[bubblewand]

Add to it that all our retirement accounts are invested in these companies, and it kinda looks indistinguishable from a really roundabout way to have a very-regressive redistributive retirement scheme that also has crazy-high fees (whatever part of the overpayment to healthcare companies that doesn't make it to shareholders is basically part of the account management fees)

Yes, I'm suggesting that like 10% of our nominal GDP is actually a deeply fucked up regressive wealth redistribution scheme that doesn't buy tangible productivity, but is essentially a tax-like drag on the economy, but way less efficient than most government-run redistribution schemes. Because it is.

[mindslight]

I don't think squinting and framing things that way is particularly productive on its own, and you didn't go anywhere with the idea. One could also characterize it as big jobs program. But these framings belie that the structural "inefficiency" is the crux of the problem - both resource-consumption wise, and also in terms of (not) providing good healthcare. For example, how many full time skilled doctor equivalents are flat-out wasted by being spent jumping through "insurance" company bureaucracy? Or how many nurses is the "insurance" industry wasting directly?

[bubblewand]

I agree that the core problem is that we’re simply spending far more than necessary for the level of care we receive, but the side effects like being a white-collar makework jobs program (the upscale counterpart to the military, sort of) and redistributing (a little of the) money toward retirement accounts are what make the problem “sticky”. There’s a lot of temporary collateral damage if you fix it.

[mindslight]

But does that framing have predictive utility? Which would you say resonates more with voters, especially the middle/upper-middle class voters with skin in both games - "Healthcare reform is going to make your retirement account shrink" or "Healthcare reform is going to take away your employer plan and replace it with the same option the poors get" ?

Also my additional point is that nobody really thinks we need to create additional jobs for doctors, as we've currently got a dire shortage of healthcare. I just inquired about rescheduling a primary care visit for my aunt and the office told me they're scheduling out an entire year from now. That's obviously not the same as how soon they could see her for something urgent, but the sheer magnitude of that delay does highlight a problem. I've also seen many 4+ month waits for specialist appointments.