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Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doc

Education and health care are both dominated by government as the single largest player in the marketplace. The U.S. government actively sets the number of doctors, the types of procedures that can be covered by insurance, and dominates market spending through its Medicare, Medicaid, and VA programs. And if you aren't on a government program, the tax code forces you into a employer-provided insurance ghetto. Healthcare innovation will remain low, and costs will continue to grow at double digits, until America passes real healthcare reform. Allow insurance competition across state lines, give private individuals the same tax treatment as employers when buying healthcare, and allow individuals to form groups to purchase health care (e.g. alumni groups, church groups, etc). Those three steps would go a long way to opening up the industry to the web and to innovative, competitive forces.

prodigal_erik 15y ago
I don't think more small risk pools are a good solution, due to adverse selection. The very sick or old often need more treatment than they can possibly afford (because what we develop isn't limited to the value of the typical patient's labor, which is a good thing!) so our choices are to let them die through triage, or to subsidize their treatment by preventing the well and young from gravitating into cheaper risk pools which find ways to exclude the sick or old. Tax-funded Medicare and Medicaid are effectively additional risk pools you're paying for even when they aren't covering you, and yet they aren't really acting as insurers of last resort (except for certain people who meet the criteria).
pinaceae 15y ago
or, those individuals could form an even larger group to ensure equal coverage for all people. could call it a state or a country or civilization. the government is people.
jacoblyles 15y ago
Fortunately for students education had fewer licensing requirements than healthcare. This allowed for the home school loophole, and for a network of alternative education providers to slowly grow and flourish outside of government control. Healthcare faces much stricter regulations as to who can provide care and how they administer it, so I expect much less change and improvement.
MJR 15y ago
First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad brush statements like "allow insurance competition across state lines", the complexities of that single issue alone are staggering. Are you aware that the strength of most in-state insurance carriers is their in-state network. An insurance company IS it's network. In addition each individual state has a Department of Insurance which also regulates all carriers in that state. DOI rules and regulations vary from state to state. Expanding your coverage to another state is a very complex undertaking. Also, Individual groups do have the ability to purchase healthcare - see many professional organizations(AIGA, etc) as working examples of this today. In either case, making those changes won't just magically open the industry to "the web and to innovative, competitive forces". There are already competitive forces at play. Any new player attempting to join the fray faces an uphill battle just in the regulatory aspects of the business alone. What do the advantages of the web and new technologies bring to insurance? How do these changes the provider networks which are the backbone of major insurance coverage today? These are the types of questions which need to be posed, and the people in the best position to answer these questions and change the game are insurers themselves. There are many smart and talented people working in insurance. The recent proposed Healthcare changes have helped to begin the process of moving forward and thinking differently, but with an industry like this it will take time. It is happening, insurance providers are looking at new technologies and ways to provide the coverage that people expect, for lower costs, in new and different ways.
- jacoblyles 15y ago
  >"The government currently does not regulate individual/employer coverage." Are you sure about that? Last I checked, the feds mandate an immense number of details about how private insurance is provided, and that is only growing with the new health care law. >"I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean?" 1 of every 2 dollars spent in health care in the US is spent by the government. These three programs are clearly the 800 pound gorillas in the room. Medicare's price controls directly drive shortages and oversupply, and its billing practices set the standard for the rest of the industry.
marshallp 15y ago
clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery
- nradov 15y ago
  WTF? My house is pretty far from being a sterile environment.
  - marshallp 15y ago
    creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)
    - nradov 15y ago
      Creating even a small sterile environment is actually quite hard. What is the robot going to do, autoclave or boil everything in my bedroom? The main reason that most patients actually survive surgery now is that a huge amount of effort goes into keeping operating rooms sterile.
      - rsheridan6 15y ago
        The robot would probably bring its own portable sterile bubble.
maxxxxx 15y ago
Group insurance should be abolished. Take the whole country as one big group. It doesn't make sense to have small groups negotiate their coverage.

