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

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

#91

Post by ryandrake »

Ekaros wrote: post #77
natsucks wrote: post #63

Earlier quoted context omitted.

"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 inc…

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.

Why is healthcare so uniquely expensive in the USA, but nowhere else?

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

#93

Post by jmyeet »

> 1 in 4 American workers stay in their jobs because of the healthcare. It suppresses wages and working conditions - and prevents innovators from heading out on their own.

Yes. That is the point. This is how capitalism works. Just look at the story of Tetris as the pefect example of capitalism in action. Some Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add? Licensing and sub-licensing agreements. Or, to put it another way, just building enclosures.

The idea that capitalism fosters innovation is a fairy tale. Companies reach a point where the only way to satisfy the market's need for growing profits is by cutting costs and raising prices. All of the inflation we've seen from the pandemic has been the "raising prices" part. AI exists for dynamic pricing. Dynamic pricing is nothing more than raising prices. Nobody is using dynamic prices to reduce prices. Why would they?

But the big part of AI is in labor displacement. This suppresses wages. Those who kept their jobs aren't asking for raises and aren't saying no to extra unpaid labor. Because they're in fear of losing their jobs. That's not a side effect. It's the goal.

US healthcare, if you can call it that, is part of this economic coercion. Being expensive to access out of employment is a feature not a bug. Everybody wins. Employers keep people who want to live. Healthcare company profits go up. You, as the individual? Nobody cares about you. Get back to work.

The end state for all this is something that looks like South Asian brick kilns where workers have debt they can never escape. Westerners are being loaded up with debt for a reason: to enrich various companies and to make sure we can't leave our jobs.

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

#94

Post by megaman821 »

stult wrote: post #73
megaman821 wrote: post #12

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.

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 ki…

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.

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

#95

Post by DrScientist »

abeppu wrote: post #25

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - 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…

Markets require information to operate efficiently, but it's not actually in the interest of the companies involved. Who wants to have to endlessly ruthlessly compete? They would much prefer monopolies or cartels - however governments regulate against those.

Hence the "Confusopoly".

The more complex and opaque the system is, the more opportunities for value extraction by those on the inside.

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

#96

Post by balderdash »

abeppu wrote: post #25

In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but: - 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…

I don't think think I've ever had a job offer where this wasn't a topic of conversation. its further down the flow signing bonus, salary + bonus/equity/incentive are obviously the big ones, but I've always seen vacation, 401k+match, summary health care, relo package, etc care before accepting an offer admittedly its never been a obstacle and probably only moves the total comp needle a couple of percent. honestly its always been the easiest place for me to pick up money with little push back (extra week vacation, 5 years seniority at start for full 401k vesting/match etc.)

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

#97

Post by mbgerring »

My partner and I both just got new jobs after a long period of unemployment. Neither of our new employers offer subsidized health insurance. We both have chronic conditions for which we need regular access to medication. The financial cliff we will both go over going from Medicaid to paying for health insurance via Covered California, and likely paying higher prices for medication in addition to astronomically high (and increasing!) monthly premiums, is going to eat a huge percentage of our increased incomes.

I have no idea who is supposed to benefit from this system, other than the private health insurance companies.

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

#98

Post by therealdrag0 »

ajross wrote: post #19
Taikonerd wrote: post #7

Earlier quoted context omitted.

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!

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,…

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.

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

#99

Post by nlitened »

Synthetic7346 wrote: post #20

One thing that's never been clear to me is how either system plans on scaling healthcare. You have X doctors who can see (just a guess) 30X patients. Unless the number of doctors increase, some patients are going to be left out. In the current system it's those without employment. I'm other countries there's a waitlist. How can we make sure there's enough staff to provide adequate healthcare for everyone?

I have a very simple and easy solution: allow any person with any medical education from any country around the world to practice medicine in their field of study, and relieve them from any medical malpractice responsibility (apart from criminal). Let them prescribe medicine, no paperwork, no regulation.

Anybody can choose to which hospital they go, the “state-licensed” crazy expensive one or the “unlicensed” one for 50 dollars a visit.

As far as I understand, currently the pool of people in the US who are allowed to do medical work is artificially limited, and doctors’ salaries are inflated. Just look around the world, there’s a huge supply of doctors with no student debt who would be happy to work for 60k a year. Also tens of thousands of US citizens will just go get a cheap medical degree from other countries, come back, and open private practice.

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

#100

Post by Ekaros »

ryandrake wrote: post #91
Ekaros wrote: post #77

Earlier quoted context omitted.

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.

Why is healthcare so uniquely expensive in the USA, but nowhere else?

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.

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