Private healthcare makes industries less innovative. It's time for change

It is just a really awful system overall.

United Healthcare is pretty big in the US, they are also famous for forcing people to spend a lot of time on the phone, waiting on hold or advocating for care. I expect this ends up taking time that the employee would otherwise have been working as well as negatively impacting morale.

Hence the "Confusopoly".

The more complex and opaque the system is, the more opportunities for value extraction by those on the inside.

Most people don't care, including me. Until I got cancer, then I cared, because suddenly this was the stuff that could make the difference between me living and dying.

While I am incredibly privileged, it shouldn't be this way. Beyond the waste it's horribly anti-competitive for consumers. Consumers want better plans, and they have the money. They can't get them. That's a huge smell for "the market is fucked". And fucked it is, beyond belief.

There are countries where private health insurance works great. The problem in US is how it is regulated.

The dental coverage was screwed up for the first 4 months of the year. An assumption was made that all dental plans were basically the same in terms of payments to dentists. This turned out not to be the case.

Everyone should have this, but until we do, it will be a reasonable negotiating point. Why should non-health-care employers be in the healthcare business?

"how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.

All the job interviews that went to the point of discussing compensation, healthcare benefits were almost always included when negotiating what actual compensation would be. A difference of them covering several hundred dollars a month in premiums and them matching some % of HSA contributions is several thousand dollars a year in compensation differences. When multiple job offers are pretty close, that can make a difference.

Also, the few times employers have offered healthcare concierge as a benefit it was definitely mentioned in the overall compensation package.

But for many normal jobs it’s very normal to use health care coverage as a negotiation or decision point.

I disagree. We went over healthcare benefits with a fine tooth comb when my wife was deciding to take a position. It certainly mattered.

Another factor is that even if the employer covers nothing and you have to pay the entire premium, just being able to buy the plan through the employer is _significantly_ cheaper than buying it as an individual.

That being said, nothing tells me the plans won't completely change in a few months of course. That's just the "game" and I also hate it.

Just give me the money directly and let me pick my plan from a marketplace that doesn't suck balls. If employers still want to give some incentives to be more competitive fine, but I shouldn't have to time my job switching to avoid coverage gaps.

Health insurance has been a primary topic in every job offer I’ve had, my entire career.

If a company won’t discuss the insurance situation or provide details about the employee contribution, that’s a warning sign. This is a routine topic for negotiations and any company hiding this data is not a company you want to be working with.

But tax deduction or not isn’t what makes individual health insurance so expensive. When you have employer provided health insurance you’re in a completely different risk pool than people buying on the open market.

The Republicans have utterly failed to offer *any* alternative at all to Obamacare after 16 years, which is insane for many reasons, but especially considering that they could have put decoupling insurance from employment at the heart of an alternative (even more than the ACA) market-oriented reform. Letting individuals choose their own insurance would put more pressure on insurance companies to actually deliver quality care because, unlike employers, individuals are highly sensitive to the quality of care they receive and are more likely to switch insurers if the insurer unreasonably denies claims or otherwise fails to deliver a decent product. On the other side, individuals are also more sensitive to costs so with greater control over their plan choices would be more able to pick plans that are structured to match their anticipated costs.

In other words, individual insurance would improve the functioning of the market, which should in theory appeal to Republicans. Instead, they only focus on making individuals pay more at the point of care, on the theory that cost-sharing discourages insured people from over-consuming healthcare. Yet they don't think about how the current system makes it impossible for individuals to be truly cost sensitive when selecting plans.

I would guess the Republicans haven't adopted the idea because they are not really in favor of free markets, they are in bed with big business, and employer-provided insurance tends to favor larger companies that can demand better terms from insurers, that can amortize the HR overhead over a larger number of employees, and that tend to benefit disproportionately from lower labor mobility compared to small business (people are more likely to be involuntarily locked into a big company job for security than at a small business, and it's harder for people who are worried about maintaining quality healthcare access to move to a startup, reducing the competition experienced by the bigger companies).

private healthcare is getting more and more expensive due to private prices available to bulk insurers but not for private person

even if this is not completely deliberate, effect is that you are "serf of whomever pays your insurance" or go bankrupt the moment you have any kind of emergency

in europe some private healthcare providers are showing their colors from different perspective, they outright refuse or cancel private contracts when you are above certain age

It's funny that he (accurately) quotes the Cato Institute as being opposed to employer-provided health insurance... and then implies that the sole alternative is the NHS. Um, I'm pretty sure that's not what the libertarian Cato Institute was suggesting!

