Another way to say it, there is more to health than how an employer affects a person's life, and those things are none of the business' business.

Even today, most people will pay several hundred dollars a month for insurance; the employer will pay several hundred dollars and the plan will still have a $2K or so deductible. That's a lot of money that most people make no use of at all.

Do they really? I've see only select hedge funds actually advertise their health plans. Even that is usually that "we pay 100% of premiums." Most plans are impossible to assess until you actually get to the job and see the tiers available and support available. The devil is in the details -- network coverage for your specific state, co-insurance, co-pays, deductibles, % premium paid, support like QoS/tier.

What's unserious about this?

Move to single payer, kill the medical insurance industry, and save these costs:

The health insurance industry employs approximately 605,000-912,000 people directly. The top 10 companies generate over $1.5 trillion in combined revenue annually. Conservative estimates suggest these companies spend $45-90 billion annually on employee salaries.

The health insurance company's bottom line profits are determined entirely by the volume of cash that they funnel to healthcare. Their profit margins are capped by law to X% of this volume. So the only way they grow year over year is to increase the amount of cash they hoover up and direct to healthcare providers. Because the stock market demands year over year growth, they are incentivized naturally and by fiat to increase the volume of cash that flows through their network. This volume of cash is directly spent on healthcare. So you can see pretty easily that the incentive structures in our society are geared toward raising costs steadily.

If you couple that with private equity buying up healthcare providers and globbing them together, then you can see that there's a whole market system being built to make healthcare more expensive so that health insurance providers can absorb more costs and therefore increase their year over year profits. PE companies increase the negotiating power with insurance companies, and costs increase. And when costs increase, the insurance company's profit increases proportionally year over year.

So what you're saying about private companies doesn't make any sense. There doesn't even have to be collusion, although United Healthcare, an insurance provider, owns Optum, a healthcare provider, and I suspect there is a lot of collusion in relationships like that. The incentives are perfectly aligned to create this situation.

Of course they can. But why on earth would they? Health insurers are mandated by law to not exceed certain profit margins, so the only/best way to make more money is not by increasing volume and lowering margin, it's by increasing costs for your target captive market. That flows down the chain, you increase the allowed costs, so providers increase to meet that (why wouldn't they?) and the only person left hurting is the policy holder (and their employer, paying some portion of it).

> unpersuasive. It's not a serious argument

Your argument amounts to "this doesn't make sense, why wouldn't companies look to lower costs" when lowering costs in the health insurance mathematically equals lowering your profits.

What's not a serious argument is this constant belief that America is unique. "We're bigger than other countries", "our population density is different", all these things.

But you're going to need to do better than a pithy "it's not a serious argument" with no substance behind it when acknowledging that the entirety of the developed world hasn't "solved" healthcare but does a better job at making it equitable and accesible to more, at a lower cost, with oftentimes better outcomes (looked at our mortality rates around childbirth, lately?). It's not about the quality of care, it's about a system that revolves around making more money, not patient care. Another simple example, my insurer, Aetna, simply refuses to authorize 90-day (or rather, anything beyond 30-day) prescriptions from any pharmacy except the pharmacy they wholly own. Why? That doesn't provide patient benefit. There's no discount - the charged amount for the 90-day script is 3x the cost of the 30-day. It provides a worse experience for the patient, removing flexibility for them. It doesn't change their pharmacy network - they're still serving pharmacies all over, just for a subset of patient needs.

No, it's just about money. Again, there's near no incentive in the current US healthcare market to compete on price. And that's why US healthcare is ~20% of GDP, double, if not triple the cost of other developed nations.

What if their incentives aren't to lower cost? Insurance companies make more when the obfusicate pricing and payout less. That's the opposite of incentive, it's a way to cover up your profits.

> Everyone that proposes a single payer can't explain who makes less money.

If you think the healthcare industry is just doctor-insurance-you, then you're nuts. Look up pharmacy benefit managers. They're basically third parties that are in place to jack up prices.

> Even if you're able to do everything the health insurance company does and capture 100% of their margin with equal efficiency, you'll capture a profit margin of around 2-6%.

Insurance companies have had their profits capped via the ACA for more than a decade now. Where they're making their money is by using more third parties in the middle to jack up pricing and increase costs so that A) their 2-6% is bigger, and B) their "investments" in the third parties are not regulated by the ACA so they can get their massive profits their.

> The only argument I hear is "other countries do it", which is just unpersuasive. It's not a serious argument. Propose something better

Its a very serious argument, you're just happy to dismiss it for some reason. If the entire developed world uses a different system than us, gets better results and for less money, then you'd have to be insane to insist that mimic those systems is not a serious alternative.

And no, we don't have the wait times Americans are afraid of. I can visit a doctor the same day and get treatment. My friends back in the US are desperately trying to find appointments with everything filled months down the line. America has the worst of all systems combined.

I would also accept Medicare For All if we're shooting big here :)

Isn't that just great?

I too would love to disconnect healthcare from employment, but good god is this the wrong way to do it. But the current administration has shown for over 20 years that it is utterly incapable of building a solution, so they will just keep tearing down what little of this system is effective while pocketing billions.

On it's face it might seem like this isn't related to your complaint, but one of the consequences of self-insurance is that the employer essentially has a dial that they can turn that influences what level of service you get from the provider. If the pool is okay, then your employer might spring for additional benefits like free telehealth. If the pool is marginal, they might force you into a pharmacy plan. And if the pool is completely hosed, then the provider can get aggressive about requiring documentation to bring pool spend back in line.

And it's horrifying that you would advocate for violence on this issue so I flagged your comment.

The loss ratio seems to be a good incentive for insurance to pay more to hospitals in order toincrease their own cut of the premiums they are taking in.

Ha ha, “merely act as third-party administrators.” Dude, does United Health or Apple deny your claims?

Anyway, it’s a simple question. Why doesn’t Apple lobby for public health?

There is no moral, social, ethical, or related good from doing "hard work". Physical exercise is wasteful compared to other things that can be done with ones time. Significantly reducing the amount of time needed to be wasted on such activities as the only way to reduce the poison damage of our food on is ontologically good.

Go listen to Bertrand Russel[1] if you don't believe me. Ultra smart, ultra hard working people realized that they had to dedicate entire books to defend being lazy because of how many puritanical pearl clutchers exist who get physically angry at the idea that you can have something good without "earning" it.

[1] https://en.wikipedia.org/wiki/In_Praise_of_Idleness_and_Othe...