This is less about private healthcare and more about how employer-provided healthcare is tax advantaged. Credits and tax breaks should go to the individual so they can choose and keep their insurance through different jobs.
Yes, the title gave me whiplash because I went in expecting an argument for socialized healthcare, then read a couple paragraphs and realized the article was actually presenting an argument against government meddling in the healthcare industry, then read further and realized it was actually using the problems created by government meddling in the healthcare industry to argue for more government meddling.
"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it."
really it could not be because government is bad at managing massive programs and provides no incentive for high performance and efficiency....
Real truth is that health care just is massively expensive. Any efficiency gains that are also somewhat limited have been overshot by more "products".
Nurses and doctors can only handle so many patients. This has not increased that much compared to say farming or most other areas. And while there has been some gains. There is also lot more produces and costs of those.
Indeed. It's been argued that people intensive activities, like healthcare, thus become relatively more expensive as other, more automation friendly, industries become highly optinised.
ie the relative price of a new car versus a heart transplant is going to continually drop such that we spend more and more as a percentage of GDP on things like health ( and social ) care.
So it's not sure much that health care has become more expensive, as much as relatively more expensive.
The other strong effect is nobodies life is saved, death is simply delayed, and the older you get the more problems you have.
So as well as historically being relatively resistent to automation, success breeds more need.
US healthcare is very expensive because it's horribly inefficient. There's lots of insurers, lots of providers, and lots of treatments. The intersections of all of that are complex and requires huge amount of overhead to resolve.
Not to mention, the entire point of insurance is to provide that overhead. They want to deny coverage, obviously, so they're going to waste doctor's time on peer-to-peer and force their own customers to aggressively advocate for their own care. It's a huge waste of time for everyone involved, but the insurance company wants that waste of time, that's what they're optimizing for. They've gotten really good at both calling all the shots and wasting time.
Your doctor is more or less a vessel for the insurance company. The insurance company is your doctor: they decide how long visits are, what you can visit for, what medications you can take, which procedures you can get, when you can get those procedures, how much they will cost, and how you will have to pay. Your doctor gets a tiny bit of freedom. Maybe they can prescribe you a medicine out of, like, 3 predetermined choices. After, of course, you've completed all the testing. And after you've tried medicines A through C. And after you've been monitored for whatever time period the insurance decides.
One answer is it is more expensive compared to most of the rest of the first world countries because it was more expensive compared to them 50 years ago, and over that time the growth rates in health costs have been fairly similar for us and them.
The question then is why was it more expensive then? I've not seen much on that.
It is expensive in every developed country. USA just have made everyone involved to try to maximise their profits by shadiest possible practises.
Other places are less expensive. But it does not mean they are cheap. At least in as far as you think of general cost of living. The cost might not be directly visible, but it is there in some way.
The NHS is known for being pretty efficient when compared to other healthcare systems, especially the US. The problem is that there is no money and healthcare is getting more expensive.
There are incentives for high performance and efficiency. GPs are private partnerships contracted to treat patients. They can keep profits.
There's been attempts to do more private outsourcing (with the NHS still paying), but they tend to work out less efficient when you consider the whole system, because, for example they might only treat the easy cases and leave the hard ones to the normal hospitals.
While there are some centralized decisions ( we are paying only for one round of IVF, or this drug isn't good value for money ), most of it is delegated to front line doctors - by the simple mechanism of faced with a fixed time/budget they triage based on medical need.
Note that the UK system is actually a rather odd hybrid of public and private due to historic reasons. It's quite easy to queue jump the waiting for an initial consultant by going private, and then be referred back to the public system for treatment.
So do insurance based ones. And if you aren't 100% insured, that limit depends on how rich you and your parents are, and the balancing is often between health and other things.
Seeing how the US GOP has intentionally sabotaged the USPS with fiscal responsibility burdens unlike any other agency, then declare it fiscally untenable and in need of privatization: yes, I completely believe it possible conservatives will sabotage the function of government in order to demonstrate to voters that government is ineffective.
You can deduct some of your medical expenses. I think it’s over 7.5% of your AGI.
But tax deduction or not isn’t what makes individual health insurance so expensive. When you have employer provided health insurance you’re in a completely different risk pool than people buying on the open market.
And that's the issue, we need regulation to break the quid pro quo system we have right now, and an innovative enterprise to design and sell a realistic risk pool for the public.
