Private healthcare makes industries less innovative. It's time for change

I am not an expert but I am pretty sure changing a job is a "qualified life event" that allows an out-of-band change. I hate privatized insurance but I didn't think this thing in particular was a problem.

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).

That's up to the new employer. Federal law only requires special enrollment within 90 days of hire. So technically there can be up to a 3 month gap.

In practice, that is very rare. Usually new coverage becomes effective on the hire date.

Workers changing jobs often just elect for COBRA or selecting a temporary subsidized ACA plan to bridge the gap though. Nobody is really forced to go without coverage.

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.

> completely different risk pool

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.