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I think the main problem is lack of free market. Oligopolies are part of the problem, but an equally large part is lack of choice from employes. Many (most?) in

I think the main problem is lack of free market. Oligopolies are part of the problem, but an equally large part is lack of choice from employes. Many (most?) insured in the US get their healthcare through their employer. You get maybe 2 choices of insurer, often only one. You’re not going to get a new job to switch insurers. The people negotiating the plans are too far away from the people receiving care (it’s probably the finance people anyway). Not everyone has the same healthcare needs or lives in the same area, group plans don’t make sense in today’s world. The government should be promoting and incentivizing ICHRAs and similar. If you haven’t heard of ICHRAs they allow employers to give you a stipend for healthcare. You get to choose your plan (including open marketplace plans, which have some affordability regulations), you can use it for copays or to just pay for stuff out of pocket. You can choose a catastrophic plan and get insurance / a plan from your PCP so you never have to worry about “network” changes. And it’s tax free for employers and employees. Cheaper for employers too, they don’t have to hire benefits administrators and negotiate with brokers/insurance companies. If you’re a company, especially a mid to small sized one, I highly encourage you to look into ICHRAs.

ClumsyPilot 3y ago
> lack of free market. Oligopolies are part of the problem Free market produces Oligopolies, monopolies, cartels and collusion. They are perfectly absolutely natural formations. FAANH Companies form anti-poaching agreements, now they suddenly all have layoffs at the same time, you think that’s a coincidence? Even drug cartels divide up territories instead of ‘competing’.
- RamblingCTO 3y ago
  Yes, I think the better wording is: there's no efficient market/competition going on
  - gazpacho 3y ago
    Yes exactly. It’s a regulated market, but regulated by private companies.
- throw10920 3y ago
  > Free market produces Oligopolies, monopolies, cartels and collusion. You conflated two different uses of the word "free market" - one which is correctly described as "laissez-faire", and the other one, which is the one that everyone actually uses (including gazpacho, the user you were responding to). With very few exceptions, nobody on HN argues for laissez-faire capitalism - and "Oligopolies, monopolies, cartels and collusion" only happens in laissez-faire capitalism. In other words, you made a strawman argument.
whoitwas 3y ago
If you ever tried private insurance in the US, you might disagree. In my experience, it's impossible to use. The only option if you want health care in US is to be employed.
- gazpacho 3y ago
  I’m saying we should change that
- gazpacho 3y ago
  But also: could you clarify what do you mean by private insurance? You can buy insurance from Blue Cross, Cigna, United, etc on healthcare.gov. It’s the same providers you get through your employer, the only difference is that it’s the government negotiating (kinda) and you choosing instead of your employer doing both.

ClumsyPilot 3y ago

> lack of free market. Oligopolies are part of the problem Free market produces Oligopolies, monopolies, cartels and collusion. They are perfectly absolutely natural formations. FAANH Companies form anti-poaching agreements, now they suddenly all have layoffs at the same time, you think that’s a coincidence? Even drug cartels divide up territories instead of ‘competing’.

RamblingCTO 3y ago
Yes, I think the better wording is: there's no efficient market/competition going on
- gazpacho 3y ago
  Yes exactly. It’s a regulated market, but regulated by private companies.
throw10920 3y ago
> Free market produces Oligopolies, monopolies, cartels and collusion. You conflated two different uses of the word "free market" - one which is correctly described as "laissez-faire", and the other one, which is the one that everyone actually uses (including gazpacho, the user you were responding to). With very few exceptions, nobody on HN argues for laissez-faire capitalism - and "Oligopolies, monopolies, cartels and collusion" only happens in laissez-faire capitalism. In other words, you made a strawman argument.

whoitwas 3y ago

If you ever tried private insurance in the US, you might disagree. In my experience, it's impossible to use. The only option if you want health care in US is to be employed.

gazpacho 3y ago
I’m saying we should change that
gazpacho 3y ago
But also: could you clarify what do you mean by private insurance? You can buy insurance from Blue Cross, Cigna, United, etc on healthcare.gov. It’s the same providers you get through your employer, the only difference is that it’s the government negotiating (kinda) and you choosing instead of your employer doing both.