    - dv_dt 10y ago
      I have a really hard time believing that somehow companies self-managing healthcare administration is more efficient than a large group consisting of the entirety of an insurers customers let alone vs. nations with universal healthcare or even ones with single payer private healthcare. And that doesn't even address the many small businesses which need to pay for "individual" plans as if there weren't larger groups with which to distribute the risk. Even the marketing act of splitting up all these groups up as you describe is a huge waste. Now you have to shop the differences, the companies have to explain the differences, and everyone (insurance co, health provider, patients) gets to track multiple different groups with different rules. It's all a waste compared to fewer larger distributed risk pools - which is the whole point of insurance.
- em3rgent0rdr 10y ago
  High marginal tax rates incentivizes employers to offer health care benefits instead of salary. This is a main reason why health care has been so closely tied to insurance. Either tax the benefits at the marginal rate, or reduce the marginal rate to liberate health care from employment.

dalbasal 10y ago

By technical I don't mean unrelated to the question of who pays. It's certainly related. But, I think it's a mistake to spend too much time on the macro-level "medical care as a right" or "free markets." Most medical markets (including the US') have large free market & "social" elements. I don't think moving one way or another along that axis would move the needle in a predictable way. That would be decided by the more detailed points. That's what I mean by technical