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> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular.

And going to a 'single payer' model would also reduce jobs. And the whole "they want to get rid of your insurance and raise your taxes!".

Well, the taxes would be raised, but almost certainly to a smaller extent than the price of the insurance policy you pay for. A middle of the road health insurance policy for me right now is around $1k/month. Whether I pay for it, or an employer offsets some of it - it's beside the point. That's $12k/year that is effectively a 'health tax', it's just not called a 'tax'. Somehow, weirdly, we use the term 'benefit', without with I may more easily and quickly die or languish in pain. Some benefit ;)

But yes... if my taxes go up by $10k year, but I don't have to pay for a health insurance policy... I'm still ahead. If I pay for it all, and the employer is out of the loop, it'll feel 'wrong' to many employed folks, but the employer will have more money - they should either pay people more, or hire more people (who used to work in private insurance companies).

> Somehow, weirdly, we use the term 'benefit', without with I may more easily and quickly die or languish in pain. Some benefit ;)

Not dying or languishing in pain sounds like a pretty awesome benefit. And indeed, that’s the problem with health care: when one needs it, one will pay almost anything to the provider.

Prices are a communication: they signal customers how to ration goods, and producers how to produce them. The higher the price, the fewer the customers but the more the producers; the lower the prices, the more the customers but the fewer the producers. In a free economy, it is possible to say that the work output of one FAANG engineer is economically worth that of 5 New York City garbagemen or 10 Podunk, Idaho janitors or 35 burger-flippers.

How many rolls of toilet paper is one vial of insulin worth? Infinitely more, to someone who doesn’t need insulin. Some fraction, for someone who does. Some really small fraction, for someone who needs it right now. It doesn’t make any sense for all three of those people to pay the same price, for either the toilet paper or the insulin.

In a single-payer system, how much does the single payer pay? How much do the producers of health care (e.g., physicians, surgeons, nurses, medical researchers, pharmaceutical factories) get paid? It ends up being based on the whims of the people setting those prices (a wage is just a labour price), not on any fundamental voice of the market — and thus it is either too high, or too low, and there is no feedback mechanism to constrain it. And that means society will produce either too little or too much health care, which means it will produce too much or too little of other things.

Oh yeah, re benefit. I should have put it in "quotes" or something more to indicate the sarcasm. Gee.. what a great benefit the company provides me - thank you so much(!).

> not on any fundamental voice of the market ... > And that means society will produce either too little or too much health care

Are we producing 'too little' or 'too much' in the US right now? How would one tell?

> It doesn’t make any sense for all three of those people to pay the same price,

It doesn't many ANY sense at all? I produce an item and can make ... say, a 20% profit on it by selling at a standard price with my customer base. I could possibly make more with some form of dynamic pricing, but... to say my current approach doesn't make ANY sense seems a bit much, no?

I know that you put ‘benefit’ in quotes to indicate sarcasm. My earnest point is that you shouldn’t be sarcastic: not dying or being a pain is a real and genuine benefit. You should seriously be thankful for that benefit!

> Are we producing 'too little' or 'too much' in the US right now? How would one tell?

Probably both, in different circumstances. Not being able to tell is the key thing: without the constant negotiation of prices, there is no way to tell how much is too much or too little.

That’s why command economies fail so badly: they do things like multiply the average monthly usage of toilet paper by the population, and then issue it uniformly to everyone monthly, not realising that some people have digestive issues and use more than average, while others live remotely and need to get a season’s supply at once.

> It doesn't many ANY sense at all? I produce an item and can make ... say, a 20% profit on it by selling at a standard price with my customer base.

I don’t think so. The value of a thing to a customer, or across all customers, is not determined by its production cost. Prices have to increase as demand goes up, and have to decrease as demand goes down. That’s what keeps the guy who doesn’t need insulin from stockpiling ‘too much’ of it just in case (because the price is higher than the marginal utility he would have for it), and ensures that there is some insulin available in some store for the guy who will die without it (because the price there is high enough that some remains unsold; he may not like that high price but he is glad to have the insulin).

One more followup.

I don't think we should be organizing our society in such a way that "staying alive" is considered a "benefit" that is largely at the whim of employers who can revoke that "benefit" at any point.

The corporate world has bugged me for years with the "get a good job with good benefits!" then people somehow thinking they "deserve" those "benefits" from an employer. The employer relationship has amplified the brokenness of the insurance systems in place (however useful they may have originally been).

