Good article in general but such a misleading headline and framing. The problem, as described in the article's body, is employer-provided health insurance, not private healthcare.
This is less about private healthcare and more about how employer-provided healthcare is tax advantaged. Credits and tax breaks should go to the individual so they can choose and keep their insurance through different jobs.
Yeah, so long as you can mooch off US healthcare innovation like COVID vaccines and weight loss drugs. There is a difference between going to doctor and getting effective treatment, as anyone who dealt with cancer in Soviet Union can testify.
I think the article is looking at the wrong abstraction.
private healthcare - e.g if there's a lot of private clinics - people paid cash, then yeah healthcare costs would go down & most of the care was preventive not treatment. competition naturally will force prices down & since individuals payers won't be able to afford massive amounts, the market will adjust it's prices vs having one large payer (gvt) i.e public healthcare or many private large payers(current insurance industry).
right now - the issue isn't private healthcare - but the wrong incentives to bill insurance companies massive amounts of money. then insurance companies countering back - by having large bureaucratic processes to avoid paying those large bills. typical complex systems.
One thing that's never been clear to me is how either system plans on scaling healthcare. You have X doctors who can see (just a guess) 30X patients. Unless the number of doctors increase, some patients are going to be left out. In the current system it's those without employment. I'm other countries there's a waitlist. How can we make sure there's enough staff to provide adequate healthcare for everyone?
> ... my vote ... is for universal healthcare. The only real downside to it is that a bunch of companies that have entrenched their positions taking advantage of ordinary people will be denied a little profit.
Make that "many, many billions of dollars of profit". Then add on the probably-millions of jobs which the staggering inefficiencies of the current system support. (Everything from lobbyists for those companies, to the minions stamping "Denied" on health insurance claims, to the opposing medical billing staff who work for doctors & hospitals & such that need to get paid, to ...)
It'd be lovely if the leviathan could be slain, but don't hold your breath.
In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but:
- job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point
- except when subject to some kind of union negotiated contract, the employer can change their insurance options from year to year as they try to save costs, but it's not regarded as a mass pay cut when they do
- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"
Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives, I do think that people would be more willing to switch jobs if they could know their plan was at least as good as the one they were leaving, both in money spent and in employee satisfaction. Opacity, in part owing to lack of commitment from employers, makes this harder.
I don’t think it’s just healthcare, you have mortgages for inflated housing prices, expensive groceries and bills, and other expenses that make most people go to the route of boring stable job rather than innovative startup that might be out of business in a year and/or paying peanuts. Look at Canada for example, you can have a boring government job looking at excel sheets in the few hours you “actually” work in that week and still make $140k a year plus generous benefits, meanwhile you can grind your ass in a startup doing embedded firmware development and paid $70k a year with barely any benefits, hell, I have seen “senior robotic engineers” with a job descriptions enough to launch rockets and the pay is $60k!
Obviously people will go with the first option, innovation won’t feed their kids.
I'd love to decouple insurance form employment and I'd also love to do away with the private insurance system in the US. I've always had insurance and the experience has been as uniformly poor, regardless of provider, as it is continuous. Any positive interactions and outcomes have felt like happy accidents, not the system working.
Remove the private actors, the adversarial billing, the friction with providers. It, at its best, ranges from bad to outright awful.
(I'd also love to do away with tax prep — the government knows what is owed, so why make folks prepare their own count and hope it matches?)
We could easily do this and it would actually be significantly cheaper.
But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance.
So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.
Wanna see less innovation in healthcare under a single payer? Come to Canada, you will be on a queue for an MRI for at least 8 months (if you even get one).
It also kills many, many people, so, the profit motive needs to be permanently and forever abolished from healthcare. In the US doctors look at patients with dollar signs in their eyes and simply ask, "How much money can I squeeze out of this NPC?" leading to countless abuses, from unecessary and harmful procedures being forced on non-consenting patients (like infant genital mutilation) to denial of needed healthcare because it isn't profitable enough and has an opportunity cost.
Typically, all single payer medical cost schemes are based on government facilities and intervention. Many Americans have little faith in their government to do anything, much less handle there medical care costs. This is why the employer model still exists.
Americans are different - they see themselves as not Europe or Asians - and they are proud of that. The "rugged individual" is still an ideal many cling to as part of their identity.
> 1 in 4 American workers stay in their jobs because of the healthcare. It suppresses wages and working conditions - and prevents innovators from heading out on their own.
Yes. That is the point. This is how capitalism works. Just look at the story of Tetris as the pefect example of capitalism in action. Some Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add? Licensing and sub-licensing agreements. Or, to put it another way, just building enclosures.
The idea that capitalism fosters innovation is a fairy tale. Companies reach a point where the only way to satisfy the market's need for growing profits is by cutting costs and raising prices. All of the inflation we've seen from the pandemic has been the "raising prices" part. AI exists for dynamic pricing. Dynamic pricing is nothing more than raising prices. Nobody is using dynamic prices to reduce prices. Why would they?
But the big part of AI is in labor displacement. This suppresses wages. Those who kept their jobs aren't asking for raises and aren't saying no to extra unpaid labor. Because they're in fear of losing their jobs. That's not a side effect. It's the goal.
US healthcare, if you can call it that, is part of this economic coercion. Being expensive to access out of employment is a feature not a bug. Everybody wins. Employers keep people who want to live. Healthcare company profits go up. You, as the individual? Nobody cares about you. Get back to work.
The end state for all this is something that looks like South Asian brick kilns where workers have debt they can never escape. Westerners are being loaded up with debt for a reason: to enrich various companies and to make sure we can't leave our jobs.
