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.
really it could not be because government is bad at managing massive programs and provides no incentive for high performance and efficiency....
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.
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.
The question then is why was it more expensive then? I've not seen much on that.
Not to mention, the entire point of insurance is to provide that overhead. They want to deny coverage, obviously, so they're going to waste doctor's time on peer-to-peer and force their own customers to aggressively advocate for their own care. It's a huge waste of time for everyone involved, but the insurance company wants that waste of time, that's what they're optimizing for. They've gotten really good at both calling all the shots and wasting time.
Your doctor is more or less a vessel for the insurance company. The insurance company is your doctor: they decide how long visits are, what you can visit for, what medications you can take, which procedures you can get, when you can get those procedures, how much they will cost, and how you will have to pay. Your doctor gets a tiny bit of freedom. Maybe they can prescribe you a medicine out of, like, 3 predetermined choices. After, of course, you've completed all the testing. And after you've tried medicines A through C. And after you've been monitored for whatever time period the insurance decides.
Yes, that's all very expensive.
ie the relative price of a new car versus a heart transplant is going to continually drop such that we spend more and more as a percentage of GDP on things like health ( and social ) care.
So it's not sure much that health care has become more expensive, as much as relatively more expensive.
The other strong effect is nobodies life is saved, death is simply delayed, and the older you get the more problems you have.
So as well as historically being relatively resistent to automation, success breeds more need.
While there are some centralized decisions ( we are paying only for one round of IVF, or this drug isn't good value for money ), most of it is delegated to front line doctors - by the simple mechanism of faced with a fixed time/budget they triage based on medical need.
Note that the UK system is actually a rather odd hybrid of public and private due to historic reasons. It's quite easy to queue jump the waiting for an initial consultant by going private, and then be referred back to the public system for treatment.
There are incentives for high performance and efficiency. GPs are private partnerships contracted to treat patients. They can keep profits.
There's been attempts to do more private outsourcing (with the NHS still paying), but they tend to work out less efficient when you consider the whole system, because, for example they might only treat the easy cases and leave the hard ones to the normal hospitals.
But tax deduction or not isn’t what makes individual health insurance so expensive. When you have employer provided health insurance you’re in a completely different risk pool than people buying on the open market.
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.
>profit caps
We have profit caps on health insurance. It has many downsides though. The first is that it removes incentives for health insurers to reduce healthcare costs. It actually incentives them to want higher healthcare costs because 15% of a bigger number is more money.
Second, it incentives things like spinning out your insurance division into separate company and then buying an urgent care clinic to run as a sibling company to the insurance company.
Then when the insurance company spends their required 85% on healthcare costs, they just make sure a big chunk of that is spent on services from the sibling provider company.
United Healthcare does exactly this.
Of course functional regulators could stop this, but it’s hard and they don’t. Which is why I think offering a public instead of some of these direct regulations of private companies might work better.
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).
The fact that they are not tells me there must be some other financial incentives at work that are unclear to me.
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.
That’s because before Obama picked it up, it was the Republican free market compromise plan in the face of a growing for socialized healthcare.
And now the Republican Party has been taken over by Trump. To the extent any political party has real principles they have given up theirs completely. Their principles are whatever Trump says they are this week.
So the question is “why hasn’t Trump pushed for separating healthcare from employment?” And the answer to that could be as simple as because he doesn’t think it’s exciting enough.