Health care 'job lock' stifles entrepreneurship
seattletimes.nwsource.com
seattletimes.nwsource.com
Seems to me like it would provide many startups a large cost savings if one were to join.
then 4 years in my country, i never buy one
actually over my lifetime, i never ever go to hospital and ask my insurance to pay for it (too much hassle and i hate meeting doctor)
the fud tactic used (you will pay 1 million dollar when you visit a hospital) always amuses me
maybe a better way is to take care of yourself, exercise, read health textbooks, read wikipedia on generic OTC drugs, eat real food, avoid extreme sports, don't smoke, use common sense etc
never ask an insurance company, "do i need coverage?"
In the U.S. an appendectomy can easily run you $20,000, and this is one of the most common non-elective surgeries.
Then look at car accident stats and the cost of trauma care.
Then look at new cancer incidence rates (there will be ~1.3 million new cases next year - CDC) and treatment costs.
The whole healthcare cost problem would disappear almost immediately if people paid medical bills directly and were reimbursed for only the truly unforeseen medical expenses. If doctors and hospitals were forced to compete on price like normal businesses, costs would plummet. It's the lack of a real market that's the problem. What other business has no prices out on display or in advertisements? Try calling up a hospital and asking the cash price for a procedure. It typically doesn't even exist; they're only set up to bill insurance companies and the government at different rates.
"Healthcare in the US is socialism without a central plan and capitalism without markets or prices."
In my opinion, we can't ever have a true capitalist market for healthcare because the price elasticity of demand for some treatments is so high.
The idea that you can negotiate as an individual with health care providers is silly. When I had my heart attack, I was in no position to call half-a-dozen hospitals to get the best price. Try going to your pharmacy to get the price of a prescription knocked down. Individuals have very little negotiating power against corporations. If you doubt that, take a look at the history of the labor movement.
That said, if you are low income and need expensive meds, many pharmaceutical companies have plans for certain drugs. Costco gives a small discount for people with no insurance.
Hint: you can, I've done it. Now that I have insurance, I just pick the guy closest to me. Why should I bother to price shop when I don't get the savings?
When consumers price shop, corporations compete on price. See for example Walmart, Jetblue and Dell. And a lot of medicine is delivered by individuals or small businesses (i.e., 5 doctors in 1 office), not by corporations.
Why did that happen? Most people do not have heart attacks.
If you can afford COBRA, you can usually afford to pay directly for a plan.
(BTW, I'm not suggesting that healthcare is screwed up in a number of dimensions, I just think the premise of the article is flawed).
The premiums are much less "affordable" if this is an issue for you or your family.
If you have a pre-existing condition, (probability of becoming sick) == 1. In this case, insurance is pointless.
The vision plan at my recent open enrollment demonstrated this clearly. You pay $X, and everyone's sitting there determining if they get $X+ back from the plan. And in this case, the vision plan isn't even insurance, because basically the only people going on it have a 100% chance of paying out. And it turns out that if you work the math, for one person, or one person + spouse/SO, you pay in $X and the max payout is $X-, precisely because the probability of payout is so very close to 100%. (This is because the plan only covers glasses and routine eye exams; catastrophic eye damage is covered by normal health insurance.)
(I further note that vision coverage has been one of the most free market of medical endeavors, precisely because of this math.)
How do we know the system is distorted? Because almost nobody actually realizes that this is an insurance system, that you should be expected to pay routine costs out-of-pocket, and that the system is physically incapable of giving everybody in the pool more than they pay in. Unfortunately, this attitude is so ingrained that every government plan I've ever seen also reifies this mindset too, and I think any plan that is conceptualized that way will fail because from the very beginning, you've built it on a shoddy foundation.
We have got to pry insurance away from the employers. (Once again, I note that we've managed to export this problem to the rest of the world. Similarly, I often think that the US would be really screwed by our crappy school system, except that we managed to export it to the entire rest of the world first, so nobody actually has a good system, just slightly different iterations of the same crappy model. "Fortunately" for the US!)
And maybe you should specify your exact country. For instance, France (http://www.npr.org/templates/story/story.php?storyId=9241927... ): "France, like the United States, relies on both private insurance and government insurance. Also, just like in America, people generally get their insurance through their employer." Government health care as seen in the UK is hardly any different from employer health care in practice... it's slightly more disconnected from feedback, but employer health care is already pretty disconnected. So, exactly which country has fully individual health care with no government or employer involvement?
I live in Switzerland. No government involvement is not realistic, but in Switzerland you are required to have your own health insurance (changing jobs has no effect on it). The government gets involved by putting a cap on how much insurance companies can make, which makes it less useful for them to use sleazy tricks to try and maximize profits.
As far as the UK being basically the same thing, what system would you suggest? I personally like the Swiss system the best of everything I've seen, but it could be argued that it is just a variation of what the UK has. That is, we all must have insurance, therefor we all must pay for it and the major expenses that people I don't know end up costing me more money. The only real difference is that the insurance isn't government owned and there is some competition in it.
But I can't imagine a system that could work better then these. The only other thing you could do is simply not cover some percentage of the people, but the US is a pretty solid example case that this doesn't work well. I believe that the reason employers are paying insurance is because the plans are already quite expensive and the employers can get a major group discount.
"what system would you suggest?" - The Swiss system you describe is what I would suggest. Perhaps not in every detail, because I'm sure you don't capture the full complexity in two sentences :).
The way in which it is not the same lies in the individuals ability to punish their provider, thus closing the feedback loop that markets critically depend on. (Where there is no feedback loop, there is no market, period. Another example: Monopolies are bad because they destroy the feedback loop, because there is no "elsewhere" to take your business.) When the health-care provider is your government, it basically has no reason to care whether you are being served well. (Odds are, the health-care providing part is not even elected so even the only feedback loop a government has is not in play.) It has no competition. In the US, there is only ever so slightly more feedback; technically, if enough of the company complained to HR, they might consider changing the plans they offer, but that's still a very diffuse feedback loop with a central point of failure (HR, easily bribed, or even just overloaded to the point where they can't afford to look at alternatives).
If you're buying insurance individually, and you have the ability to change it as easily as changing my car insurance would be, then you have a market feedback loop, even if you've got the government fiddling around the edges. (I'm only a little-l libertarian, so I'm not necessarily opposed to that, even as I think the US and UK systems are grossly flawed.) For all the rhetoric about the coldness of the capitalist system, you generally get more caring and concern from an entity you can abandon at will than one that gets your money regardless of what you think and has no real incentive to care.
(I also observe this doesn't fix every problem. But what I think it would do is get things moving in the right direction, and create forces that could help resolve the rest. Right now, the dominant forces tend to make things worse and worse over time, instead, as we continually move farther and farther towards guessing what will work... and politicians guessing, no less... instead of actually having the information necessary to figure it out.)
I too think it would be a good idea to have every individual required to have their own insurance (or the government pays for those who can't) in the US, but first something has to be done about the corruption. I didn't deal with a lot of insurance companies while I lived/worked there, but from the ones I did, more than half tried all kinds of things to get out of paying claims.