[roenxi]

I don't live in America, but having strong opinions is fun so I'll wade in anyway :D

The things you are talking about are regulatory standards. I've not seen anyone really suggesting that regulatory standards are a problem in the Americas (on the contrary, everything I've read suggests if you have in insurance the whole process can be pretty comfortable).

gp's post is, in my eyes, clearly going towards the point that people should be choosing their own insurers, rather than their employers choosing insurers (on employees behalf). It seems like common sense to me that an individual will be better at choosing a healthcare provider than their employer.

The idea that healthcare benefits are a factor to consider when choosing an employer is bizarre. The only reason to link the two is because Americans enjoy being different. And strangely anti-individual-choice in this instance. That dynamic is an obvious perversion of the market to deregulate.

[wpietri]

> It seems like common sense to me that an individual will be better at choosing a healthcare provider than their employer.

I have picked insurance as an individual and as an employer, and that is 100% wrong.

Any kind of insurance is difficult to shop for, because it's for something you'll only really need if you're unlucky; that means it's hard to tell whether the choice you make is a good one. Health insurance is worse, because it's an extremely complicated product.

A company, on the other hand, gets to amortize the cost of figuring out the right options across all of the employees, meaning they can do a better job. They will often have a professional doing it, which helps more. They also get to gather statistical data on how well the insurance performs. And they have have much more negotiating power than individuals.

One way to think of it is that markets work best when you have actors a) of approximately equal power, b) making frequent choices, c) where the products can be easily evaluated, and d) where experience with the product happens quickly, so that the feedback loops are short. Health insurance is exactly none of those things. Markets are tools, not magic wands.

> but having strong opinions is fun so I'll wade in anyway :D

Note that this is literally a life or death question for people in the US. You might think it's fun/funny. Having watched both my parents deal with cancer, that comes across poorly to me.

> The only reason to link the two is because Americans enjoy being different.

No. The American system grew up as it did for particular local reasons, not just a random desire to be contrary on some imagined global stage. It was in retrospect an obviously bad choice given that we spend way more than others while getting worse results. But it made sense at the time.

[cr1895]

You might like to read up on the Dutch system. Everyone is compelled to have private insurance, but insurance is tightly regulated so that the basic level is more or less comprehensive. Insurers compete on the perks...specific hospital compatibility, vision, physical therapy, etc; you can buy nicer perks, but the basics are always covered.

Sometimes employers reimburse employees for health coverage, and sometimes they negotiate a nicer rate package that any employee is free to use; but it’s not tied to employment like it is in the US.

If you’re under 18 it doesn’t cost anything. If you can’t afford it you receive a government subsidy. GP visits are part of the basic insurance, and the system functions with the GP as a gatekeeper.

It’s certainly not a perfect system...for example, a non-urgent surgery might take months to be scheduled if demand is high.

But, overall, I’m convinced this is a vastly better system for society than what exists in America.

Edit: it’s funded through taxes, insurance premiums that are about €110-130 per month, and deductibles which are at least €385 per year

[TheRealDunkirk]

> I have picked insurance as an individual and as an employer, and that is 100% wrong.

Wha..? So, are you in favor of your employer picking out your car insurance or your home owners insurance? Sure, health insurance is complicated, but have you read your car insurance policy? I don't see the two as being FUNDAMENTALLY more or less complicated. Further, I will probably blame any irreducible complications you may quote as vestiges of a product that is primarily sold to... corporate specialists. I think these things would change if we got our employers out of the loop.

[wpietri]

Life-long medical care is vastly more complicated than dealing with a car accident. It's true that the American system piles additional complexity on top of that. But the worst case in car repair is buying a new car. Medical care is so complex we can't even pick a worst case, but the many, many terrible cases can last years, cost millions of dollars, and have no clear answers from beginning to end.

[roenxi]

> Health insurance is worse, because it's an extremely complicated product.

Get sick, go to hospital, insurer covers. There is a shortlist of things the insurer won't cover. You pay the insurer each month.

Insurance isn't complicated. It is a complicated by bad regulation that mean insurers aren't trying to sell to individuals.

