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Compared to what? Nationalized insurance? Nationalized insurance plus inclusion of private clinics? I would argue the lack of transparency in the marketplace a

Compared to what? Nationalized insurance? Nationalized insurance plus inclusion of private clinics? I would argue the lack of transparency in the marketplace and the inability for anyone to make an informed choice of hospitals or what it will cost them (the linked article seems to indicate the consumer has a choice to go to a "nice" hospital or a "not so nice" hospital, but most times we don't have the choice when we need care - it's close to our home. The times we do have the choice (sometimes for birth, cancer treatment, etc) is where you see hospitals investing heavily to get high margin services from consumers. Does Employer-provided care make medical care unfair? One could argue that employer-provided care with the tax incentive might lead to better resources for an employed person electing that care, but any time money is involved you will likely get better care. EDIT: More succinctly - There will always be some inequality / unfairness in care because there will always be inequality of wealth. I'm not sure explicitly here that employer-provided is the problem or that any subsidized care will create this kind of inequality. I'm not sure you can argue effectively that granting the same medical care to all as a matter of law will fly because people will always find a way to get better care if they can afford it. Does employer-provided do this at a larger scale? Maybe? The best way to ensure fairness and efficiency is to get the data out there and available, and make healthcare more like a market instead of a black box.

jon-wood 7y ago
> I don't think you can argue effectively that granting the same medical care to all as a matter of law will fly. People will always find a way to get better care if they can afford it. I’m not sure anyone is arguing that. In almost any country with single payer health care you’ll also find a thriving market in private health care, but they’re typically competing on things like providing private rooms and maybe a shorter waiting list rather than whether you get to live or die.
- s_y_n_t_a_x 7y ago
  It's not live or die in America, in the worst possible scenario you may go into a deep debt, but they won't kick you to the curb if you're dying.
  - cyphar 7y ago
    Nope, it's definitely life-or-death. According to a 2009 study, 45000 people die annually due to lack of health insurance in the US[1]. Due to the ACA there are now more people who are insured but it's still a massive segment of the US population (not to mention that healthcare plans have been covering less and less over time). The number of people who die due to lack of healthcare is ZERO for countries that have universal healthcare. Fourty. Five. Thousand. Every. Year. [1]: https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ https://news.harvard.edu/gazette/story/2009/09/new-study-fin...
    - s_y_n_t_a_x 7y ago
      My point was that the hospitals don't turn you away if you are in need of urgent care. That statistic is looking at patients who avoided regular healthcare due to lack of insurance. Which is a problem. And if we're looking at that, you have to look at the other side of the coin. Socialized healthcare systems have much larger wait times and you can find deaths attributed to those, so it's disingenuous to say ZERO people died in countries that have universal healthcare. More research needs to be done before enforcing such a system on a wide scale in America. There has been data suggesting deaths and suffering related from long wait times in Canada. Then you have the increase of Canadians coming to America to escape the wait times. As well what we've seen with VA and ObamaCare wait times. > 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009 https://www.huffingtonpost.ca/bacchus-barua-/wait-times-canada_b_5505110.html https://www.huffingtonpost.ca/bacchus-barua-/wait-times-cana... Basically you trade the fear of going into debt and not getting healthcare vs wanting to get healthcare and not being allowed to for an arbitrary amount of time. There are more pros and cons to each system, but my point is that socialized healthcare systems has it's fault and certainly does cause deaths in some instances. > 19.8 weeks between referral from a general practitioner and receipt of treatment > across the 10 provinces, the total number of procedures for which people are waiting in 2018 is 1,082,541 https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2018 https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
- sailfast 7y ago
  Agreed. I guess my point, more succinctly is that this will always be the case, regardless of from whom folks obtain their insurance. A better question might be "does employment-based insurance make medical care MORE or VERY inefficient / unfair".
sgt101 7y ago
>The best way to ensure fairness and efficiency is to get the data out there and available, and make healthcare more like a market instead of a black box. Markets without perfect information are neither efficient or fair; I think it's reasonable to say that no healthcare market can have anything approximately resembling perfect information. Also the idea of efficiency in healthcare is problematic. Does efficient healthcare means refusing care to old people and to people who need heroic interventions and instead focusing care only on interventions that provide a high return of healthy productive years per $? I would like a clear articulation of efficient and fair in this context.
- sailfast 7y ago
  If I could choose which hospital to go to based on available data, pricing, luxury levels, outcomes, etc so that I understood the costs I would incur (at a high level) to get that care, and then get quotes from different places, I think that would go a long way to ensuring at a minimum that folks understood what they were getting, rather than being forced toward outcomes due to lack of information. As for "efficient" and "fair" I would also be interested in a better definition there, one the article didn't quite provide to my satisfaction based on its question.
  - deleted 7y ago
    [deleted]
- jwbwater 7y ago
  No market has perfect information, but many still work pretty well. Just knowing what a healthcare service would cost before you get it would be a huge improvement in the US. And how about requiring providers to charge everyone the same price for the same service, instead of radically higher prices for the uninsured.
cyphar 7y ago
The fact that the rest of the developed world has universal healthcare (in one form or another) and most have better health outcomes and overall public health than the US tells me that your theory is flawed. It should be noted that the Bernie Sanders proposal actually does allow for supplemental private insurance (for elective surgeries, or shorter waiting times). Most countries with universal healthcare have a private insurance industry, it's just that you get a basic level of care from government-provided free insurance.
- sailfast 7y ago
  My theory is that no matter what there will be things that are unfair or inequal in healthcare any time folks have more resources than others to apply to treatment. I agree with you that based on overall spending and outcomes something needs to change a great deal. I admit that even after reading the original article I don't really understand why employer-provided care is creating these asymmetries except to say that typically employer provided care is more reasonably priced to the employee than comparable coverages to a private citizen, because of course it is. It's an incentive.