Which is to say, not uniformly poor?

> I'd also love to do away with tax prep — the government knows what is owed

Sometimes! We would probably have to simplify the tax code first. Otherwise instead of spreading out the work of identifying income and tax credit eligibility amongst taxpayers and such upon them who are most proximal to this knowledge, we would have a centralized body need to know all of the things that you and I know about ourselves, such as how many kids we have, what kind of car we drive, whether we use solar power, whether we invest in crypto, whether we earned money from gifts or gambling or dividends or farming. Or we could just simplify the code, which I would like.

The term “private healthcare” is mostly referring to the fact that there is no such thing as non-private healthcare for the majority of Americans.

Anybody can choose to which hospital they go, the “state-licensed” crazy expensive one or the “unlicensed” one for 50 dollars a visit.

As far as I understand, currently the pool of people in the US who are allowed to do medical work is artificially limited, and doctors’ salaries are inflated. Just look around the world, there’s a huge supply of doctors with no student debt who would be happy to work for 60k a year. Also tens of thousands of US citizens will just go get a cheap medical degree from other countries, come back, and open private practice.

FWIW, it's about 1500X plus or minus.

> How can we make sure there's enough staff to provide adequate healthcare for everyone?

The solution now seems to be headed towards using FNP's and similar in place of fully licensed MDs. Which for things like primary care makes good sense IMO.

Of course, doctors do not earn nearly as much in England as the USA, thus good luck ever getting something like to change in the USA. In America, most people go to medical school for the prestige and the paycheck, and our system utterly reflects both.

(If Americans are thinking, "huh, that sounds like Obamacare / the ACA marketplace!" then you're right.)

It is like parliamentarianism, campaign financing regulations, gun control, multiple political parties, etc. Americans call these things "Socialism" and then freak out about them and refuse to see any good on them.

It's interesting: 3 states (Vermont, Colorado, and Massachusetts) did recently try to make state-level single-payer systems. https://www.thirdway.org/report/single-payer-health-care-a-t...

At the most basic level, this shows up as folks avoiding working more than a certain amount to avoid losing some government benefits. This is a result of "benefit cliffs"[1] that actually reduce net income as you work harder. It's "lazy" in the sense that you're maximizing your earnings at others' expense by working less than you otherwise could, but it's also a perfectly rational decision given the incentives.

My preferred solution is to have all benefits taper off gradually with income instead of having hard "cut offs". Done right this ensures there's never a financial penalty for working more. It does make the tax system more complicated though.

[1] https://en.wikipedia.org/wiki/Effective_marginal_tax_rate

This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D).

Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US).

There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways.

Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop).

I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.

It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding.

Take your dissatisfaction with the way the government manages payments to the voting booth instead of advocating dismantling what is on the whole a quite equitable system that has a history of actually producing very good health outcomes.

I actually have on the whole extremely pleasant experiences here in my corner of Ontario. And then I hear horror stories.

The system is underfunded and inconsistent. The province is to blame for that.

Canada's public healthcare system is massively overloaded and it seems to be getting worse.

I really didn't appreciate how much of a problem this is in my 20s and 30s (while I didn't need much healthcare) and it was easy to assume the bellyaching from older folks was overblown. Time makes fools of us all.

Capitalism created the computers whose Soviet copies were Tetris' native platform, it made the languages Pajitnov used and the machines he ported it to. It incentivized people to bring Tetris to the rest of the world, and who knows, it might have spread on its own eventually, just for free, but maybe not.

> All of the inflation we've seen from the pandemic has been the "raising prices" part.

Superficially true, but vacuous. In anyway that matters this is flagrantly and amazingly false. But maybe you weren't aware of the $931 billion US dollars of stimulus paid to individuals, or you may not be familiar with the principle of supply and demand. More dollars in supply, the less the value of each dollar. Prices change to match the devalued currency.

> Being expensive to access out of employment is a feature not a bug.

I think this may qualify as a bug, to which you can credit the Revenue Act of 1954 for codifying the tax break given to companies who provide healthcare directly rather than pay that money as income to the employee. Classic example of a stale law. Now, vested interests may be keeping it in place, but I also see no significant awareness on the voter side of this issue nor the will to reform this discriminatory tax policy.