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I don't think employers should even offer health insurance. Leave it to the consumer to buy just like all other insurance. In fact the increase in wages could

I don't think employers should even offer health insurance. Leave it to the consumer to buy just like all other insurance. In fact the increase in wages could be used to fund a basic preventative care plan (read not full on single payer) for all Americans.

pstuart 9y ago
What value do the insurance companies add for each dollar spent on healthcare?
- ekianjo 9y ago
  Not much. Negociation of prices with government and pharma companies, maybe.
- nasredin 9y ago
  You get to call your insurance company and test your anger management skills every time they deny you coverage. OK that's not really "value". They do add jobs though. There's "coders", they deal with medical codes.
  - nradov 9y ago
    Claims will have to be coded regardless of who pays the bill.
- pmorici 9y ago
  They negotiate discounts with the providers.
  - UnoriginalGuy 9y ago
    But aren't the prices artificially inflated to build in the supposed "discount?" To use an analogy, it is like how vehicle manufacturers adds 10% to reach the MSRP, which is "discounted" at the dealership for every vehicle sold. It is a shell game, there is no winning when the game is rigged for the game's own existence. If discounts were banned tomorrow on medical services, you'd see the costs drop significantly to reflect that.
    - pmorici 9y ago
      I think the main driver of the inflated base price is there is no cost transparency wethere you have insurance or not. Have you ever gone to a doctor and known the costs ahead of time or shopped around for the best price?
- danjayh 9y ago
  Their primary function is risk pooling. Secondarily they ration limited resources, attempting to distribute the available resources to effect the greatest good (this is why you often have such a hard time getting them to cover things, and why everyone loves to hate them). They've also traditionally been in the business of managing moral hazard in such a way that people feel it necessary to sign up for insurance while healthy, but the government has dramatically changed that function in the last few years. There's also the basic book-keeping and shuffling money around the system ... and while all of the things I listed are somewhere in between crusted puke and a fresh horse turd in terms of their appeal, they are necessary functions that any system (even a government run one) has to perform. One huge advantage that the government has in the moral hazard department is that they can use guns and jail time to prod people into paying ... but for whatever reason the single-payer folks typically ignore that particular evil when campaigning against the private insurance companies. Personally, I feel that the government's tactic of taking someone's freedom for refusal to participate is much worse than refusing coverage, which is what the private companies do.
  - SubiculumCode 9y ago
    When the whole nation is the pool, then there is no need for the insurance company.
    - danjayh 9y ago
      The insurance company's methods of establishing the pool are far less coercive and destructive than the state's. Additionally, people can opt not to participate with an insurance company (or at least they used to be able to), so they have some motivation to be efficient and provide a basically decent level of service ... this is not true of the state. So establishing that large, mandatory pool has a downside.
      - SubiculumCode 9y ago
        Sometimes innovation is about figuring out ways to make more money, not by lowering costs to attract more consumers, but by limiting choices, creating illusion of choice, denying coverage, cheating consumers. Not all corporate innovation is good thing. Certain industries the possibility for real innovation is practically non-existent, and the 'innovation' that occurs is not in the public interest.
nedwin 9y ago
This is why the US system is broken. Wind the clock back 70 ish years and stop this and you'll likely end up with the same system as other developed countries like the U.K. Or Australia.
- stass 9y ago
  So we end up waiting for several month for a surgery like other developed countries?
  - grogenaut 9y ago
    When, besides emergencies, do you go in to the doctor and come out with a surgery in the same day in the US or even the same week? My only real surgery was emergency or reconstructive right after the swelling went down. All of my oral surgeries were at least 2 weeks and could easily have been a few months out. Wifes major oral surgery was months in advanced.
    - lsaferite 9y ago
      In the US, health insurance and dental insurance are very different things.
  - nedwin 9y ago
    I tried to find some good data around surgery wait times by OECD countries but couldn't find much except it seems that Canada + UK + US have bad wait times compared to other OECD countries. Does double healthcare cost = less wait times? Are there less wait times for private insured vs those using public system? Would love to see the data if you have any... I did find some stats around infant mortality and life expectancy. US ranks 5th on infant mortality and 31st on life expectancy. https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe... Yet US still ranks #1 on total health expenditure. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
  - nedwin 9y ago
fragsworth 9y ago
But as an employer in the U.S., you get to write off medical insurance as an expense that isn't counted as income for the employee. It's entirely tax free, and a rational employee will take it into account as part of their compensation package. If you don't want employers to give it to employees, then we should fix the tax situation.
- arikr 9y ago
  Yes. As Charlie Munger says: "Never think about something else when you should be thinking about the power of incentives."
  - charleslmunger 9y ago
    Worse yet is that the cost of these benefits creates an incentive for companies to prefer younger, unmarried, and childless employees over others. Until the ACA with the new preexisting conditions rules, it also meant that if you had a chronic condition of some kind, you were essentially stuck at the job you were at when you were diagnosed - if you switched jobs, your employer may not cover your preexisting condition, which could bankrupt you pretty quickly.
    - ams6110 9y ago
      Many (most?) employee plans would cover pre-existing conditions as long as there wasn't a "gap in coverage." So if you didn't start your new job right away, and weren't paying for COBRA or other insurance in the interim, you could have been in trouble.