jon-wood 7y ago

> I don't think you can argue effectively that granting the same medical care to all as a matter of law will fly. People will always find a way to get better care if they can afford it. I’m not sure anyone is arguing that. In almost any country with single payer health care you’ll also find a thriving market in private health care, but they’re typically competing on things like providing private rooms and maybe a shorter waiting list rather than whether you get to live or die.

s_y_n_t_a_x 7y ago
It's not live or die in America, in the worst possible scenario you may go into a deep debt, but they won't kick you to the curb if you're dying.
- cyphar 7y ago
  Nope, it's definitely life-or-death. According to a 2009 study, 45000 people die annually due to lack of health insurance in the US[1]. Due to the ACA there are now more people who are insured but it's still a massive segment of the US population (not to mention that healthcare plans have been covering less and less over time). The number of people who die due to lack of healthcare is ZERO for countries that have universal healthcare. Fourty. Five. Thousand. Every. Year. [1]: https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/ https://news.harvard.edu/gazette/story/2009/09/new-study-fin...
  - s_y_n_t_a_x 7y ago
    My point was that the hospitals don't turn you away if you are in need of urgent care. That statistic is looking at patients who avoided regular healthcare due to lack of insurance. Which is a problem. And if we're looking at that, you have to look at the other side of the coin. Socialized healthcare systems have much larger wait times and you can find deaths attributed to those, so it's disingenuous to say ZERO people died in countries that have universal healthcare. More research needs to be done before enforcing such a system on a wide scale in America. There has been data suggesting deaths and suffering related from long wait times in Canada. Then you have the increase of Canadians coming to America to escape the wait times. As well what we've seen with VA and ObamaCare wait times. > 25,456 and 63,090 Canadian women may have died as a result of increased wait times between 1993 and 2009 https://www.huffingtonpost.ca/bacchus-barua-/wait-times-canada_b_5505110.html https://www.huffingtonpost.ca/bacchus-barua-/wait-times-cana... Basically you trade the fear of going into debt and not getting healthcare vs wanting to get healthcare and not being allowed to for an arbitrary amount of time. There are more pros and cons to each system, but my point is that socialized healthcare systems has it's fault and certainly does cause deaths in some instances. > 19.8 weeks between referral from a general practitioner and receipt of treatment > across the 10 provinces, the total number of procedures for which people are waiting in 2018 is 1,082,541 https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2018 https://www.fraserinstitute.org/studies/waiting-your-turn-wa...
sailfast 7y ago
Agreed. I guess my point, more succinctly is that this will always be the case, regardless of from whom folks obtain their insurance. A better question might be "does employment-based insurance make medical care MORE or VERY inefficient / unfair".

sgt101 7y ago

>The best way to ensure fairness and efficiency is to get the data out there and available, and make healthcare more like a market instead of a black box. Markets without perfect information are neither efficient or fair; I think it's reasonable to say that no healthcare market can have anything approximately resembling perfect information. Also the idea of efficiency in healthcare is problematic. Does efficient healthcare means refusing care to old people and to people who need heroic interventions and instead focusing care only on interventions that provide a high return of healthy productive years per $? I would like a clear articulation of efficient and fair in this context.

sailfast 7y ago
If I could choose which hospital to go to based on available data, pricing, luxury levels, outcomes, etc so that I understood the costs I would incur (at a high level) to get that care, and then get quotes from different places, I think that would go a long way to ensuring at a minimum that folks understood what they were getting, rather than being forced toward outcomes due to lack of information. As for "efficient" and "fair" I would also be interested in a better definition there, one the article didn't quite provide to my satisfaction based on its question.
- deleted 7y ago
  [deleted]
jwbwater 7y ago
No market has perfect information, but many still work pretty well. Just knowing what a healthcare service would cost before you get it would be a huge improvement in the US. And how about requiring providers to charge everyone the same price for the same service, instead of radically higher prices for the uninsured.

cyphar 7y ago

The fact that the rest of the developed world has universal healthcare (in one form or another) and most have better health outcomes and overall public health than the US tells me that your theory is flawed. It should be noted that the Bernie Sanders proposal actually does allow for supplemental private insurance (for elective surgeries, or shorter waiting times). Most countries with universal healthcare have a private insurance industry, it's just that you get a basic level of care from government-provided free insurance.

sailfast 7y ago
My theory is that no matter what there will be things that are unfair or inequal in healthcare any time folks have more resources than others to apply to treatment. I agree with you that based on overall spending and outcomes something needs to change a great deal. I admit that even after reading the original article I don't really understand why employer-provided care is creating these asymmetries except to say that typically employer provided care is more reasonably priced to the employee than comparable coverages to a private citizen, because of course it is. It's an incentive.