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I have a choice of exactly two health insurance companies because that's who my employer selected for me. Both are for profit companies, with Aetna just posting

I have a choice of exactly two health insurance companies because that's who my employer selected for me. Both are for profit companies, with Aetna just posting record profits, and we see our premiums rise year upon year. But beyond me, the fact that someone working minimum wage, unemployed, or at a startup using the Obamacare exchange pays more than an executive at a fortune 500 makes no rational sense. That's because the market has been silo-ed by employer instead of each individual insured. The US would be in a much better state if everyone had to get their insurance from the exchange. One of the two political parties is constantly drumming the "competition" drum as a magical solution, but they're too scared to actually make the market competitive. - Give everyone in the US a HSA (health savings account). - Increase HSA contribution maximums significantly ($20K/year or more) - Allow employers to give money, tax free, to employees via their HSA - Allow employees to pay their insurance premiums via the HSA - Ban employers from directly picking the employee's insurance or providing the insurance - Employees (and everyone else) would pick insurance from the health insurance marketplace - Medicaid would pay 100% of premiums, but Medicaid recipients still pick their own insurance - The VA would move to a mixed model, help pay for regular insurance (via the HSA), and offer bespoke services specific to former enlisted personnel. Most common services would be received at regular healthcare providers, not VA hospitals. Now instead of employers paying $1000/month for your health insurance they put that $1000 into your HSA, you then go onto the health insurance marketplace find insurance, and use your HSA to pay your premiums. Don't like your insurance company? Change. This is how you spurn competition. Additionally if your employer doesn't help you with health benefits, you can contribute to your HSA yourself tax free and you won't be further punished (i.e. pay the same overall premium, with same tax benefits, as someone with a better employer, unlike now).

djsumdog 9y ago
This is what was talked about in the book "Redefining Health Care." The employer based model is totally broken. What you're describing is more open capitalism in health care where everyone is on an open playing field. I use to really believe in this at one point years ago, even when working in Health Insurance. Today, I'm not even for this compromise. I think it should be taken out of our taxes in single payer. Insurance would still be contracted out to those private insurers (cause America). We might even be able to create a system where people chose which insurance provider they use, but it should be payed for by taxes .. it's there for everyone and everyone pays the same proportion of income and everyone gets the same level of coverage. If something is in short supply, then it's going to need a needs based + lottery system (just like organ transplants currently). For profit and _non-for-profit_ (not to be confused with non-profits; most health care companies are non-for-profits which is a weird legal area) have no place when it comes to public welfare services. People don't pay individually for private security/police. We don't pay for fire. We don't pay a fee to visit a city park (and I'm against fee based national parks actually). The general good should be paid for equally by everyone to their abilities.
- jedberg 9y ago
  > People don't pay individually for private security/police. We don't pay for fire. Sure they do. Rich people hire private security all the time. Heck, not-rich people do it too. Like your local Chuck E Cheese who hires a security guard on Friday night. Same with fire protection. There are plenty of private fire protection companies. Everyone gets those basic services paid for out of their taxes, but some people want more than basic service, and there is nothing wrong with that. The OPs system would work great and you could modify it simply enough to account for your system too -- everyone pays a health tax, which is then redistributed as an HSA payment to every American, setting a base level of funding. I'm actually a big fan of single payer, but not because of the social impacts, only because of the ease of administration aspects. But if you did OPs system and made sure everyone could participate, it would probably work just as well, because there would need to basically be a health payment cleaning house to make it work.
  - TillE 9y ago
    Germany is one of very few countries with a robust public insurance scheme which also allows private insurance, but I wouldn't expect that to last too much longer - there's a growing consensus (57.6% in a recent poll) around the idea that receiving faster or better care because you can pay more is fundamentally unfair. People need the health care that they need. Unless we're talking about small things like your own private bed in a hospital, there's no room in a just society for a "basic service" which does not provide the best possible care.
    - jedberg 9y ago
      > there's no room in a just society for a "basic service" which does not provide the best possible care. Unfortunately health care is still a finite resource, and you can't give everyone the best care. You either give some the best care and everyone else good care, or you give everyone pretty good care, but no one gets the best care. Each has its merits, but my personal feeling is if no one gets "the best care", then we as a society will forget how to give such care, and medical innovation will become stagnant. There is a reason that the health systems with at least some private participation (USA, France, Germany) also have the most innovation. We need a balance so there can still be a motive for innovation.
snotrockets 9y ago
You program still treats health care as a market commodity, which it isn't: unlike the usual perfect market model, there isn't any upper bound on the utility function. You'd be willing to pay any price, even a non-rational one, for health. So prices are lower bound. What more, your program assumes health care isn't a right, as even if it makes it more affordable, it still keeps it at a constant rate: that is, me and someone who makes half of what I'm making would pay the same, but that would be a different chunk of our paycheck. And unlike, say, going to a fancy restaurant vs cooking at home, you can't substitute health care. If you take health care has a right (art. 25 of the Universal Declaration of Human Rights does), then there is a simple solution for the above, known as single payer. Of course, it won't work in the US, because it isn't as biased against the poor as the "free market" health care.
mabufo 9y ago
70% of americans live paycheck to paycheck. There is no money to put into an HSA - let alone to put into a savings account. Medicare for all is the only sense making option, truly. Insurance doesn't make sense in the context of healthcare. Everything else is just a half measure. Healthcare makes zero sense as a market; it is completely busted.
z3ugma 9y ago
This is a fantastic plan, similar to Singapore's - they have among the best metrics for health outcomes and an inexpensive system where primary care is paid for out of HSA-like tax-incentivized accounts and catastrophic care is funded by the state. It's a fantastic meeting of markets and a giant risk pool.

