4 ms·

Ah, but look at the results! If you accept my contention that the primary distinguishing feature of the American system is the employer involvement, and the dem

by beat 12y ago

Ah, but look at the results! If you accept my contention that the primary distinguishing feature of the American system is the employer involvement, and the demonstrable facts that a: American health care is twice as expensive as the rest of the civilized world, and b: America fails to cover 15% of the population... well, then it seems that employer-based insurance is a significant contributor to the high cost and coverage gaps. So if the purpose in the free market is to add value, it's pretty much a dismal failure. The thing is, though, that employer-based insurance wasn't there for some dream of free market efficiency. Rather, it's a legacy from mid-20th century labor negotiation. Back when insurance was largely nonexistent, labor unions negotiated for it as a benefit, and it became widely accepted practice. This, along with commie-phobia, kept America from adopting a more socialist model. Today, it's a political problem, because unions are actually against eliminating employer-based insurance, as it's a powerful negotiating tool for them. So it's hard for Democrats to attack it.

jjoonathan 12y ago
> well, then it seems that employer-based insurance is a significant contributor to the high cost That conclusion would follow only if employer-based insurance were the only plausible explanation we had to explain the increased cost. Off the top of my head, here are a few alternatives: 1. Pharma lobby has neutered efforts to centralize bargaining for drug purchases for private insurance companies (what is the bargaining power of BCBS Wyoming vs the NHS? Nothing.) 2. Doctor's guild has created an artificial scarcity of doctors by squeezing the training pipeline. 3. Differences in entry-level health plans prevent price competition because the valuation process is too difficult for consumers (allowing insurance companies to differentiate based on ads and such). > So if the purpose in the free market is to add value, it's pretty much a dismal failure. No kidding. Sometimes it works miracles, sometimes it falls flat on its face. Here it has fallen flat on its face. Repeatedly. And we keep throwing money at it hoping it will fix itself :/ > employer-based insurance wasn't there for some dream of free market efficiency. Rather, it's a legacy from mid-20th century labor negotiation. That's the narrative they taught it a health care economics class I took. I don't buy it. Say what you will about the market, but it does not hesitate to tear down economic structures that have outlasted their utility. In particular, if you think that individual insurance plans are more expensive due to cultural legacy rather than due to economics, I invite you to create your own insurance company and undercut the incumbents ;) > Today, it's a political problem Yup. The only real question is how long the circus will continue. ACA was a step in the right direction, but it doesn't go far enough. Time will tell. My fear is that stopgap solution is the enemy of the good solution.

by beat 12y ago

jjoonathan 12y ago

> well, then it seems that employer-based insurance is a significant contributor to the high cost That conclusion would follow only if employer-based insurance were the only plausible explanation we had to explain the increased cost. Off the top of my head, here are a few alternatives: 1. Pharma lobby has neutered efforts to centralize bargaining for drug purchases for private insurance companies (what is the bargaining power of BCBS Wyoming vs the NHS? Nothing.) 2. Doctor's guild has created an artificial scarcity of doctors by squeezing the training pipeline. 3. Differences in entry-level health plans prevent price competition because the valuation process is too difficult for consumers (allowing insurance companies to differentiate based on ads and such). > So if the purpose in the free market is to add value, it's pretty much a dismal failure. No kidding. Sometimes it works miracles, sometimes it falls flat on its face. Here it has fallen flat on its face. Repeatedly. And we keep throwing money at it hoping it will fix itself :/ > employer-based insurance wasn't there for some dream of free market efficiency. Rather, it's a legacy from mid-20th century labor negotiation. That's the narrative they taught it a health care economics class I took. I don't buy it. Say what you will about the market, but it does not hesitate to tear down economic structures that have outlasted their utility. In particular, if you think that individual insurance plans are more expensive due to cultural legacy rather than due to economics, I invite you to create your own insurance company and undercut the incumbents ;) > Today, it's a political problem Yup. The only real question is how long the circus will continue. ACA was a step in the right direction, but it doesn't go far enough. Time will tell. My fear is that stopgap solution is the enemy of the good solution.