[Taikonerd]

Yeah, the article sort of conflates the two.

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!

[ajross]

With all respect: what exactly is the alternative you're imagining? The market emphatically did not provide accessible private health care to individuals, largely because of the wellness trap (no one buys insurance until they need it). It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA.

Employer health care may have bad externalities, but it has the extremely important (but... maybe invisible to the median libertarian) property that it constitutes collective bargaining. You can force insurers to cover folks they wouldn't want to otherwise by bringing more customers (employees) to the table.

It's so weird that even now, with the ACA having been proved out over decades, that we have to have these weird free market arguments. It didn't work, guys. It's not a good that works well in an efficient market sense.

[mattmcknight]

> It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA.

100% untrue. There were affordable catastrophic coverage plans available, and many were made illegal by the ACA and the requirement to provide boutique services for "free" (i.e., forced to pay for even if you don't use).

[ajross]

> There were affordable catastrophic coverage plans available

Not for anyone who needed them! If you were already sick, you would die poor without coverage. Are we really continuing to have this discussion?[1]

The market failed in this case. We all know it.

[1] Just to short circuit: you'll want to deflect to a non-economic discussion of whose "fault" it was that they were stuck with a pre-existing condition. But my point is: who cares? There was a product and a consumer which could not be exchanged at a reasonable price in an unregulated environment. And that's bad regardless of fault (doubly or triply so because it's a really important product).

[mattmcknight]

Guaranteed issue can be achieved without requiring "free" checkups. However, it can't be achieved without the individual mandate. And no one has shown any interesting in enforcing the individual mandate (despite the forced taxation approach being a much more expensive and less flexible version of the same).

[therealdrag0]

Markets are made by the government, just cuz the government is involved doesn’t mean there’s not dichotomy of private and public healthcare. Countries like Switzerland or the Netherlands or Singapore have competitive private insurance markets as the primary form of healthcare. Similarly, even in the United States car insurance, for example, is private even though it’s mandated and expected to be universal. There is no car wellness trap.

[akramachamarei]

> You can force insurers to cover folks they wouldn't want to otherwise by bringing more customers (employees) to the table.

The word you're looking for is "convince," not "force." This whole discussion is replete with misuses of words like "free" and "force," and it's a little worrying.

[ajross]

Arguments about words are a little woke for my taste. Fine fine, pretend I said "convince" and then reply to that. Thanks.

[akramachamarei]

I'm beginning to think you don't understand the words "argument" or "woke" either.... But anyway, I'm merely pointing out for the sake of readers that insurance companies are engaging willingly (and very gainfully) in this arrangement, so as to not oversell the power of the collective bargaining enabled by uniting coemployed health insurance buyers. I guess I would just question whether this collective bargaining is working quite well for us employees (the self-employed have it better.) I may be in a collective, but I don't seem to have any influence within my collective whatsoever over which insurance company I have. This is like a union with no voting. No bueno.

I'm also curious (since this is closely related) whether you favor the tax break to employer health insurance. You wanna talk about my woke focus on words, well well, take "externality." I'm not familiar with these bad externalities of the institution of employer provided insurance of itself, but I can see negatives from the tax break. Namely, by subsidizing my employer's health plan, my private health insurance purchasing power is effectively nerfed. Bit of a stretch to call that external.

[Taikonerd]

My point was there are lots of models available, not just 2. My post above wasn't endorsing one in particular.

I would say that the ACA is on the free market-ish side of the design space: individuals purchasing (subsidized) insurance from private companies.

[ajross]

> My point was there are lots of models available, not just 2. My post above wasn't endorsing one in particular.

Yeah, so... my question stands: name one you're thinking of, even if you qualify that it isn't an "endorsement". I contend there isn't one and you're fooling yourself.

[Taikonerd]

Name a healthcare model that's neither a 100% free-market model, nor a fully-socialized model like the NHS? OK, how about...

* Medicare in the US (single-payer, private providers)

* Medicare Advantage in the US (government provides capitated payments to competing private companies, which then do all the administration work)

* The Singaporean system (complicated, but revolves around mandatory payments to HSAs)

etc.

[ajross]

That seems like a strawman. Upthread you were pretty clearly arguing from a libertarian perspective (I genuinely thought that your "only NHS" quip was humor, not that you were being literal -- the article obviously doesn't say that at all).

Now you're saying I'm wrong because there are other socialized forms than NHS that work too. Well, OK! I submit. Use one of those.

[Taikonerd]

I think that you misread my earlier post -- I'm not endorsing a libertarian approach. I was just saying that the Cato Institute presumably would.