6 ms·

Sufficiently advanced regulation is indistinguishable from single-payer - insurance is completely reliable, covers everything, and is completely fungible. Who

Sufficiently advanced regulation is indistinguishable from single-payer - insurance is completely reliable, covers everything, and is completely fungible. Who cares what name is on the card? The easiest way to accomplish that is just to have a single government insurer. But you can finagle your way in the back door by regulating the shit out of insurance companies too. One-third of the US population is on a US single-payer system right now.

DennisP 8y ago
If you define single payer that broadly, ok. I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.
- kaibee 8y ago
  > I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively. How does all of this additional overhead provide more value to the consumer at the end? How are they actually differentiated?
  - DennisP 8y ago
    I'm not sure (possibly because I read the book years ago). The other two countries handle it differently. Japan's healthcare cost is the lowest of the three though, at 5% GDP, despite an aging population of heavy smokers. So there doesn't seem to be that much overhead.
    - philwelch 8y ago
      Despite Japan's aging, heavy-smoking population, Japanese people tend to be very healthy for reasons that aren't necessarily related to their healthcare system.
      - kenhwang 8y ago
        And Americans tend to be overweight and unhealthy. Access to healthcare doesn't automatically shift culture to live a healthier lifestyle (and I suspect it might even do the opposite).
        whitepoplar 8y ago
        It would be great if gym memberships could be made free for everyone. I bet it would even be cheaper in the long run to buy an Equinox membership for every American than it would be to do nothing.
        ethbro 8y ago
        American health care plans are starting to offer financial incentives for maintaining fitness. Which seems a bit like a tragedy of the commons situation. In that insurance company X is paying me for later life benefits that may be reaped by insurance company Y that I have 40 years from now. We need to hurry up and get to baseline genetic risks, then directly rebate insured out of a central pot if they exceed their expected fitness metrics.
        distant_hat 8y ago
        Free gym memberships are unlikely to result in higher use. I've had multiple workplaces where gym is free and I've rarely used it, thankfully, I am blessed with a skinny physique and parents who inculcated good food habits. In fact, places which charged for gyms explicitly saw slightly higher usage since some folks logic went, since I am paying for it, I might as well get my money's worth.
        thinkcontext 8y ago
        The paper considers that hypothesis and rejects it, honing in on prices not utilization as the problem. Indeed its title is "It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt" https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144 https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144
      - 8y ago
ascar 8y ago
Germany has a split system between mandatory government healthcare and voluntary private healthcare, once you pass a certain income threshold (about 80% above average income) or are self-employed. There are differences. The voluntary insurance usually pays 2x to 3x of the mandatory one and covers more treatments that are seen as optional by the government insurance. E.g. physiotherapy is covered by government insurance only for clear indications while private insurances might cover it as a precautionary measure in many more cases. Also private patients can usually skip some waiting time (e.g. days instead of a few weeks). But (nearly) everyone is covered, government or private, and can go to the doctor without worrying about money. Even the government insurance isn't a single entity, but you can choose between multiple providers. All charge the same 14.6% of pre-tax income (capped at ~55k income) plus an additional 0.7% to 1.x% depending on the provider. They also compete on additional services. E.g. my provider adds a free professional tooth-cleaning per year and free travel-vaccination among other things.
- null000 8y ago
  > Also private patients can usually skip some waiting time (e.g. days instead of a few weeks). See, now, that just really doesn't sound like a good idea to my ears. Why should someone be forced to sit through weeks of suffering while a handful of others don't, for the sole reason that they have more money to throw at the problem? I can understand buying better or more thorough treatment, or buying treatment from more expensive providers I guess, but line jumping via money just seems immoral when it comes to health care.
  - ascar 8y ago
    Why do you think line-jumping is more immoral than getting worse treatment? In one case you just have to wait in non life-threatening and non-urgent cases (you only have to wait if you actually can wait). In the other case you are actually in a worse physical or mental position.
    - asdff 8y ago
      This is like if the whole town is on fire, but you have enough money to pay the fireman to save your house first. Priority access to universal needs shouldn't be given based on personal wealth. I wonder if the people who wrote this line jumping into law qualified for the public or private insurance.

