3 ms·

I don't think it's a _bad law_* as much as it's an _incomplete law_. I don't know what the complete version looks like, but it would include both customer cost

I don't think it's a _bad law_* as much as it's an _incomplete law_. I don't know what the complete version looks like, but it would include both customer cost controls and reward innovation-based efficiency gains. Alternatively, some places have taken the approach that these are mutually exclusive and just generally removed profit from the picture entirely by socializing it. * Health care costs were growing out of control before these laws, which seem to have slowed that trend short-term but not long-term as the industry pivoted.

amluto 3y ago
IMO the most effective consumer cost control is competition. An actual, non-corrupt, free market where customers are not locked in and there are more than just a handful of providers generally results in low prices. We do not have this in healthcare. Providers form cartels - at least in Northern California, this is so bad that the state AG is investigating (not very effectually) [0]. Customers generally can't even tell what a provider charges, so there is no price competition. There aren't many insurers, and they compete on so many incomprehensible dimensions that customers can't usefully choose. (And the most useful thing customers can look at is the network, but see the above issue with provider cartels.) Pharmacy benefits are highly corrupt and incomprehensible. [0] We have Sutter Health, UCSF, Stanford, and Kaiser. There is very little in the way of independent providers left. Sutter Health in particular has aggressively merged with any available competition.
- izzydata 3y ago
  Wouldn't a free market eventually lead to all these insurance companies combining into 1-2 even more mega insurance companies until there is no competition again? At least if all their profits are capped there is no reason to merge.
  - amluto 3y ago
    Let me quote myself: > An actual, non-corrupt, free market where customers are not locked in and there are more than just a handful of providers I’m not suggesting an unregulated market. I’m suggesting a market in which antitrust laws are aggressively enforced.
- status_quo69 3y ago
  We do have this in a way with healthcare.gov, since the marketplace allows consumers to view multiple insurers rather than those tied to their jobs. However these plans are still pricey, I put in some dummy data with a higher than average income (60k) and got plans at 280 per month at the bottom of the barrel. Seems to me like it's a good step in the right direction but the marketplace doesn't have an actual market driving force to reduce prices even with the 11 million plans selected for 2023. Having worked in healthcare billing processing software, this lines up, insurance companies really don't give a shit about reducing prices to compete since consumers at the point of billing are always a captive audience (if you don't have it and you have an emergency, you're fucked)

amluto 3y ago

IMO the most effective consumer cost control is competition. An actual, non-corrupt, free market where customers are not locked in and there are more than just a handful of providers generally results in low prices. We do not have this in healthcare. Providers form cartels - at least in Northern California, this is so bad that the state AG is investigating (not very effectually) [0]. Customers generally can't even tell what a provider charges, so there is no price competition. There aren't many insurers, and they compete on so many incomprehensible dimensions that customers can't usefully choose. (And the most useful thing customers can look at is the network, but see the above issue with provider cartels.) Pharmacy benefits are highly corrupt and incomprehensible. [0] We have Sutter Health, UCSF, Stanford, and Kaiser. There is very little in the way of independent providers left. Sutter Health in particular has aggressively merged with any available competition.

izzydata 3y ago
Wouldn't a free market eventually lead to all these insurance companies combining into 1-2 even more mega insurance companies until there is no competition again? At least if all their profits are capped there is no reason to merge.
- amluto 3y ago
  Let me quote myself: > An actual, non-corrupt, free market where customers are not locked in and there are more than just a handful of providers I’m not suggesting an unregulated market. I’m suggesting a market in which antitrust laws are aggressively enforced.
status_quo69 3y ago
We do have this in a way with healthcare.gov, since the marketplace allows consumers to view multiple insurers rather than those tied to their jobs. However these plans are still pricey, I put in some dummy data with a higher than average income (60k) and got plans at 280 per month at the bottom of the barrel. Seems to me like it's a good step in the right direction but the marketplace doesn't have an actual market driving force to reduce prices even with the 11 million plans selected for 2023. Having worked in healthcare billing processing software, this lines up, insurance companies really don't give a shit about reducing prices to compete since consumers at the point of billing are always a captive audience (if you don't have it and you have an emergency, you're fucked)