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Isn’t the biggest problem in the US health insurers operating on state level only? This is due to some regulation preventing formation of federal insurers. I n

Isn’t the biggest problem in the US health insurers operating on state level only? This is due to some regulation preventing formation of federal insurers. I never understood why there are no independent national health insurers (read Allianz for example) providing health care for self employed people like in Europe. Edit: A classic by John Mackey (Whole Foods Inc.) but still valid: https://www.wsj.com/articles/SB10001424052970204251404574342170072865070 https://www.wsj.com/articles/SB10001424052970204251404574342... Quote: „Repeal government mandates regarding what insurance companies must cover.“

ageitgey 5y ago
The US has states that are larger than countries in Europe. This may or may not contribute to the problem, but it is tiny in the big picture of US healthcare issues. The issue in the US is that the system is hugely inefficient compared to the models in Europe. There is an absolutely massive administrative layer between care providers and payers, price negotiations aren't transparent or efficient, the whole system is hugely complex, and the vested interests are incentivized to keep it that way.
toast0 5y ago
Most of the big insurers operate in multiple states. But operation in each state is regulated by that state, and I've heard, but not verified, that most ACA plans offer in-state coverage only, with some exceptions for communities at state borders (if you live near Lake Tahoe, an ACA plan probably covers doctors in the area in NV and CA) Shopping for plans on the marketplace is already terrible when they all cover the same stuff. It'll be way worse if I have to decide between terrible options for what's covered. Especially since we all know none of that is going to be clear or easily comparable, and certainly not pick the things you want covered.... It'll be like broken bones are in the package that excludes cysts, and brain cancer coverage is not available with any other cancers, and to get coverage for any sort of dermatology, you also need coverage for skiing and parachuting incidents. As-is, I can take my list of prefered facilities, look and see who has them in network, and then add the premiums to the out of pocket max to find my rough worst case cost and pick the one with the least worst case cost and call it a day. This is usually also the one with the least premiums, so it's also the least cost if I don't visit the doctor at all.

ageitgey 5y ago

The US has states that are larger than countries in Europe. This may or may not contribute to the problem, but it is tiny in the big picture of US healthcare issues. The issue in the US is that the system is hugely inefficient compared to the models in Europe. There is an absolutely massive administrative layer between care providers and payers, price negotiations aren't transparent or efficient, the whole system is hugely complex, and the vested interests are incentivized to keep it that way.

toast0 5y ago

Most of the big insurers operate in multiple states. But operation in each state is regulated by that state, and I've heard, but not verified, that most ACA plans offer in-state coverage only, with some exceptions for communities at state borders (if you live near Lake Tahoe, an ACA plan probably covers doctors in the area in NV and CA) Shopping for plans on the marketplace is already terrible when they all cover the same stuff. It'll be way worse if I have to decide between terrible options for what's covered. Especially since we all know none of that is going to be clear or easily comparable, and certainly not pick the things you want covered.... It'll be like broken bones are in the package that excludes cysts, and brain cancer coverage is not available with any other cancers, and to get coverage for any sort of dermatology, you also need coverage for skiing and parachuting incidents. As-is, I can take my list of prefered facilities, look and see who has them in network, and then add the premiums to the out of pocket max to find my rough worst case cost and pick the one with the least worst case cost and call it a day. This is usually also the one with the least premiums, so it's also the least cost if I don't visit the doctor at all.