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A much simpler first step that I think would be really helpful is: 1) Prevent any group discounts or employer discounts for health insurance 2) Possibly, to g

A much simpler first step that I think would be really helpful is: 1) Prevent any group discounts or employer discounts for health insurance 2) Possibly, to go even farther, ban health insurance as employee compensation Benefits: 1) People see the actual cost of their health insurance 2) People can choose insurance on a competitive market instead of picking between 3 packages their employer subsidizes, so insurance companies actually have to be competitive 3) People aren't forced to pick a difference insurance company every time their employer renegotiates with a different provider, which can also change their healthcare network 4) Lower barrier to leave or change jobs since you can keep paying the same known amount for health insurance and receive the same service 5) Lower barrier to self-employment since you are no longer at a disadvantage for health care costs

diffeomorphism 4y ago
For 2) it is much simpler to say something like "employer pays half of the monthly rate up to $X", while you freely pick which insurance. That is how it works in Germany by the way. Concerning the competition I would caution that from my experience some American insurances lack standards. For example insane copay, cancer not covered or other crazy exceptions. So to have actual competition you should also require by law that all essentials have to be covered with a limited copay and not discriminate. The insurances can still compete on non-essentials (e.g. fitness, cheaper checkups). Otherwise you run into the issue that poor people are forced to buy scam insurance.
- stetrain 4y ago
  Agreed. We actually have some of those standards for insurance packages in the “Obamacare” market. But many people don’t participate in that market because they get a much better deal with their employer’s negotiated and subsidized option.
Auracle 4y ago
Step 1 should be “every health plan is a high deductible health plan.” Step 2 should be “Absolute price transparency.” We need to make patients cost-sensitive. It’s utterly ridiculous that there’s a pill to treat low testosterone that’s $1,000 a month when a weekly injection costs $20 a month. Sure, taking a pill is easier and less painful. 99.9% of people would still choose the needle if they actually had to pay for it - and that would mean the manufacturer of the pills would have to lower the cost. The same thing goes for many other medications and treatments. Why bother trying to price out that MRI if you’re hitting your deductible either way? Not like they’d tell you the cost up front anyways.
- mrtranscendence 4y ago
  Switching everyone to a high-deductible would be disastrous for people with expensive chronic conditions like diabetes. It would force people to forgo treatment or select suboptimal treatment even in the absence of chronic conditions, leading to complications that require further treatment down the line. Not a fan of this idea.
  - Auracle 4y ago
    Ideally for the truly low income there would be subsidies, but it’d have to be limited enough for them to still have skin in the game. The end point is that what are now expensive, chronic conditions would become much less expensive. There would be some pain in the interim. Frankly I’d be all for tying our drug prices to the prices in other countries. If I were king for a day I’d do both that and what I detailed above.
vkou 4y ago
> 2) People can choose insurance on a competitive market instead of picking between 3 packages their employer subsidizes, so insurance companies actually have to be competitive You're only solving half the problem. The other half of the problem is that you'll still have no idea as to what you'll be getting for the money you pay your insurer. I don't really care about whether the copay for a doctor's visit is $10 or $20, what I care about is whether or not I'll get a surprise bill for $15,000 for a medical procedure. And I can't predict which insurer it's more likely to happen with. When you're buying a pig in a poke, knowing how much you'll pay for it isn't of much use.
- stetrain 4y ago
  Sure, but you also can’t guarantee that without insurance either. Are you going to ask the ambulance to take you to a different hospital when the first one gives you their rate schedule for heart attack interventions?
  - vkou 4y ago
    That's the other, other half of the problem.
    - stetrain 4y ago
      I haven't used it and don't know how good it actually is, but I have browsed for insurance on the Healthcare Marketplace (aka Obamacare) and they set out some pretty strict levels of coverage, services, deductibles, etc. in a standardized way. But most people don't participate in that market because it would be silly to when your employer gives you a group buy rate plus an extra employer-paid subsidy to incentivize you to be part of the group buy.
lettergram 4y ago
You’re still just adding more regulation. More complexity and spaghetti laws aren’t going to solve things. Pre 1970s healthcare costs were in-line with the rest of the world. Revert the push to corporatize and socialize and we’d have cheaper care. The fact employers pay for healthcare isn’t an issue. Who cares? It’s just part of compensation. I can take my money and do the same thing. No one will btw, they’d just buy cheaper insurance and have a higher out of pocket expense. End-of-the-day Medicare and regulatory capture is the issue. I can’t go to my local store and get antibiotics, even if I have a test showing strep. Instead, I have to go to a doctors office. A doctor who is intentionally being made scarce (ie driving up demand). Then I get my antibiotics, but they request a follow up. No amount of insurance wizardry will fix that scenario. You have to deregulate to fix it. i do think, Insurance companies will insist you follow their rules to cut their costs. Making healthcare worse for you. Even if you were to deregulate, insurance will still be able to apply pressure. IMO ban insurance outright for medical related items. You have a right to medical privacy and the idea insurance is required is BS.
- stetrain 4y ago
  > I can take my money and do the same thing. It will cost more than the package negotiated by your employer since you are out of the group-rate. Which means it isn’t actually a free market choice with competition. Applying free market choice to the healthcare itself sounds great but it’s difficult to make such choices when unconscious in the back of an ambulance, or after a drug company or doctor causes you permanent injury or death.