    - justforFranz 9y ago
      I doubt the ACA will ever fully live up to its promise because Congressional Republicans need to try and overturn it every 4 months. Even if they don't succeed, they still end up injecting uncertainty into the market, which drives up prices. And it will go on forever and ever. It'll be one of those things Republicans never, ever let go of like abortion and guns.
- 9y ago
evanlivingston 9y ago
What if a consumer can't afford it?
- ekianjo 9y ago
  thats already the case where companies dont offer insurance.
  - evanlivingston 9y ago
    no doubt, but when a person makes a suggestion to move closer to a stricter market based system, the inequality of that solution must be made clear.
- tertius 9y ago
  Rest of his comment. > In fact the increase in wages could be used to fund a basic preventative care plan (read not full on single payer) for all Americans.
zaptheimpaler 9y ago
Yeah this would overall be good, but not short-term. Once consumers are directly exposed to the shit show that is insurance and pre-existing conditions and zero price transparency, and they have no collective negotiation power as they do when a company purchases, they will revolt and it will force a change. There are a few people who cannot get insurance individually thanks to pre-existing conditions. They can only get insurance via employers group plans. Short-term a few of these people go bankrupt or die, but whats a few deaths in service of a good ideology?
- toomuchtodo 9y ago
  > There are a few people who cannot get insurance individually thanks to pre-existing conditions. Denying insurance due to pre-existing conditions is currently prohibited unless the Affordable Care Act is repealed. https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co... I agree with your other points though ("directly exposed to the shit show that is insurance"): removing employer provided health insurance would speed up the current system's collapse and push us to single payer at ludicrous speed. There would be no other option palatable.
  - viraptor 9y ago
    > and push us to single payer at ludicrous speed. There would be no other option palatable. Considering how many people are against any kind of collective payment for health and how many protections Republicans are happy to sacrifice... is it really the only option? It could just go worse with few people getting any kind of insurance. (Enough to keep the system profitable, but not necessarily helpful)
    - toomuchtodo 9y ago
      > Considering how many people are against any kind of collective payment for health There is more support for single payer than you might have been led to believe. "Currently, 60% say the federal government is responsible for ensuring health care coverage for all Americans, while 39% say this is not the government’s responsibility. These views are unchanged from January, but the share saying health coverage is a government responsibility remains at its highest level in nearly a decade." "Even among those who say the federal government is not responsible for ensuring Americans have health care coverage, there is little public appetite for government withdrawing entirely from involvement in health care coverage. Among the public, 33% say that health care coverage is not the government’s responsibility, but that programs like Medicare and Medicaid should be continued; just 5% of Americans say the government should not be involved at all in providing health insurance." Emphasis mine. http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/ http://www.pewresearch.org/fact-tank/2017/06/23/public-suppo... EDIT: HN throttling, sorry for editing this instead of replying. @nerfhammer: That doesn't mean you don't try.
davexunit 9y ago
Every other major country does single payer. We need single payer, too.
- martin1975 9y ago
  I don't think you realize what you're asking for... "The Pitfalls of Single-Payer Health Care: Canada’s Cautionary Tale" http://www.nationalreview.com/article/446689/canadas-single-payer-health-care-system-cautionary-tale http://www.nationalreview.com/article/446689/canadas-single-...
  - UnoriginalGuy 9y ago
    That article argues that other single payer systems work better than Canada's system. But you're linking it like it is some smoking gun assassination of single payer as a concept; did you read your own article? For example it links this article: http://www.commonwealthfund.org/publications/press-releases/2014/jun/us-health-system-ranks-last http://www.commonwealthfund.org/publications/press-releases/... Which shows single payer and universal healthcare dominating the top spots.
    - martin1975 9y ago
      Canada's often cited as some example to follow.... This puts a hole in that theory. And your #1 on that list? UK's NHS? Both the availability and quality sucks - waitlists and infections galore across their hospitals. The thing with single payer is it's just like communism.. it looks REALLY great on paper.
      - ionised 9y ago
        Both the availability and quality sucks - waitlists and infections galore across their hospitals. That's an exaggeration. I live in the UK and I know first-hand how it is. I've personally never had to wait more than a day, even for an operation. There are waiting time and service problems recently, but you can thank the Tory government for purposely underfunding the service ion an attempt to drum up support for privatisation. I mean, our current health secretary wrote a book stating that he wanted to privatise the NHS and now denies wanting to do so. It would be hilarious if it wasn't so sad. The thing with single payer is it's just like communism.. it looks REALLY great on paper We still have people covered for health care better than the US does. So make of that what you will. Plus, nearly every developed country in the world has free healthcare in some form, it's just the US that refuses to spot a good thing and fix its broken-ass system. Kinda like the metric system in that respect. If enough rich politicians and leaders of industry label something communist, enough gullible Americans will drop their support for it even when it would clearly help them.
tehlike 9y ago
One thing i learned that i enjoyed sharing: employee provided healthcare started with ww2 to lure employees to a company since they couldnt increase wages.
justforFranz 9y ago
OK, but as long as individuals buy their insurance through an exchange so that they can benefit from group purchasing. Otherwise, people who purchase as an individual won't be able to negotiate for lower prices.

