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> Health insurance is such a weird thing. It shouldn't exist. You insure yourself against exceptional things. Yet we use insurance for our yearly flu-shot, hard

> Health insurance is such a weird thing. It shouldn't exist. You insure yourself against exceptional things. Yet we use insurance for our yearly flu-shot, hardly exceptional. I knew this in theory, but never really thought much about it. I need a flu shot, so the company that makes the flu shot needs to be compensated (paid), and the nurse that knows how to inject it into my arm needs to be compensated, and that's it. The manufacturer and nurses provided a sufficient infrastructure to administer flu shots. But in America, I also have to pay a bunch of insurance companies. I used to make 6 figures as a programmer in the insurance industry. I knew my salary ultimately came from the high medical bills everyone pays, and while I didn't blame myself personally for a nation wide problem, I would have been happy to see my job and my company rendered obsolete and all of us move onto more useful jobs. I want to see a political cartoon where someone gets a flu shot and then does their patriotic duty, opens their wallet, and starts handing out money to half the nation. In the end, there's even a few bucks left for the nurse. I exaggerate a bit. In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries (if I remember correctly). I really do have to pay all those people every time I have a medical bill. Fixing healthcare costs will require a lot of people losing their job, and that wont be popular.

mgkimsal 2y ago
> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular. And going to a 'single payer' model would also reduce jobs. And the whole "they want to get rid of your insurance and raise your taxes!". Well, the taxes would be raised, but almost certainly to a smaller extent than the price of the insurance policy you pay for. A middle of the road health insurance policy for me right now is around $1k/month. Whether I pay for it, or an employer offsets some of it - it's beside the point. That's $12k/year that is effectively a 'health tax', it's just not called a 'tax'. Somehow, weirdly, we use the term 'benefit', without with I may more easily and quickly die or languish in pain. Some benefit ;) But yes... if my taxes go up by $10k year, but I don't have to pay for a health insurance policy... I'm still ahead. If I pay for it all, and the employer is out of the loop, it'll feel 'wrong' to many employed folks, but the employer will have more money - they should either pay people more, or hire more people (who used to work in private insurance companies).
- throwway120385 2y ago
  It's a "health tax" that's administered entirely by a private entity that you can't get rid of except by quitting your job or by spending thousands of dollars extra per month out of pocket. I think if it's politically untenable to go single-payer then every employer must instead be required to give you a stipend every month to buy your own insurance. Then make it illegal for a company to offer insurance for their own employees. If everyone saw what it really cost and what they were really getting there would be a lot more impetus for changes.
  - kaibee 2y ago
    Honestly at this point I'd be happy if employers would include on the paystub, the amount the company is actually paying for health insurance for the employee. So many people go around saying oh they have a job with great health insurance that's only $100/month.
- lostlogin 2y ago
  > That's $12k/year You dont need to pay that much. You can halve that. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...
  - mgkimsal 2y ago
    Unsure what you're getting at with that list. Do you mean I can move to another country?
- eadmund 2y ago
  > Somehow, weirdly, we use the term 'benefit', without with I may more easily and quickly die or languish in pain. Some benefit ;) Not dying or languishing in pain sounds like a pretty awesome benefit. And indeed, that’s the problem with health care: when one needs it, one will pay almost anything to the provider. Prices are a communication: they signal customers how to ration goods, and producers how to produce them. The higher the price, the fewer the customers but the more the producers; the lower the prices, the more the customers but the fewer the producers. In a free economy, it is possible to say that the work output of one FAANG engineer is economically worth that of 5 New York City garbagemen or 10 Podunk, Idaho janitors or 35 burger-flippers. How many rolls of toilet paper is one vial of insulin worth? Infinitely more, to someone who doesn’t need insulin. Some fraction, for someone who does. Some really small fraction, for someone who needs it right now. It doesn’t make any sense for all three of those people to pay the same price, for either the toilet paper or the insulin. In a single-payer system, how much does the single payer pay? How much do the producers of health care (e.g., physicians, surgeons, nurses, medical researchers, pharmaceutical factories) get paid? It ends up being based on the whims of the people setting those prices (a wage is just a labour price), not on any fundamental voice of the market — and thus it is either too high, or too low, and there is no feedback mechanism to constrain it. And that means society will produce either too little or too much health care, which means it will produce too much or too little of other things.
mapt 2y ago
To participate in an American healthcare treatment you need to interact with a private for-profit company which will shut down if it doesn't on average attain significant profitability; Let's say 30% goes to shareholders, taxes, receptionists, keeping the lights on. But they don't deal with everything. They have to interact with upstream providers! And they have to pay somebody to negotiate with them. So another 30%, and add 5% just to pay somebody to bargain the price with the Flu Shot Distributor. But the flu shot distributor has to interact with yet more upstream providers - the flu shot packager, who interacts with the flu shot pharmaceutical company, and the syringe company. Everybody adds their overhead and then their premium; "Price signals" become exponentially complex and more a matter of the mood of the negotiation than anything else. This is all an externality of a non-vertically-integrated capitalist system, which is somehow, somewhy, supposed to be regulated by your desire to get a flu shot relative to your ability to pay; It is not at all optimal in the market system for everybody to get a flu shot, that defeats the fundamental mechanism of the supply-demand curve. https://siderea.dreamwidth.org/1179450.html https://siderea.dreamwidth.org/1179450.html this essay series offers some of the better hypotheses on cost disease that I'm familiar with.
polygotdomain 2y ago
> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular. Agreed, but I also don't think it _has_ to be this way. First and foremost, a switch to single payer would mean that a lot of the infrastructure that's currently in medical insurance industry would need to shift towards being government employees. While there'd be massive administrative savings with single payer, there wouldn't be zero administration at all. I'd also posture that the US would never go full single payer, and that there'd be supplemental plans similar to the German model (and Medicare, to be fair), so while private insurers would still exist, the administrative burden would significantly lower. In the end, you'd still end up with a lot of people losing their job, but it wouldn't be a complete wipe out of the industry. Certain areas would get hit harder than others with the insurance brokers likely getting cut out big time. > In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries That seems pretty high to me. I wonder what made you come up with those numbers.