That might look like the government requiring freedom of choice in your employer healthcare plan -- eg: the employer has to allow you to port a defined contribution amount to any healthcare plan you prefer, including simply taking the money as salary (disincentivized by taxation though).
It might look like regulating mandatory profit caps on high priced insurance -- meaning if you overpay for your actual risk you get a refund, or maybe free months on the plan etc.
I don't want the government to be the insurance/solution, I want them to set standards that make the game fair and companies can play if they want.
I agree we need to do more. I do wonder if just providing a public option to compete against private insurance is the way to go though.
>profit caps
We have profit caps on health insurance. It has many downsides though. The first is that it removes incentives for health insurers to reduce healthcare costs. It actually incentives them to want higher healthcare costs because 15% of a bigger number is more money.
Second, it incentives things like spinning out your insurance division into separate company and then buying an urgent care clinic to run as a sibling company to the insurance company.
Then when the insurance company
spends their required 85% on healthcare costs, they just make sure a big chunk of that is spent on services from the sibling provider company.
United Healthcare does exactly this.
Of course functional regulators could stop this, but it’s hard and they don’t. Which is why I think offering a public instead of some of these direct regulations of private companies might work better.
I don't get why decoupling insurance from employment isn't a bigger part of the healthcare reform discourse. It's the most obvious, easiest, lowest hanging fruit for improving the US healthcare system, and almost uniquely politically acceptable to both Democratic and Republican voters. Decoupling also doesn't entail disrupting any of the established incumbents (pharma, AMA, insurance companies, etc.) who typically kill any reform. The policy is also arguably market-oriented, or at least is not a form of government intervention that would otherwise offend Republicans, yet benefits individuals over large companies so can appeal to Dems too.
The Republicans have utterly failed to offer *any* alternative at all to Obamacare after 16 years, which is insane for many reasons, but especially considering that they could have put decoupling insurance from employment at the heart of an alternative (even more than the ACA) market-oriented reform. Letting individuals choose their own insurance would put more pressure on insurance companies to actually deliver quality care because, unlike employers, individuals are highly sensitive to the quality of care they receive and are more likely to switch insurers if the insurer unreasonably denies claims or otherwise fails to deliver a decent product. On the other side, individuals are also more sensitive to costs so with greater control over their plan choices would be more able to pick plans that are structured to match their anticipated costs.
In other words, individual insurance would improve the functioning of the market, which should in theory appeal to Republicans. Instead, they only focus on making individuals pay more at the point of care, on the theory that cost-sharing discourages insured people from over-consuming healthcare. Yet they don't think about how the current system makes it impossible for individuals to be truly cost sensitive when selecting plans.
I would guess the Republicans haven't adopted the idea because they are not really in favor of free markets, they are in bed with big business, and employer-provided insurance tends to favor larger companies that can demand better terms from insurers, that can amortize the HR overhead over a larger number of employees, and that tend to benefit disproportionately from lower labor mobility compared to small business (people are more likely to be involuntarily locked into a big company job for security than at a small business, and it's harder for people who are worried about maintaining quality healthcare access to move to a startup, reducing the competition experienced by the bigger companies).
I’m likewise baffled. Healthcare spending is a major cost for all employers. Decoupling healthcare from employment would theoretically remove this cost immediately. Shouldn’t pro-business groups have long been lobbying for this?
The fact that they are not tells me there must be some other financial incentives at work that are unclear to me.
I think a lot of people want to decouple insurance from employment but the mechanics would be tricky.
Ideally all business would take what they pay for insurance and stick it in the employee's paycheck and then the employee would buy insurance with that money. Reality says, a lot less people end up having insurance if you do it that way. Maybe force companies who once offered insurance to fund an employee HSAs and change the HSA rules so it can be used to buy insurance. It would take some thoughtful design to actually pull off the transition while keeping people on insurance.
> The Republicans have utterly failed to offer any alternative at all to Obamacare after 16 years
That’s because before Obama picked it up, it was the Republican free market compromise plan in the face of a growing for socialized healthcare.
And now the Republican Party has been taken over by Trump. To the extent any political party has real principles they have given up theirs completely. Their principles are whatever Trump says they are this week.
So the question is “why hasn’t Trump pushed for separating healthcare from employment?” And the answer to that could be as simple as because he doesn’t think it’s exciting enough.