DennisP 8y ago

If you define single payer that broadly, ok. I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively.

kaibee 8y ago
> I'll just mention that Japan gives you your choice of about 2,000 insurance providers, which advertise extensively. How does all of this additional overhead provide more value to the consumer at the end? How are they actually differentiated?
- DennisP 8y ago
  I'm not sure (possibly because I read the book years ago). The other two countries handle it differently. Japan's healthcare cost is the lowest of the three though, at 5% GDP, despite an aging population of heavy smokers. So there doesn't seem to be that much overhead.
  - philwelch 8y ago
    Despite Japan's aging, heavy-smoking population, Japanese people tend to be very healthy for reasons that aren't necessarily related to their healthcare system.
    - kenhwang 8y ago
      And Americans tend to be overweight and unhealthy. Access to healthcare doesn't automatically shift culture to live a healthier lifestyle (and I suspect it might even do the opposite).
      - whitepoplar 8y ago
        It would be great if gym memberships could be made free for everyone. I bet it would even be cheaper in the long run to buy an Equinox membership for every American than it would be to do nothing.
        ethbro 8y ago
        American health care plans are starting to offer financial incentives for maintaining fitness. Which seems a bit like a tragedy of the commons situation. In that insurance company X is paying me for later life benefits that may be reaped by insurance company Y that I have 40 years from now. We need to hurry up and get to baseline genetic risks, then directly rebate insured out of a central pot if they exceed their expected fitness metrics.
        distant_hat 8y ago
        Free gym memberships are unlikely to result in higher use. I've had multiple workplaces where gym is free and I've rarely used it, thankfully, I am blessed with a skinny physique and parents who inculcated good food habits. In fact, places which charged for gyms explicitly saw slightly higher usage since some folks logic went, since I am paying for it, I might as well get my money's worth.
      - thinkcontext 8y ago
        The paper considers that hypothesis and rejects it, honing in on prices not utilization as the problem. Indeed its title is "It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt" https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144 https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144
    - 8y ago

ascar 8y ago

Germany has a split system between mandatory government healthcare and voluntary private healthcare, once you pass a certain income threshold (about 80% above average income) or are self-employed. There are differences. The voluntary insurance usually pays 2x to 3x of the mandatory one and covers more treatments that are seen as optional by the government insurance. E.g. physiotherapy is covered by government insurance only for clear indications while private insurances might cover it as a precautionary measure in many more cases. Also private patients can usually skip some waiting time (e.g. days instead of a few weeks). But (nearly) everyone is covered, government or private, and can go to the doctor without worrying about money. Even the government insurance isn't a single entity, but you can choose between multiple providers. All charge the same 14.6% of pre-tax income (capped at ~55k income) plus an additional 0.7% to 1.x% depending on the provider. They also compete on additional services. E.g. my provider adds a free professional tooth-cleaning per year and free travel-vaccination among other things.

null000 8y ago
> Also private patients can usually skip some waiting time (e.g. days instead of a few weeks). See, now, that just really doesn't sound like a good idea to my ears. Why should someone be forced to sit through weeks of suffering while a handful of others don't, for the sole reason that they have more money to throw at the problem? I can understand buying better or more thorough treatment, or buying treatment from more expensive providers I guess, but line jumping via money just seems immoral when it comes to health care.
- ascar 8y ago
  Why do you think line-jumping is more immoral than getting worse treatment? In one case you just have to wait in non life-threatening and non-urgent cases (you only have to wait if you actually can wait). In the other case you are actually in a worse physical or mental position.
  - asdff 8y ago
    This is like if the whole town is on fire, but you have enough money to pay the fireman to save your house first. Priority access to universal needs shouldn't be given based on personal wealth. I wonder if the people who wrote this line jumping into law qualified for the public or private insurance.