djsumdog 9y ago

This is what was talked about in the book "Redefining Health Care." The employer based model is totally broken. What you're describing is more open capitalism in health care where everyone is on an open playing field. I use to really believe in this at one point years ago, even when working in Health Insurance. Today, I'm not even for this compromise. I think it should be taken out of our taxes in single payer. Insurance would still be contracted out to those private insurers (cause America). We might even be able to create a system where people chose which insurance provider they use, but it should be payed for by taxes .. it's there for everyone and everyone pays the same proportion of income and everyone gets the same level of coverage. If something is in short supply, then it's going to need a needs based + lottery system (just like organ transplants currently). For profit and _non-for-profit_ (not to be confused with non-profits; most health care companies are non-for-profits which is a weird legal area) have no place when it comes to public welfare services. People don't pay individually for private security/police. We don't pay for fire. We don't pay a fee to visit a city park (and I'm against fee based national parks actually). The general good should be paid for equally by everyone to their abilities.

jedberg 9y ago
> People don't pay individually for private security/police. We don't pay for fire. Sure they do. Rich people hire private security all the time. Heck, not-rich people do it too. Like your local Chuck E Cheese who hires a security guard on Friday night. Same with fire protection. There are plenty of private fire protection companies. Everyone gets those basic services paid for out of their taxes, but some people want more than basic service, and there is nothing wrong with that. The OPs system would work great and you could modify it simply enough to account for your system too -- everyone pays a health tax, which is then redistributed as an HSA payment to every American, setting a base level of funding. I'm actually a big fan of single payer, but not because of the social impacts, only because of the ease of administration aspects. But if you did OPs system and made sure everyone could participate, it would probably work just as well, because there would need to basically be a health payment cleaning house to make it work.
- TillE 9y ago
  Germany is one of very few countries with a robust public insurance scheme which also allows private insurance, but I wouldn't expect that to last too much longer - there's a growing consensus (57.6% in a recent poll) around the idea that receiving faster or better care because you can pay more is fundamentally unfair. People need the health care that they need. Unless we're talking about small things like your own private bed in a hospital, there's no room in a just society for a "basic service" which does not provide the best possible care.
  - jedberg 9y ago
    > there's no room in a just society for a "basic service" which does not provide the best possible care. Unfortunately health care is still a finite resource, and you can't give everyone the best care. You either give some the best care and everyone else good care, or you give everyone pretty good care, but no one gets the best care. Each has its merits, but my personal feeling is if no one gets "the best care", then we as a society will forget how to give such care, and medical innovation will become stagnant. There is a reason that the health systems with at least some private participation (USA, France, Germany) also have the most innovation. We need a balance so there can still be a motive for innovation.

snotrockets 9y ago

You program still treats health care as a market commodity, which it isn't: unlike the usual perfect market model, there isn't any upper bound on the utility function. You'd be willing to pay any price, even a non-rational one, for health. So prices are lower bound. What more, your program assumes health care isn't a right, as even if it makes it more affordable, it still keeps it at a constant rate: that is, me and someone who makes half of what I'm making would pay the same, but that would be a different chunk of our paycheck. And unlike, say, going to a fancy restaurant vs cooking at home, you can't substitute health care. If you take health care has a right (art. 25 of the Universal Declaration of Human Rights does), then there is a simple solution for the above, known as single payer. Of course, it won't work in the US, because it isn't as biased against the poor as the "free market" health care.

mabufo 9y ago

70% of americans live paycheck to paycheck. There is no money to put into an HSA - let alone to put into a savings account. Medicare for all is the only sense making option, truly. Insurance doesn't make sense in the context of healthcare. Everything else is just a half measure. Healthcare makes zero sense as a market; it is completely busted.

z3ugma 9y ago

This is a fantastic plan, similar to Singapore's - they have among the best metrics for health outcomes and an inexpensive system where primary care is paid for out of HSA-like tax-incentivized accounts and catastrophic care is funded by the state. It's a fantastic meeting of markets and a giant risk pool.