> A company, on the other hand, gets to amortize the cost of figuring out the right options...

That sounds like a pretty decent argument until the implications are examined. An identical argument could be made for:

* Food

* Housing

* Schooling

* Entertainment

The truth is that the amortization of figuring out what people want is best done by the insurer, and then people just buy whatever their friends have. Like everything else.

> You might think it's fun/funny.

I think it is funny that I'm commenting on a system more than an ocean away, I'm not laughing at sick people. That would be a bit weird.

> No. The American system grew up as it did for particular local reasons...

The reasons are, in hindsight, stupid. They should switch to using a system that makes sense. Either the capitalist way or the socialist way. The crazy hybrid that is used in practice is crazy.

Just because there is a stupid system in place today is not a reason to stick to it, and everyone agrees with that idea.

[wpietri]

> Get sick, go to hospital, insurer covers. There is a shortlist of things the insurer won't cover. You pay the insurer each month.

It is extraordinarily clear that you've never had to do this. And apparently never had to deal with a serious illness in your family. Which is great for you, but please understand that's not the case for others.

> An identical argument could be made for [...]

No, not at all. The only one of those that might meet the four factors I describe is schooling, which is also a highly fraught choice, but it's still not as bad on dimensions B, C, and D. Individual educational needs are also less varied and more predictable than medical care needs. And for choosing education, society puts extensive effort into helping people make those choices well: school rankings, guidance counselors, oceans of books and articles, school accreditation, etc, etc. Until the ACA, there was basically no assistance for picking an individual care plan. ACA marketplaces help a bit, but it's still an extremely difficult choice.

[majormajor]

> Get sick, go to hospital, insurer covers. There is a shortlist of things the insurer won't cover. You pay the insurer each month.

> Insurance isn't complicated. It is a complicated by bad regulation that mean insurers aren't trying to sell to individuals.

It's complicated in America because the right wing in America's position is not "if everyone buys private insurance it'll be good," but rather is "I have good cheap-to-me insurance through my job that I like, and I'll be damned if i contribute a penny to those who don't, and you shouldn't force them to buy it, even if that means that only the unhealthy people will be in the private market."

When Republicans complain about the ACA's health insurance regulations they're talking about regulations that mean "people should be required to have coverage to keep the market healthy" and "that coverage shouldn't be practically-useless bullshit"

[iguy]

> Get sick, go to hospital, insurer covers. There is a shortlist of things the insurer won't cover. You pay the insurer each month. > Insurance isn't complicated.

But for things they do cover, what price do they pay? That seems to be the crux here.

Something like travel insurance is simpler, because when they buy you a hotel room / a new suitcase, most of the other buyers are not insurance, and so there's a market price they can refer to. But healthcare isn't like that, and it seems the the prices of many procedures vary wildly, like 100x between different hospitals. Nobody can afford a 100x increase in premiums.

From what I understand about better-functioning health insurance systems, there's usually also a pricelist written up by the government. That seems like the crucial foundation for a useful health insurance market. Much as I wish there was a nice market mechanism for this, I have yet to see one.

[TeMPOraL]

> Get sick, go to hospital, insurer covers. There is a shortlist of things the insurer won't cover. You pay the insurer each month.

> Insurance isn't complicated. It is a complicated by bad regulation that mean insurers aren't trying to sell to individuals.

I live in a country with public healthcare and even there, private medical insurance is ridiculously complicated. I'd wager insurance in general is in top 3 of the most complicated products available for regular people. Nowhere else I had to read and sign a TOS the size of a long novel. I imagine that for Americans, it's only worse.

And as for the book-length TOS, almost nothing in there seemed to me like regulatory requirements - it all read like the usual "try to exploit the customer as much as possible while making sure the customer can't exploit us" terms.

[thebooktocome]

> I've not seen anyone really suggesting that regulatory standards are a problem in the Americas

This was a major component of Trump's platform, and where the "selling insurance across state lines" thing comes from.

[TheRealDunkirk]

Excuse me, but I've been saying this for a lot longer than Trump has been President. Not everything is about him, you know. Perhaps it is, in fact, a problem that needs to be addressed, regardless of who is in office.