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!
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.
I would say that the ACA is on the free market-ish side of the design space: individuals purchasing (subsidized) insurance from private companies.
(If Americans are thinking, "huh, that sounds like Obamacare / the ACA marketplace!" then you're right.)
In Germany there is nothing like bronze/silver/gold plans. All statutory health insurance covers what is required to be covered by regulations, with just a few bonus services, at the regulated tariff plus just a few percentage points of variation. So the 90% of people in Germany who have statutory health insurance [1] have essentially the same coverage. The tariff is a percentage of income (up to a cap), not a flat fee.
[1] not everyone is required to have statutory health insurance, for example employees above an income threshold and self-employed people
It is like parliamentarianism, campaign financing regulations, gun control, multiple political parties, etc. Americans call these things "Socialism" and then freak out about them and refuse to see any good on them.
private healthcare - e.g if there's a lot of private clinics - people paid cash, then yeah healthcare costs would go down & most of the care was preventive not treatment. competition naturally will force prices down & since individuals payers won't be able to afford massive amounts, the market will adjust it's prices vs having one large payer (gvt) i.e public healthcare or many private large payers(current insurance industry).
right now - the issue isn't private healthcare - but the wrong incentives to bill insurance companies massive amounts of money. then insurance companies countering back - by having large bureaucratic processes to avoid paying those large bills. typical complex systems.
The term “private healthcare” is mostly referring to the fact that there is no such thing as non-private healthcare for the majority of Americans.
Make that "many, many billions of dollars of profit". Then add on the probably-millions of jobs which the staggering inefficiencies of the current system support. (Everything from lobbyists for those companies, to the minions stamping "Denied" on health insurance claims, to the opposing medical billing staff who work for doctors & hospitals & such that need to get paid, to ...)
It'd be lovely if the leviathan could be slain, but don't hold your breath.
- job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point
- except when subject to some kind of union negotiated contract, the employer can change their insurance options from year to year as they try to save costs, but it's not regarded as a mass pay cut when they do
- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"
Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives, I do think that people would be more willing to switch jobs if they could know their plan was at least as good as the one they were leaving, both in money spent and in employee satisfaction. Opacity, in part owing to lack of commitment from employers, makes this harder.
"how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.
But for many normal jobs it’s very normal to use health care coverage as a negotiation or decision point.
Obviously people will go with the first option, innovation won’t feed their kids.
Remove the private actors, the adversarial billing, the friction with providers. It, at its best, ranges from bad to outright awful.
(I'd also love to do away with tax prep — the government knows what is owed, so why make folks prepare their own count and hope it matches?)
But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance.
So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.
It's interesting: 3 states (Vermont, Colorado, and Massachusetts) did recently try to make state-level single-payer systems. https://www.thirdway.org/report/single-payer-health-care-a-t...
It’s pretty much a no-brainer cost reduction for everyone.
This doesn’t even mean you need to get rid of private insurance companies (see: Germany).
private healthcare is getting more and more expensive due to private prices available to bulk insurers but not for private person
even if this is not completely deliberate, effect is that you are "serf of whomever pays your insurance" or go bankrupt the moment you have any kind of emergency
in europe some private healthcare providers are showing their colors from different perspective, they outright refuse or cancel private contracts when you are above certain age
using what money? Most people get their money from their employer.
That's why in normal countries public healthcare is a thing and it competes with the private healthcare sector, forcing it to offer relatively affordable premium services.
Let's not pretend either system is perfect, or that the _underlying principles_ that both systems hold are the absolute correct way to organize a society.
Americans have be primed with _decades_ of rugged individualism and the idea that collective action is inherently weaker/flawed (just don't think about Social Security). It might have been reasonably true 100 years ago that everyone could pay for their own health care, but we're now in a world where the average person is perpetually on medications that are expensive to produce, and will demand increasingly expensive medical interventions throughout their life (heart health, cancer care, etc.). Combine that with AI probably wiping out a ton of industries/jobs - something has to change. I'm not going to pretend to have a solution, but I think it is disingenuous to suggest any EU nation has it figured out either and is obviously correct.
It is just a really awful system overall.
All the job interviews that went to the point of discussing compensation, healthcare benefits were almost always included when negotiating what actual compensation would be. A difference of them covering several hundred dollars a month in premiums and them matching some % of HSA contributions is several thousand dollars a year in compensation differences. When multiple job offers are pretty close, that can make a difference.
Also, the few times employers have offered healthcare concierge as a benefit it was definitely mentioned in the overall compensation package.
United Healthcare is pretty big in the US, they are also famous for forcing people to spend a lot of time on the phone, waiting on hold or advocating for care. I expect the ends up taking time that the employee would otherwise have been working as well as negatively impacting morale.
petesergeant•39m ago
I would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.
AlexandrB•31m ago
Canada's public healthcare system is massively overloaded and it seems to be getting worse.
I really didn't appreciate how much of a problem this is in my 20s and 30s (while I didn't need much healthcare) and it was easy to assume the bellyaching from older folks was overblown. Time makes fools of us all.
cwillu•22m ago
AlexandrB•16m ago
wat10000•31m ago
Taikonerd•24m ago
The "Bismarck model"[0] describes a family of healthcare models where people pay into a central healthcare fund, and that fund then pays medical providers -- which can be private businesses.
[0]: https://en.wikipedia.org/wiki/Bismarck_model
cmrdporcupine•30m ago
It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding.
Take your dissatisfaction with the way the government manages payments to the voting booth instead of advocating dismantling what is on the whole a quite equitable system that has a history of actually producing very good health outcomes.
I actually have on the whole extremely pleasant experiences here in my corner of Ontario. And then I hear horror stories.
The system is underfunded and inconsistent. The province is to blame for that.
petesergeant•24m ago
It may outperform the US, but it doesn't outperform normal countries.
AlexandrB•17m ago
And vote for who? I have yet to hear a compelling solution from any party. At most, politicians advocate for throwing more money at the problem.
> The system is underfunded
Hot take: the system will always be underfunded. The demand for healthcare is nearly infinite in practice. What stops people from going to the doctor for every sniffle is either cost (in a private system) or waiting times (in a public system). If you had infinite resources to offer services, there are some folks who would be going in for MRIs every year "just in case" and getting prescriptions for every flu they have.
mchusma•14m ago
This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D).
Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US).
There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways.
Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop).
I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.