prodigal_erik 15y ago

I don't think more small risk pools are a good solution, due to adverse selection. The very sick or old often need more treatment than they can possibly afford (because what we develop isn't limited to the value of the typical patient's labor, which is a good thing!) so our choices are to let them die through triage, or to subsidize their treatment by preventing the well and young from gravitating into cheaper risk pools which find ways to exclude the sick or old. Tax-funded Medicare and Medicaid are effectively additional risk pools you're paying for even when they aren't covering you, and yet they aren't really acting as insurers of last resort (except for certain people who meet the criteria).

pinaceae 15y ago

or, those individuals could form an even larger group to ensure equal coverage for all people. could call it a state or a country or civilization. the government is people.

jacoblyles 15y ago

Fortunately for students education had fewer licensing requirements than healthcare. This allowed for the home school loophole, and for a network of alternative education providers to slowly grow and flourish outside of government control. Healthcare faces much stricter regulations as to who can provide care and how they administer it, so I expect much less change and improvement.

MJR 15y ago

First, most Americans fall outside Medicare, Medicaid and the VA programs. The government currently does not regulate individual/employer coverage. I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean? The whole second paragraph makes it clear that you don't understand the complexities of the Healthcare industry. You provide very broad brush statements like "allow insurance competition across state lines", the complexities of that single issue alone are staggering. Are you aware that the strength of most in-state insurance carriers is their in-state network. An insurance company IS it's network. In addition each individual state has a Department of Insurance which also regulates all carriers in that state. DOI rules and regulations vary from state to state. Expanding your coverage to another state is a very complex undertaking. Also, Individual groups do have the ability to purchase healthcare - see many professional organizations(AIGA, etc) as working examples of this today. In either case, making those changes won't just magically open the industry to "the web and to innovative, competitive forces". There are already competitive forces at play. Any new player attempting to join the fray faces an uphill battle just in the regulatory aspects of the business alone. What do the advantages of the web and new technologies bring to insurance? How do these changes the provider networks which are the backbone of major insurance coverage today? These are the types of questions which need to be posed, and the people in the best position to answer these questions and change the game are insurers themselves. There are many smart and talented people working in insurance. The recent proposed Healthcare changes have helped to begin the process of moving forward and thinking differently, but with an industry like this it will take time. It is happening, insurance providers are looking at new technologies and ways to provide the coverage that people expect, for lower costs, in new and different ways.

jacoblyles 15y ago
>"The government currently does not regulate individual/employer coverage." Are you sure about that? Last I checked, the feds mandate an immense number of details about how private insurance is provided, and that is only growing with the new health care law. >"I would not characterize the entire private insurance industry as an "employer-provided insurance ghetto" - what does that even mean?" 1 of every 2 dollars spent in health care in the US is spent by the government. These three programs are clearly the 800 pound gorillas in the room. Medicare's price controls directly drive shortages and oversupply, and its billing practices set the standard for the rest of the industry.

marshallp 15y ago

clayton christensen advises that the solution to healthcare is personalized medicine, technologies like portable diabetes monitors. Imagine if you needed surgery, a robot comes to your house and performs it, much cheaper than doctors and hospitals. such system are currently being developed with military funding - battlefield telerobotic surgery

nradov 15y ago
WTF? My house is pretty far from being a sterile environment.
- marshallp 15y ago
  creating a small area of sterility isn't a impossible task, if you can create large one in an operating room, creating a smaller one can't be all that hard (with robotic equipment)
  - nradov 15y ago
    Creating even a small sterile environment is actually quite hard. What is the robot going to do, autoclave or boil everything in my bedroom? The main reason that most patients actually survive surgery now is that a huge amount of effort goes into keeping operating rooms sterile.
    - rsheridan6 15y ago
      The robot would probably bring its own portable sterile bubble.

maxxxxx 15y ago

Group insurance should be abolished. Take the whole country as one big group. It doesn't make sense to have small groups negotiate their coverage.