My partner and I both just got new jobs after a long period of unemployment. Neither of our new employers offer subsidized health insurance. We both have chronic conditions for which we need regular access to medication. The financial cliff we will both go over going from Medicaid to paying for health insurance via Covered California, and likely paying higher prices for medication in addition to astronomically high (and increasing!) monthly premiums, is going to eat a huge percentage of our increased incomes.
I have no idea who is supposed to benefit from this system, other than the private health insurance companies.
Since this is a comparison between entire economies --- not just health care but the impact on economic mobility as a whole --- an inconvenient fact for this analysis is that PMC Americans are generally better off under our private insurance system than they would be if they relocated to the UK; as in, they come out financially ahead, after pricing in insurance and provider fees.
Another problem with this analysis is that the UK's national health system isn't the only example of a major developed country with a functioning health system. Many countries without the US's problems have private providers and private health insurance.
It's plainly obvious that the US has severe problems. Ideological polarization has fixated the discussion on a contest between public single payer and everybody-for-themselves private insurance. But the core problems have not much at all to do with insurance. They are, probably:
(1) Most Americans get their health insurance through their job, as a path-dependent consequence of bad 1950s tax policy. This in turn insulates insurers from their customers and breaks most of the mechanisms an ordinary market (like food, or transportation, or tax preparation) has from going off the rails.
(2) Americans pay doctors (and providers generally) anywhere from 2-5x more than other countries do. Providers account for the overwhelming majority of all health spending; compared to providers, drugs are almost a rounding error. This in turn is probably a consequence of policy decisions we made in the early 1990s, when the AMA lobbied Medicare to cap the number of residencies funded every year, which in turn generates artificial scarcity.
28 comments
[ 0.23 ms ] story [ 10.9 ms ] threadI would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.
private healthcare - e.g if there's a lot of private clinics - people paid cash, then yeah healthcare costs would go down & most of the care was preventive not treatment. competition naturally will force prices down & since individuals payers won't be able to afford massive amounts, the market will adjust it's prices vs having one large payer (gvt) i.e public healthcare or many private large payers(current insurance industry).
right now - the issue isn't private healthcare - but the wrong incentives to bill insurance companies massive amounts of money. then insurance companies countering back - by having large bureaucratic processes to avoid paying those large bills. typical complex systems.
Make that "many, many billions of dollars of profit". Then add on the probably-millions of jobs which the staggering inefficiencies of the current system support. (Everything from lobbyists for those companies, to the minions stamping "Denied" on health insurance claims, to the opposing medical billing staff who work for doctors & hospitals & such that need to get paid, to ...)
It'd be lovely if the leviathan could be slain, but don't hold your breath.
- job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point
- except when subject to some kind of union negotiated contract, the employer can change their insurance options from year to year as they try to save costs, but it's not regarded as a mass pay cut when they do
- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"
Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives, I do think that people would be more willing to switch jobs if they could know their plan was at least as good as the one they were leaving, both in money spent and in employee satisfaction. Opacity, in part owing to lack of commitment from employers, makes this harder.
Obviously people will go with the first option, innovation won’t feed their kids.
Remove the private actors, the adversarial billing, the friction with providers. It, at its best, ranges from bad to outright awful.
(I'd also love to do away with tax prep — the government knows what is owed, so why make folks prepare their own count and hope it matches?)
But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance.
So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.
It’s pretty much a no-brainer cost reduction for everyone.
This doesn’t even mean you need to get rid of private insurance companies (see: Germany).
Americans are different - they see themselves as not Europe or Asians - and they are proud of that. The "rugged individual" is still an ideal many cling to as part of their identity.
Yes. That is the point. This is how capitalism works. Just look at the story of Tetris as the pefect example of capitalism in action. Some Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add? Licensing and sub-licensing agreements. Or, to put it another way, just building enclosures.
The idea that capitalism fosters innovation is a fairy tale. Companies reach a point where the only way to satisfy the market's need for growing profits is by cutting costs and raising prices. All of the inflation we've seen from the pandemic has been the "raising prices" part. AI exists for dynamic pricing. Dynamic pricing is nothing more than raising prices. Nobody is using dynamic prices to reduce prices. Why would they?
But the big part of AI is in labor displacement. This suppresses wages. Those who kept their jobs aren't asking for raises and aren't saying no to extra unpaid labor. Because they're in fear of losing their jobs. That's not a side effect. It's the goal.
US healthcare, if you can call it that, is part of this economic coercion. Being expensive to access out of employment is a feature not a bug. Everybody wins. Employers keep people who want to live. Healthcare company profits go up. You, as the individual? Nobody cares about you. Get back to work.
The end state for all this is something that looks like South Asian brick kilns where workers have debt they can never escape. Westerners are being loaded up with debt for a reason: to enrich various companies and to make sure we can't leave our jobs.
I have no idea who is supposed to benefit from this system, other than the private health insurance companies.
Another problem with this analysis is that the UK's national health system isn't the only example of a major developed country with a functioning health system. Many countries without the US's problems have private providers and private health insurance.
It's plainly obvious that the US has severe problems. Ideological polarization has fixated the discussion on a contest between public single payer and everybody-for-themselves private insurance. But the core problems have not much at all to do with insurance. They are, probably:
(1) Most Americans get their health insurance through their job, as a path-dependent consequence of bad 1950s tax policy. This in turn insulates insurers from their customers and breaks most of the mechanisms an ordinary market (like food, or transportation, or tax preparation) has from going off the rails.
(2) Americans pay doctors (and providers generally) anywhere from 2-5x more than other countries do. Providers account for the overwhelming majority of all health spending; compared to providers, drugs are almost a rounding error. This in turn is probably a consequence of policy decisions we made in the early 1990s, when the AMA lobbied Medicare to cap the number of residencies funded every year, which in turn generates artificial scarcity.