I've got a similar bugbear with the word "scholarship" as a shorthand for "money" when... there's usually nothing "scholarly" about it. Yes, it's typically used for attending a university with nominally scholastic aspects to it, but "getting a scholarship" because... you hit a baseball X number of times, or what not... the language bugs me more than anything (as with "benefits").

> I don't think we should be organizing our society in such a way that "staying alive" is considered a "benefit" that is largely at the whim of employers who can revoke that "benefit" at any point.

One’s employer literally pays one the money one uses to feed, clothe and shelter oneself. And — in the U.S. — often the money one uses to insure oneself against certain risks.

Employers don’t do it out of the goodness of their hearts, of course: they want one’s labour. In exactly the same sense, one doesn’t labour out of the goodness of one’s heart: one wants that money, insurance and other benefits. Likewise, the farmers who grow food, the truckers who transport it, the grocers who stock it, the tailors, the weavers, the cotton growers, the builders, the electricians, the plumbers: everyone trades what he has for what he wants more, and in every single one of those trades everyone gets better off. Your employer is richer with your work than if it just kept your salary and benefits, while at the exact same time your are richer with your salary and benefits than if you kept your work. Likewise for all the other participants in the economy.

Your proposal appears to be single-payer health insurance. If you pay doctors more than you should, your proposed economy will get more doctors and less other things than it should; if you pay them not enough, you will get a shortage of doctors and too many other things. You don’t know how much is fair to pay a doctor (neither do I). We don’t know how much is a fair price for a painkiller. None of us knows how much a heart operation should cost. None of us can make the right call for someone else when a procedure is worthwhile or not.

It's a "health tax" that's administered entirely by a private entity that you can't get rid of except by quitting your job or by spending thousands of dollars extra per month out of pocket.

I think if it's politically untenable to go single-payer then every employer must instead be required to give you a stipend every month to buy your own insurance. Then make it illegal for a company to offer insurance for their own employees. If everyone saw what it really cost and what they were really getting there would be a lot more impetus for changes.

Honestly at this point I'd be happy if employers would include on the paystub, the amount the company is actually paying for health insurance for the employee. So many people go around saying oh they have a job with great health insurance that's only $100/month.

> That's $12k/year

You dont need to pay that much. You can halve that.

https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...

Unsure what you're getting at with that list. Do you mean I can move to another country?

> Fixing healthcare costs will require a lot of people losing their job, and that wont be popular.

Agreed, but I also don't think it _has_ to be this way. First and foremost, a switch to single payer would mean that a lot of the infrastructure that's currently in medical insurance industry would need to shift towards being government employees. While there'd be massive administrative savings with single payer, there wouldn't be zero administration at all.

I'd also posture that the US would never go full single payer, and that there'd be supplemental plans similar to the German model (and Medicare, to be fair), so while private insurers would still exist, the administrative burden would significantly lower.

In the end, you'd still end up with a lot of people losing their job, but it wouldn't be a complete wipe out of the industry. Certain areas would get hit harder than others with the insurance brokers likely getting cut out big time.

> In truth I think about 20% of US workers are involved with the healthcare industry and the surrounding insurance and other supporting industries

That seems pretty high to me. I wonder what made you come up with those numbers.

To participate in an American healthcare treatment you need to interact with a private for-profit company which will shut down if it doesn't on average attain significant profitability; Let's say 30% goes to shareholders, taxes, receptionists, keeping the lights on.

But they don't deal with everything. They have to interact with upstream providers! And they have to pay somebody to negotiate with them. So another 30%, and add 5% just to pay somebody to bargain the price with the Flu Shot Distributor.

But the flu shot distributor has to interact with yet more upstream providers - the flu shot packager, who interacts with the flu shot pharmaceutical company, and the syringe company. Everybody adds their overhead and then their premium; "Price signals" become exponentially complex and more a matter of the mood of the negotiation than anything else.

This is all an externality of a non-vertically-integrated capitalist system, which is somehow, somewhy, supposed to be regulated by your desire to get a flu shot relative to your ability to pay; It is not at all optimal in the market system for everybody to get a flu shot, that defeats the fundamental mechanism of the supply-demand curve.

https://siderea.dreamwidth.org/1179450.html this essay series offers some of the better hypotheses on cost disease that I'm familiar with.