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by matthewdgreen
269 days ago
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Well, US health insurance is insurance. That’s one function. But it’s also managed healthcare. The management is being performed by a series of large corporations with somewhat broken incentives, with the government backstopping and certifying everything and filling in all the gaps. That’s why other countries achieve such better results with government-managed healthcare, because our system genuinely has very little relationship with the free market and already is a kind of planned system; it’s just an exceedingly inefficient planned system. But the lesson you should take from this is not “we should just deregulate it a bit and hope the free market takes hold.” This is the planned system we designed in one of the most capitalist countries on earth: it got to the state of being a planned system because the truly competitive market systems kept failing. I’m not sure where you can go to find a truly competitive system that isn’t in some way underpinned and supported by the government (and the US government specifically.) People often point to third world countries where they can pay cash, but I think that’s mostly just rich US people buying luxury healthcare at lower prices, not a real working free-market health system that delivers broadly-shared results. You have to entertain the hypothesis that when the ideal “free market system” exists nowhere, the reason is because the free market system was tried (here in the US, even) and it worked so poorly that it was replaced with one of the systems that survived. Because that’s the pattern we see everywhere with healthcare (and with roads and fire departments, too, outside of a few exceptions.) The pharma investment problem is a problem, but just to be clear: it’s a question of financial allocation. There are many ways to solve it that aren’t what we have right now. |
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We didn't really "design" it though, it emerged organically out of the various constraints, many of them historical.
For example, why is quality health insurance in US tied to employers? Because during WW2, when federal government froze salaries, companies started to use various benefits to attract employees instead, and one of the most lucrative benefits turned out to be health insurance. And, since companies were large customers negotiating on behalf of all their employees, they could get more out of insurers for the same amount of money. And so gradually it evolved into what things have been before ACA, and ACA is basically a crutch that preserves this historical nonsense.
FWIW I don't think that free market is the answer here, but that doesn't mean that it can't produce significantly better results than what we currently have (it's not hard because our existing system essentially combines the downsides of free market with the downsides of centralized healthcare - you don't get the choice and you get fleeced).
It should also be noted that there are many different ways in which less-than-free market can be implemented. Single payer is a fairly extreme take with no clear evidence that it works better than more market-friendly approaches as seen across Europe. The one model that I'm really curious about and that doesn't seem to exist anywhere, though, is one where the government simply provides healthcare at a certain level as a non-profit public service, thereby setting the baseline, but doesn't try to heavily regulate private healthcare, and doesn't require citizens to participate in the public plan. Germany has some similarities but I don't think it's quite there yet.