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Yes, I have a similar question. One of the major reasons to have social programs that buy things like health insurance is that governments have a lot more barg

by rwl 13y ago

Yes, I have a similar question. One of the major reasons to have social programs that buy things like health insurance is that governments have a lot more bargaining power than individuals (up to and including the legal authority to set price caps). In the case of healthcare, governments can get the same coverage and care much cheaper per capita than individuals could if they purchased it on their own. Giving individuals a basic income does not give them this bargaining power, so doesn't that mean that either (a) there will still be a need for social welfare programs for things like healthcare, even with the basic income; or (b) the basic income level must be much higher per capita than what the government would spend on these programs? I think I am probably missing something here, so I'd appreciate it if someone would explain this.

dragonwriter 13y ago
Consider the ACA model (even minus the subsidy aspect), which uses (1) purchase mandates, (2) minimum standards, and (3) state exchanges through which private insurance can be purchased. This applies most of the the large-purchaser effect of a social program, but isn't a traditional social benefit program (sure, the actual ACA, which has subsidies for some purchasers, includes a traditional social benefit program as a component, but there is no reason that the rest couldn't be maintained with similar benefits without the subsidy in a BI system.)
- rwl 13y ago
  > This applies most of the the large-purchaser effect of a social program... Does it, though? That's what I'm wondering. Is there any evidence that the model followed by the Affordable Care Act is not significantly more expensive per capita than a single-payer, "Medicare for all" kind of system?
  - dragonwriter 13y ago
    Well, there's the large-purchaser effect when the purchased good is privately-offered health insurance, and the large purchaser effect when the purchased good is actually health care services. Aside from the effects of the non-discrimination requirements which shift costs from the older and less healthy to the young and healthy, the ACA model increases the number of people that can benefit from large-purchaser group rates on insurance -- its almost certainly less efficient than single-payer overall still (as, for that matter is Medicare, which hasn't been single payer for decades, due to Risk HMO / Part C / Medicare Advantage plans, which are actually make it very similar in model to the ACA except with a public option.)

by rwl 13y ago

dragonwriter 13y ago

Consider the ACA model (even minus the subsidy aspect), which uses (1) purchase mandates, (2) minimum standards, and (3) state exchanges through which private insurance can be purchased. This applies most of the the large-purchaser effect of a social program, but isn't a traditional social benefit program (sure, the actual ACA, which has subsidies for some purchasers, includes a traditional social benefit program as a component, but there is no reason that the rest couldn't be maintained with similar benefits without the subsidy in a BI system.)

rwl 13y ago
> This applies most of the the large-purchaser effect of a social program... Does it, though? That's what I'm wondering. Is there any evidence that the model followed by the Affordable Care Act is not significantly more expensive per capita than a single-payer, "Medicare for all" kind of system?
- dragonwriter 13y ago
  Well, there's the large-purchaser effect when the purchased good is privately-offered health insurance, and the large purchaser effect when the purchased good is actually health care services. Aside from the effects of the non-discrimination requirements which shift costs from the older and less healthy to the young and healthy, the ACA model increases the number of people that can benefit from large-purchaser group rates on insurance -- its almost certainly less efficient than single-payer overall still (as, for that matter is Medicare, which hasn't been single payer for decades, due to Risk HMO / Part C / Medicare Advantage plans, which are actually make it very similar in model to the ACA except with a public option.)