3 ms·

Most of the problems I see with the system are inherent in the idea of attempting to socialize costs using the model of "insurance". For example, a friend of mi

by mjn 14y ago

Most of the problems I see with the system are inherent in the idea of attempting to socialize costs using the model of "insurance". For example, a friend of mine was born with a heart defect. No rational free-market insurance would sell him coverage at any price he could possibly pay, because the expected lifetime cost is quite high. The only real way to deal with such cases is to spread them across a large population, so people not born with heart defects subsidize those who were (and likewise for other major issues). But of course the population has to be selected in a way that is reasonably representative, rather than only the least healthy people opting in. The three traditional non-adverse-selected populations are: 1) the entire population of a country (the socialized-medicine solution); 2) the members of a large union; or 3) the employees of large corporations (the U.S. solution of employer-tied group plans). But #3 is showing cracks as corporate-jobs-for-life get less common. In a world where you change jobs more frequently, now there are messes of coverage gaps, COBRA, etc. Not to mention that this arrangement discourages freelancing and entrepreneurship, since you must work for a large corporation with a group plan to be part of a health-care pool, a connection that otherwise seems rather arbitrary (why should where you get risk-pooled for health-care purposes depend on who you work for? only because corporation-tied pools are a way of minimizing adverse selection in the pool).

VLM 14y ago
Has anyone in the world ever tried a variation of selection criteria #1 where the property tax of the residents in the coverage footprint of a hospital pay for the hospital? It seems logical and cheap to administer, which is why it would be opposed in the US, not much room to profit. However it does seem "fair".
- mjn 14y ago
  I believe Sweden's system is organized roughly in that manner, though not all the way down to individual hospitals. The majority of the funding comes from local/regional taxes that pay for the healthcare system within the region. Then it's supplemented with some national funds that subsidize poorer and more rural regions, and which also provide grants to incentivize regions to do some things that the national government considers priorities. A quick look at Wikipedia says it's overall 71% funded at a local/regional level and 29% at a national level. Switzerland also has a system based on compulsory insurance within each canton. The state doesn't operate the healthcare directly, but residents of each canton have to buy insurance from one of a small number of nonprofit insurance providers available in their canton, which end up doing the risk pooling.
  - VLM 14y ago
    The Swedish model brings up a good point that the regional childrens hospital in my area would have to gather revenue from multiple county govts not just the city its located in. There is also a Mayo Clinic facility in my state with at least theoretically national coverage which would have to gather money from the feds. It might be simpler for "regional and bigger" hospitals and specialty clinics to back bill the patients local hospital. The swiss model looks similar to how we used to bill old fashioned landline long distance telephone lines in the USA. Other than the profit/non-profit thing.
talmand 14y ago
#1 was the attempt with the legislation in question but it gives too many people an easy way out which is part of the problems it creates. But the other problem is that not everyone can contribute evenly. Thus begins the problem of pushing for fairness so that some pay more than others. Then to be more fair there's a push to increase the limit as to what constitutes "too poor" to pay. Next thing you know politicians are using it to buy votes. Today it's "vote for me or they'll take away your Social Security!" and tomorrow it will be "vote for me or they'll take away your health insurance!" #2 is the most common way in the US but not necessarily through just unions. It's all about group plans and whatnot in an effort to control pricing. The problem is that this method doesn't cover everyone and discourages certain types of employment as described elsewhere in this thread. In some cases, large unions use the benefits as leverage against their members for various reasons and/or against the employer as a PR tool such as "they are hurting our kids!" type of tactic. #3 is part of my point as one of the reasons that companies went wild on offering health benefits to workers was to get around a government enforced wage freeze during war. There were companies that offered such benefits before but during the wage freeze it started to become normal to be offered the benefits. I find it fascinating that after decades of escalation in the problems in US healthcare and insurance the best solutions anyone can come up with and/or get passed is to increase the very thing that almost everyone agrees is broken. "He's been shot three times and he's dying! What should we do?" "Shoot him three more times and see if that helps. Otherwise, we'll have to think of something else."

by mjn 14y ago

VLM 14y ago

Has anyone in the world ever tried a variation of selection criteria #1 where the property tax of the residents in the coverage footprint of a hospital pay for the hospital? It seems logical and cheap to administer, which is why it would be opposed in the US, not much room to profit. However it does seem "fair".

mjn 14y ago
I believe Sweden's system is organized roughly in that manner, though not all the way down to individual hospitals. The majority of the funding comes from local/regional taxes that pay for the healthcare system within the region. Then it's supplemented with some national funds that subsidize poorer and more rural regions, and which also provide grants to incentivize regions to do some things that the national government considers priorities. A quick look at Wikipedia says it's overall 71% funded at a local/regional level and 29% at a national level. Switzerland also has a system based on compulsory insurance within each canton. The state doesn't operate the healthcare directly, but residents of each canton have to buy insurance from one of a small number of nonprofit insurance providers available in their canton, which end up doing the risk pooling.
- VLM 14y ago
  The Swedish model brings up a good point that the regional childrens hospital in my area would have to gather revenue from multiple county govts not just the city its located in. There is also a Mayo Clinic facility in my state with at least theoretically national coverage which would have to gather money from the feds. It might be simpler for "regional and bigger" hospitals and specialty clinics to back bill the patients local hospital. The swiss model looks similar to how we used to bill old fashioned landline long distance telephone lines in the USA. Other than the profit/non-profit thing.

talmand 14y ago

#1 was the attempt with the legislation in question but it gives too many people an easy way out which is part of the problems it creates. But the other problem is that not everyone can contribute evenly. Thus begins the problem of pushing for fairness so that some pay more than others. Then to be more fair there's a push to increase the limit as to what constitutes "too poor" to pay. Next thing you know politicians are using it to buy votes. Today it's "vote for me or they'll take away your Social Security!" and tomorrow it will be "vote for me or they'll take away your health insurance!" #2 is the most common way in the US but not necessarily through just unions. It's all about group plans and whatnot in an effort to control pricing. The problem is that this method doesn't cover everyone and discourages certain types of employment as described elsewhere in this thread. In some cases, large unions use the benefits as leverage against their members for various reasons and/or against the employer as a PR tool such as "they are hurting our kids!" type of tactic. #3 is part of my point as one of the reasons that companies went wild on offering health benefits to workers was to get around a government enforced wage freeze during war. There were companies that offered such benefits before but during the wage freeze it started to become normal to be offered the benefits. I find it fascinating that after decades of escalation in the problems in US healthcare and insurance the best solutions anyone can come up with and/or get passed is to increase the very thing that almost everyone agrees is broken. "He's been shot three times and he's dying! What should we do?" "Shoot him three more times and see if that helps. Otherwise, we'll have to think of something else."