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The single tool that AFAIK every other advanced-economy state (OECD, if you like, but even some outside that) uses, despite all the different approaches in the

The single tool that AFAIK every other advanced-economy state (OECD, if you like, but even some outside that) uses, despite all the different approaches in the wild, is: price controls. The more-free-market ones simply dictate prices on some things and services (with, for the more-free-market ones like Singapore, the very real implicit threat of dictating even more of them if the market gets too greedy, with the less-free-market ones dictating more prices from the outset), and at the less-free-market end of the spectrum you have state monopsony (single-payer) or even direct state control of healthcare service providers, so the price controls are more de facto. I'm not aware of a single system outside the US [EDIT: in a developed state, that is—I've not looked into developing-world systems] that doesn't achieve their results with price controls. Even the relatively "free market" ones—again, Singapore is usually the prime example people bring out for that, and they use some price controls and a very credible threat of further intervention to make their system work. Given this, I don't have much hope of success for any reform that doesn't either directly set at least some prices and threaten to set even more, or take even more control over price-setting (monopsony power, or nationalizing providers), given how universal that element seems to be.

SomewhatLikely 5y ago
Are there any examples where a public option is available at a reasonable price so any private practices have to compete on price?
- huitzitziltzin 5y ago
  Not exactly as you may be thinking, but in many countries there is a parallel, private health care sector. The fact that patients have the choice to go to the public sector instead of the private likely keeps prices in the private sector down, but if there is literature on the extent and magnitude of those effects, I’m not familiar with it. Mexico is an example of such a country.
- handrous 5y ago
  None that I'm aware of. My guess would be that this is because if you do it poorly, it doesn't help a damn thing, and if you do it well, it's just single-payer with extra steps. This is because to do it right you'd effectively have to dictate that ~all providers take the public option insurance, and at that point you may as well do single-payer. Otherwise, there's no reason to expect a public option, as in just another insurer that happens to be government-run, would be able to compete when providers can just refuse to take them unless they raise compensation to roughly match everyone else. At best it would apply only light downward pressure on prices. There are some systems that have private (though, perhaps, non-profit only) insurance and a public insurer as a kind of public option, as an insurer of last resort, but they place all kinds of restrictions on this, like standardizing basic-coverage plans and dictating that all insurers offer them, mandating that providers all accept these plans (including the government one) and so on, and often still having other price controls on top of it.
  - Closi 5y ago
    What about the UK? Free at the point of service healthcare with relatively high quality and low cost private options eg via Bupa (when compared to the prices in the USA)
    - handrous 5y ago
      That's a private system on top of a universal public one, no? It's not an option as in "instead of private insurance, you can do this, but you can also forego this and use only private insurance". You have access to public care, period, and can pay for extra on top from the private system. Right? [EDIT] To clarify, "public option" proposals in the US involve a government-run insurer operating on the same market as private insurers, not any kind of universal or default coverage. There are lots of systems with private components or additions or even that are primarily private (with heavy regulation and price controls, typically) but I'm not aware of any that do what US public option proposals have called for. US public option proposals that have made it as far as bills have also come with restrictions, like only allowing those without employer-sponsored insurance options available to choose to pay for a public option, which would almost certainly have done weird and undesirable things to the risk pools for the public plans.

SomewhatLikely 5y ago

Are there any examples where a public option is available at a reasonable price so any private practices have to compete on price?

huitzitziltzin 5y ago
Not exactly as you may be thinking, but in many countries there is a parallel, private health care sector. The fact that patients have the choice to go to the public sector instead of the private likely keeps prices in the private sector down, but if there is literature on the extent and magnitude of those effects, I’m not familiar with it. Mexico is an example of such a country.
handrous 5y ago
None that I'm aware of. My guess would be that this is because if you do it poorly, it doesn't help a damn thing, and if you do it well, it's just single-payer with extra steps. This is because to do it right you'd effectively have to dictate that ~all providers take the public option insurance, and at that point you may as well do single-payer. Otherwise, there's no reason to expect a public option, as in just another insurer that happens to be government-run, would be able to compete when providers can just refuse to take them unless they raise compensation to roughly match everyone else. At best it would apply only light downward pressure on prices. There are some systems that have private (though, perhaps, non-profit only) insurance and a public insurer as a kind of public option, as an insurer of last resort, but they place all kinds of restrictions on this, like standardizing basic-coverage plans and dictating that all insurers offer them, mandating that providers all accept these plans (including the government one) and so on, and often still having other price controls on top of it.
- Closi 5y ago
  What about the UK? Free at the point of service healthcare with relatively high quality and low cost private options eg via Bupa (when compared to the prices in the USA)
  - handrous 5y ago
    That's a private system on top of a universal public one, no? It's not an option as in "instead of private insurance, you can do this, but you can also forego this and use only private insurance". You have access to public care, period, and can pay for extra on top from the private system. Right? [EDIT] To clarify, "public option" proposals in the US involve a government-run insurer operating on the same market as private insurers, not any kind of universal or default coverage. There are lots of systems with private components or additions or even that are primarily private (with heavy regulation and price controls, typically) but I'm not aware of any that do what US public option proposals have called for. US public option proposals that have made it as far as bills have also come with restrictions, like only allowing those without employer-sponsored insurance options available to choose to pay for a public option, which would almost certainly have done weird and undesirable things to the risk pools for the public plans.