pstuart 9y ago

What value do the insurance companies add for each dollar spent on healthcare?

ekianjo 9y ago
Not much. Negociation of prices with government and pharma companies, maybe.
nasredin 9y ago
You get to call your insurance company and test your anger management skills every time they deny you coverage. OK that's not really "value". They do add jobs though. There's "coders", they deal with medical codes.
- nradov 9y ago
  Claims will have to be coded regardless of who pays the bill.
pmorici 9y ago
They negotiate discounts with the providers.
- UnoriginalGuy 9y ago
  But aren't the prices artificially inflated to build in the supposed "discount?" To use an analogy, it is like how vehicle manufacturers adds 10% to reach the MSRP, which is "discounted" at the dealership for every vehicle sold. It is a shell game, there is no winning when the game is rigged for the game's own existence. If discounts were banned tomorrow on medical services, you'd see the costs drop significantly to reflect that.
  - pmorici 9y ago
    I think the main driver of the inflated base price is there is no cost transparency wethere you have insurance or not. Have you ever gone to a doctor and known the costs ahead of time or shopped around for the best price?
danjayh 9y ago
Their primary function is risk pooling. Secondarily they ration limited resources, attempting to distribute the available resources to effect the greatest good (this is why you often have such a hard time getting them to cover things, and why everyone loves to hate them). They've also traditionally been in the business of managing moral hazard in such a way that people feel it necessary to sign up for insurance while healthy, but the government has dramatically changed that function in the last few years. There's also the basic book-keeping and shuffling money around the system ... and while all of the things I listed are somewhere in between crusted puke and a fresh horse turd in terms of their appeal, they are necessary functions that any system (even a government run one) has to perform. One huge advantage that the government has in the moral hazard department is that they can use guns and jail time to prod people into paying ... but for whatever reason the single-payer folks typically ignore that particular evil when campaigning against the private insurance companies. Personally, I feel that the government's tactic of taking someone's freedom for refusal to participate is much worse than refusing coverage, which is what the private companies do.
- SubiculumCode 9y ago
  When the whole nation is the pool, then there is no need for the insurance company.
  - danjayh 9y ago
    The insurance company's methods of establishing the pool are far less coercive and destructive than the state's. Additionally, people can opt not to participate with an insurance company (or at least they used to be able to), so they have some motivation to be efficient and provide a basically decent level of service ... this is not true of the state. So establishing that large, mandatory pool has a downside.
    - SubiculumCode 9y ago
      Sometimes innovation is about figuring out ways to make more money, not by lowering costs to attract more consumers, but by limiting choices, creating illusion of choice, denying coverage, cheating consumers. Not all corporate innovation is good thing. Certain industries the possibility for real innovation is practically non-existent, and the 'innovation' that occurs is not in the public interest.