mgkimsal 2y ago

> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular. And going to a 'single payer' model would also reduce jobs. And the whole "they want to get rid of your insurance and raise your taxes!". Well, the taxes would be raised, but almost certainly to a smaller extent than the price of the insurance policy you pay for. A middle of the road health insurance policy for me right now is around $1k/month. Whether I pay for it, or an employer offsets some of it - it's beside the point. That's $12k/year that is effectively a 'health tax', it's just not called a 'tax'. Somehow, weirdly, we use the term 'benefit', without with I may more easily and quickly die or languish in pain. Some benefit ;) But yes... if my taxes go up by $10k year, but I don't have to pay for a health insurance policy... I'm still ahead. If I pay for it all, and the employer is out of the loop, it'll feel 'wrong' to many employed folks, but the employer will have more money - they should either pay people more, or hire more people (who used to work in private insurance companies).

throwway120385 2y ago
It's a "health tax" that's administered entirely by a private entity that you can't get rid of except by quitting your job or by spending thousands of dollars extra per month out of pocket. I think if it's politically untenable to go single-payer then every employer must instead be required to give you a stipend every month to buy your own insurance. Then make it illegal for a company to offer insurance for their own employees. If everyone saw what it really cost and what they were really getting there would be a lot more impetus for changes.
- kaibee 2y ago
  Honestly at this point I'd be happy if employers would include on the paystub, the amount the company is actually paying for health insurance for the employee. So many people go around saying oh they have a job with great health insurance that's only $100/month.
lostlogin 2y ago
> That's $12k/year You dont need to pay that much. You can halve that. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...
- mgkimsal 2y ago
  Unsure what you're getting at with that list. Do you mean I can move to another country?
eadmund 2y ago
> Somehow, weirdly, we use the term 'benefit', without with I may more easily and quickly die or languish in pain. Some benefit ;) Not dying or languishing in pain sounds like a pretty awesome benefit. And indeed, that’s the problem with health care: when one needs it, one will pay almost anything to the provider. Prices are a communication: they signal customers how to ration goods, and producers how to produce them. The higher the price, the fewer the customers but the more the producers; the lower the prices, the more the customers but the fewer the producers. In a free economy, it is possible to say that the work output of one FAANG engineer is economically worth that of 5 New York City garbagemen or 10 Podunk, Idaho janitors or 35 burger-flippers. How many rolls of toilet paper is one vial of insulin worth? Infinitely more, to someone who doesn’t need insulin. Some fraction, for someone who does. Some really small fraction, for someone who needs it right now. It doesn’t make any sense for all three of those people to pay the same price, for either the toilet paper or the insulin. In a single-payer system, how much does the single payer pay? How much do the producers of health care (e.g., physicians, surgeons, nurses, medical researchers, pharmaceutical factories) get paid? It ends up being based on the whims of the people setting those prices (a wage is just a labour price), not on any fundamental voice of the market — and thus it is either too high, or too low, and there is no feedback mechanism to constrain it. And that means society will produce either too little or too much health care, which means it will produce too much or too little of other things.

mapt 2y ago

To participate in an American healthcare treatment you need to interact with a private for-profit company which will shut down if it doesn't on average attain significant profitability; Let's say 30% goes to shareholders, taxes, receptionists, keeping the lights on. But they don't deal with everything. They have to interact with upstream providers! And they have to pay somebody to negotiate with them. So another 30%, and add 5% just to pay somebody to bargain the price with the Flu Shot Distributor. But the flu shot distributor has to interact with yet more upstream providers - the flu shot packager, who interacts with the flu shot pharmaceutical company, and the syringe company. Everybody adds their overhead and then their premium; "Price signals" become exponentially complex and more a matter of the mood of the negotiation than anything else. This is all an externality of a non-vertically-integrated capitalist system, which is somehow, somewhy, supposed to be regulated by your desire to get a flu shot relative to your ability to pay; It is not at all optimal in the market system for everybody to get a flu shot, that defeats the fundamental mechanism of the supply-demand curve. https://siderea.dreamwidth.org/1179450.html https://siderea.dreamwidth.org/1179450.html this essay series offers some of the better hypotheses on cost disease that I'm familiar with.

polygotdomain 2y ago

> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular. Agreed, but I also don't think it _has_ to be this way. First and foremost, a switch to single payer would mean that a lot of the infrastructure that's currently in medical insurance industry would need to shift towards being government employees. While there'd be massive administrative savings with single payer, there wouldn't be zero administration at all. I'd also posture that the US would never go full single payer, and that there'd be supplemental plans similar to the German model (and Medicare, to be fair), so while private insurers would still exist, the administrative burden would significantly lower. In the end, you'd still end up with a lot of people losing their job, but it wouldn't be a complete wipe out of the industry. Certain areas would get hit harder than others with the insurance brokers likely getting cut out big time. > In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries That seems pretty high to me. I wonder what made you come up with those numbers.