[Travis_Pastrami]

I don't see how that would be any better than what we have now. If employer provided healthcare was removed, that would leave us with a bunch of private healthcare companies. These private companies would drive up the cost even more.

If an affordable or free healthcare option was offered on top of making employer provided healthcare illegal, then I completely am behind your idea.

[photonbeam]

Its not a given that prices would increase

Look at how these systems work in other countries

[ekianjo]

Sounds like you have no clue about whats happening in other countries

[zer0tonin]

Well let me enlighten you, as someone who doesn't live in america. I pay a bit less than 150 euros a months in health insurance in the Netherlands. It is not tied to my employer in any way. If I was poor I could ask for those payments to be subsidized by the state.

If I am sick I can just get an appointment with my GP within the day and not pay a thing, they can refer me to specialists or blood tests if needed, which are also fast and free. The remaining healthcare costs for medications or dentistry are so low I don't even notice them.

Hope this will shed some light to you about what's happening in other countries.

[patrec]

The problem with the above account is that the 150 euros you claim to pay per month for health "insurance" is transparently a fantasy number, and in reality you probably pay closer to an order of magnitude more into the Dutch health system.

[ben_w]

According to wikipedia:

> Funding for all short-term health care is 50% from employers, 45% from the insured person and 5% by the government.

…

> Premiums paid by the insured are, on average, €137 per month for basic health care

- https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Only an order of magnitude if you're in base-2.

That said, this doesn't quite track with the numbers for

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

and

https://en.wikipedia.org/wiki/International_dollar

But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier.

[patrec]

> Only an order of magnitude if you're in base-2.

Nope. Look at how much the Netherlands actually spends on Healthcare, it's about 11.2% of GDP in 2021 [1]. Per capita GDP in 2021 was ~53k€.

((53k€*11.2%)/12) ≈ 495€

Only problem is, like most developed countries, close to a majority of people are net recipients (around 40%). Someone will have to pay their share too. Chances are, if you're posting on HN, that's you, as you'll be somewhere in the top 5% income bracket. I think if the OP does the math based on their actual numbers, they'd be more likely to find themselves in the ~1000€/month ballpark than the 150€/month they seem to think they are paying.

> But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier.

The Netherlands (11% of GDP) is not quite as extreme as the US (17%), but it's certainly nothing to write home about, especially as I don't get the impression that either health care expenditure as percentage of GDP or demographics are moving in a favorable direction.

[1] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...

[rgblambda]

That's less than half of what the typical UK taxpayer pays for healthcare. Surely the Dutch health system is also partially funded by government revenue?

[shapefrog]

According to our research, the average cost of an individual private health insurance plan sits at around £85 per month or £1,020 per year!

A typical family premium (two adults in their 40s and two children under 10) can vary from £700 to £1,800 a year.

The average price of a private healthcare policy in the UK is £1,032.84 per year (February 2022)

Google results ...

[rgblambda]

>The average price of a private healthcare policy in the UK is £1,032.84 per year

I did use the word "taxpayer". The UK's health service costs £2700 per head of population. Obviously what people contribute towards that varies.

Also my question remains unanswered. Is the Dutch health system topped up by government funding?

[FireBeyond]

It’s very well documented that US healthcare and insurance costs are the highest per capita in the world.

[ffgjgf1]

The Swiss healthcare system is privatized to a higher degree than the US one (no Medicare/aid equivalents) yet it seems to be doing mostly fine because of sensible regulation?

[CaptainZapp]

While generally true it needs to be noted that health insurance is very expensive in Switzerland.

I'm not complaining since, first, this is a political decision and second, the level of service is outstanding.

For example: psychotherapy is paid for or, if your doc orders an MRI you get an appointment after tomorrow.

There's also no such shit as in network health providers (exceptions apply for some insurance models) or pre-existing conditions for the basic health plan (which is still pretty good and comprehensive).

While I do think that it's an overall good system it is expensive (and subsidized for people who can't afford it).

Also, health insurance is mandatory.

[roydivision]

- It is mandatory to have health insurance, if you don't chose one the state will chose one for you - On the whole it's very expensive, although this is somewhat offset by the high standard of living - The insurance companies are legally forced to provide a lowest tier plan

[FireBeyond]

As someone born in the UK, grew up in Australia and now in the US, who knows of paying a seven thousand dollar copay after my “platinum” insurance for “elective” surgery to remove a kidney stone that was too big to pass, versus a nine day stay for gout in Australia that resulted in a $38 out of pocket because I wanted premium TV channels in my room.