nedwin 9y ago

This is why the US system is broken. Wind the clock back 70 ish years and stop this and you'll likely end up with the same system as other developed countries like the U.K. Or Australia.

stass 9y ago
So we end up waiting for several month for a surgery like other developed countries?
- grogenaut 9y ago
  When, besides emergencies, do you go in to the doctor and come out with a surgery in the same day in the US or even the same week? My only real surgery was emergency or reconstructive right after the swelling went down. All of my oral surgeries were at least 2 weeks and could easily have been a few months out. Wifes major oral surgery was months in advanced.
  - lsaferite 9y ago
    In the US, health insurance and dental insurance are very different things.
- nedwin 9y ago
  I tried to find some good data around surgery wait times by OECD countries but couldn't find much except it seems that Canada + UK + US have bad wait times compared to other OECD countries. Does double healthcare cost = less wait times? Are there less wait times for private insured vs those using public system? Would love to see the data if you have any... I did find some stats around infant mortality and life expectancy. US ranks 5th on infant mortality and 31st on life expectancy. https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe... Yet US still ranks #1 on total health expenditure. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
- nedwin 9y ago

fragsworth 9y ago

But as an employer in the U.S., you get to write off medical insurance as an expense that isn't counted as income for the employee. It's entirely tax free, and a rational employee will take it into account as part of their compensation package. If you don't want employers to give it to employees, then we should fix the tax situation.

arikr 9y ago
Yes. As Charlie Munger says: "Never think about something else when you should be thinking about the power of incentives."
- charleslmunger 9y ago
  Worse yet is that the cost of these benefits creates an incentive for companies to prefer younger, unmarried, and childless employees over others. Until the ACA with the new preexisting conditions rules, it also meant that if you had a chronic condition of some kind, you were essentially stuck at the job you were at when you were diagnosed - if you switched jobs, your employer may not cover your preexisting condition, which could bankrupt you pretty quickly.
  - ams6110 9y ago
    Many (most?) employee plans would cover pre-existing conditions as long as there wasn't a "gap in coverage." So if you didn't start your new job right away, and weren't paying for COBRA or other insurance in the interim, you could have been in trouble.
  - justforFranz 9y ago
    I doubt the ACA will ever fully live up to its promise because Congressional Republicans need to try and overturn it every 4 months. Even if they don't succeed, they still end up injecting uncertainty into the market, which drives up prices. And it will go on forever and ever. It'll be one of those things Republicans never, ever let go of like abortion and guns.
9y ago

evanlivingston 9y ago

What if a consumer can't afford it?

ekianjo 9y ago
thats already the case where companies dont offer insurance.
- evanlivingston 9y ago
  no doubt, but when a person makes a suggestion to move closer to a stricter market based system, the inequality of that solution must be made clear.
tertius 9y ago
Rest of his comment. > In fact the increase in wages could be used to fund a basic preventative care plan (read not full on single payer) for all Americans.

zaptheimpaler 9y ago

Yeah this would overall be good, but not short-term. Once consumers are directly exposed to the shit show that is insurance and pre-existing conditions and zero price transparency, and they have no collective negotiation power as they do when a company purchases, they will revolt and it will force a change. There are a few people who cannot get insurance individually thanks to pre-existing conditions. They can only get insurance via employers group plans. Short-term a few of these people go bankrupt or die, but whats a few deaths in service of a good ideology?