diffeomorphism 4y ago

For 2) it is much simpler to say something like "employer pays half of the monthly rate up to $X", while you freely pick which insurance. That is how it works in Germany by the way. Concerning the competition I would caution that from my experience some American insurances lack standards. For example insane copay, cancer not covered or other crazy exceptions. So to have actual competition you should also require by law that all essentials have to be covered with a limited copay and not discriminate. The insurances can still compete on non-essentials (e.g. fitness, cheaper checkups). Otherwise you run into the issue that poor people are forced to buy scam insurance.

stetrain 4y ago
Agreed. We actually have some of those standards for insurance packages in the “Obamacare” market. But many people don’t participate in that market because they get a much better deal with their employer’s negotiated and subsidized option.

Auracle 4y ago

Step 1 should be “every health plan is a high deductible health plan.” Step 2 should be “Absolute price transparency.” We need to make patients cost-sensitive. It’s utterly ridiculous that there’s a pill to treat low testosterone that’s $1,000 a month when a weekly injection costs $20 a month. Sure, taking a pill is easier and less painful. 99.9% of people would still choose the needle if they actually had to pay for it - and that would mean the manufacturer of the pills would have to lower the cost. The same thing goes for many other medications and treatments. Why bother trying to price out that MRI if you’re hitting your deductible either way? Not like they’d tell you the cost up front anyways.

mrtranscendence 4y ago
Switching everyone to a high-deductible would be disastrous for people with expensive chronic conditions like diabetes. It would force people to forgo treatment or select suboptimal treatment even in the absence of chronic conditions, leading to complications that require further treatment down the line. Not a fan of this idea.
- Auracle 4y ago
  Ideally for the truly low income there would be subsidies, but it’d have to be limited enough for them to still have skin in the game. The end point is that what are now expensive, chronic conditions would become much less expensive. There would be some pain in the interim. Frankly I’d be all for tying our drug prices to the prices in other countries. If I were king for a day I’d do both that and what I detailed above.

vkou 4y ago

> 2) People can choose insurance on a competitive market instead of picking between 3 packages their employer subsidizes, so insurance companies actually have to be competitive You're only solving half the problem. The other half of the problem is that you'll still have no idea as to what you'll be getting for the money you pay your insurer. I don't really care about whether the copay for a doctor's visit is $10 or $20, what I care about is whether or not I'll get a surprise bill for $15,000 for a medical procedure. And I can't predict which insurer it's more likely to happen with. When you're buying a pig in a poke, knowing how much you'll pay for it isn't of much use.

stetrain 4y ago
Sure, but you also can’t guarantee that without insurance either. Are you going to ask the ambulance to take you to a different hospital when the first one gives you their rate schedule for heart attack interventions?
- vkou 4y ago
  That's the other, other half of the problem.
  - stetrain 4y ago
    I haven't used it and don't know how good it actually is, but I have browsed for insurance on the Healthcare Marketplace (aka Obamacare) and they set out some pretty strict levels of coverage, services, deductibles, etc. in a standardized way. But most people don't participate in that market because it would be silly to when your employer gives you a group buy rate plus an extra employer-paid subsidy to incentivize you to be part of the group buy.

lettergram 4y ago

You’re still just adding more regulation. More complexity and spaghetti laws aren’t going to solve things. Pre 1970s healthcare costs were in-line with the rest of the world. Revert the push to corporatize and socialize and we’d have cheaper care. The fact employers pay for healthcare isn’t an issue. Who cares? It’s just part of compensation. I can take my money and do the same thing. No one will btw, they’d just buy cheaper insurance and have a higher out of pocket expense. End-of-the-day Medicare and regulatory capture is the issue. I can’t go to my local store and get antibiotics, even if I have a test showing strep. Instead, I have to go to a doctors office. A doctor who is intentionally being made scarce (ie driving up demand). Then I get my antibiotics, but they request a follow up. No amount of insurance wizardry will fix that scenario. You have to deregulate to fix it. i do think, Insurance companies will insist you follow their rules to cut their costs. Making healthcare worse for you. Even if you were to deregulate, insurance will still be able to apply pressure. IMO ban insurance outright for medical related items. You have a right to medical privacy and the idea insurance is required is BS.

stetrain 4y ago
> I can take my money and do the same thing. It will cost more than the package negotiated by your employer since you are out of the group-rate. Which means it isn’t actually a free market choice with competition. Applying free market choice to the healthcare itself sounds great but it’s difficult to make such choices when unconscious in the back of an ambulance, or after a drug company or doctor causes you permanent injury or death.