[ars]

> that would leave us with a bunch of private healthcare companies.

It's already a bunch of private companies.

> These private companies would drive up the cost even more.

Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up.

Although we really should not ignore that insurance companies are not the drivers of higher costs, it's health care providers that do that.

It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. Dr.'s will have to take a pay cut, and there will have to be mass layoffs, there's no other way to reduce costs.

[quickthrowman]

> It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem.

Health insurance profits are capped only as a percentage of premiums collected, not a fixed dollar amount cap. The rule is you must pay out 80% of premiums collected, everything else is OH&P.

Turns out, if healthcare costs go up, then premiums go up. If premiums go up, then insurer profits go up.

Healthcare providers and health insurers have an aligned perverse incentive to have healthcare cost as much as possible, since that is what increases their profits.

This isn’t a hard relationship to uncover if you are familiar with the insurer profit cap portion of the ACA and also how money gets made.

[ars]

> Healthcare providers and health insurers have an aligned perverse incentive to have healthcare cost as much as possible

OK, I can agree with that - but it doesn't change my point that cost reductions need to start with providers, NOT with insurance companies.

[unusualmonkey]

> It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem.

What a delightfully naive view.

Answer me two simple questions:

1) How are insurance companies profits capped?

2) How does increasing or decreasing costs affect thier allowable profits?

[ars]

1: Obama care: 80/20 rule.

2: Costs change nothing. But increased health care expenses do allow them to earn more (the 20).

[unusualmonkey]

So if increasing healthcare expenses allow them to earn more profits, then why do you think having capped profits means that insurance companies are 'not the problem'?

Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.

[ars]

> Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.

Yes, that is true. But it doesn't change the fact that prices will have to change at the healthcare providers. Dr.s will earn less, people will be fired as positions are eliminated. There's no other way to reduce prices.

Where do you think all that "incentivized" money is going? It's going to people in healthcare will either take a pay-cut or will lose their jobs.

[joomooru]

perhaps we should sidestep the problem of profitability in healthcare entirely and create a non-profit healthcare system? which even the most free-market loving enthusiast should be in agreement with -- inelastic demand and all

[ars]

They exist. It helps nothing.

The gigantic UPMC is a non profit. Actually a TON of hospitals are non profits - every religious founded hospital is a non profit (Maimonides Medical Center, or every Mercy Hospital (Wikipedia counts 33 of them)).

60% of hospitals are non-profit.

[tchaffee]

He said a healthcare system. Not a hospital. They are related, but not the same thing.

[ars]

Non-profit insurance companies also exist. It still helps nothing.

Are you hoping for non-profit drug and equipment makers as well? How far do you need this "non-profit" thing to go before you acknowledge it doesn't help at all?

[tchaffee]

The NHS is non-profit. That's a healthcare system, not just a hospital or insurance company. I repeat that he said "system" and you continue to talk about things that are not a healthcare system.

I can acknowledge that it not just helps but that it is far more functional than the US system I've had to suffer through for many years. In addition to years of experience with the US and NHS, I also have many years of experience with Italian national healthcare which is also non-profit and better than the US system.

The US system is better for some diseases but only if you are rich. And an absolute failure if you aren't employed. Even if you can manage to stay employed with a serious illness you better have a healthy family member with a lot of energy who can fight the insurance company that really doesn't want the cost and burden of you and will make that clear in every action.

How far do you need this "for profit" thing to go before you acknowledge its very serious flaws and inadequacies?

[flagrant_taco]

If this is aimed at free-market living enthusiasts, I believe the response from them would be that the market is currently not stopping anyone from opening non-profit healthcare providers today.

[user_t123]

> Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up.

This is backwards logic. Those few large corporations have the bargaining power to negotiate lower premiums. Individual consumers have zero bargaining power.

[ars]

You wish it was backwards logic. In reality the insurance company just needs to convince a single person in a company to pick them. And they are very good at doing that.

On the other hand individual consumers have ALL the bargaining power - they can simply pick a different insurance company, and insurance companies have to work very very very hard to get customers. They would compete on price because that's by far the most important thing to a consumer.

A company on the other hand cares about other stuff, how integrated in the system, how easy can we import members, manage members, how much marketing material do they give? Do we have to educate our employees, or will the insurance company do that for us?

Just tons of other stuff that isn't price. Individuals: It's 99% price.

[ohgodplsno]

So, you spend every single day of your existence in the US being absolutely fucked by the private medical sector, and you think that for some reason having no collective bargaining ability will make you better off?

I have a bridge to sell you.