toomuchtodo 9y ago
> There are a few people who cannot get insurance individually thanks to pre-existing conditions. Denying insurance due to pre-existing conditions is currently prohibited unless the Affordable Care Act is repealed. https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html https://www.hhs.gov/healthcare/about-the-aca/pre-existing-co... I agree with your other points though ("directly exposed to the shit show that is insurance"): removing employer provided health insurance would speed up the current system's collapse and push us to single payer at ludicrous speed. There would be no other option palatable.
- viraptor 9y ago
  > and push us to single payer at ludicrous speed. There would be no other option palatable. Considering how many people are against any kind of collective payment for health and how many protections Republicans are happy to sacrifice... is it really the only option? It could just go worse with few people getting any kind of insurance. (Enough to keep the system profitable, but not necessarily helpful)
  - toomuchtodo 9y ago
    > Considering how many people are against any kind of collective payment for health There is more support for single payer than you might have been led to believe. "Currently, 60% say the federal government is responsible for ensuring health care coverage for all Americans, while 39% say this is not the government’s responsibility. These views are unchanged from January, but the share saying health coverage is a government responsibility remains at its highest level in nearly a decade." "Even among those who say the federal government is not responsible for ensuring Americans have health care coverage, there is little public appetite for government withdrawing entirely from involvement in health care coverage. Among the public, 33% say that health care coverage is not the government’s responsibility, but that programs like Medicare and Medicaid should be continued; just 5% of Americans say the government should not be involved at all in providing health insurance." Emphasis mine. http://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/ http://www.pewresearch.org/fact-tank/2017/06/23/public-suppo... EDIT: HN throttling, sorry for editing this instead of replying. @nerfhammer: That doesn't mean you don't try.

davexunit 9y ago

Every other major country does single payer. We need single payer, too.

martin1975 9y ago
I don't think you realize what you're asking for... "The Pitfalls of Single-Payer Health Care: Canada’s Cautionary Tale" http://www.nationalreview.com/article/446689/canadas-single-payer-health-care-system-cautionary-tale http://www.nationalreview.com/article/446689/canadas-single-...
- UnoriginalGuy 9y ago
  That article argues that other single payer systems work better than Canada's system. But you're linking it like it is some smoking gun assassination of single payer as a concept; did you read your own article? For example it links this article: http://www.commonwealthfund.org/publications/press-releases/2014/jun/us-health-system-ranks-last http://www.commonwealthfund.org/publications/press-releases/... Which shows single payer and universal healthcare dominating the top spots.
  - martin1975 9y ago
    Canada's often cited as some example to follow.... This puts a hole in that theory. And your #1 on that list? UK's NHS? Both the availability and quality sucks - waitlists and infections galore across their hospitals. The thing with single payer is it's just like communism.. it looks REALLY great on paper.
    - ionised 9y ago
      Both the availability and quality sucks - waitlists and infections galore across their hospitals. That's an exaggeration. I live in the UK and I know first-hand how it is. I've personally never had to wait more than a day, even for an operation. There are waiting time and service problems recently, but you can thank the Tory government for purposely underfunding the service ion an attempt to drum up support for privatisation. I mean, our current health secretary wrote a book stating that he wanted to privatise the NHS and now denies wanting to do so. It would be hilarious if it wasn't so sad. The thing with single payer is it's just like communism.. it looks REALLY great on paper We still have people covered for health care better than the US does. So make of that what you will. Plus, nearly every developed country in the world has free healthcare in some form, it's just the US that refuses to spot a good thing and fix its broken-ass system. Kinda like the metric system in that respect. If enough rich politicians and leaders of industry label something communist, enough gullible Americans will drop their support for it even when it would clearly help them.

tehlike 9y ago

One thing i learned that i enjoyed sharing: employee provided healthcare started with ww2 to lure employees to a company since they couldnt increase wages.

justforFranz 9y ago

OK, but as long as individuals buy their insurance through an exchange so that they can benefit from group purchasing. Otherwise, people who purchase as an individual won't be able to negotiate for lower prices.