If an affordable or free healthcare option was offered on top of making employer provided healthcare illegal, then I completely am behind your idea.
Look at how these systems work in other countries
It's already a bunch of private companies.
> These private companies would drive up the cost even more.
Other way around - by having to actually directly compete for customers, instead of just having to convince a few large corporation prices would go down, not up.
Although we really should not ignore that insurance companies are not the drivers of higher costs, it's health care providers that do that.
It's enjoyable to blame insurance companies, but the reality is their profits are capped by law - they are not the problem. Dr.'s will have to take a pay cut, and there will have to be mass layoffs, there's no other way to reduce costs.
What a delightfully naive view.
Answer me two simple questions:
1) How are insurance companies profits capped?
2) How does increasing or decreasing costs affect thier allowable profits?
Health insurance profits are capped only as a percentage of premiums collected, not a fixed dollar amount cap. The rule is you must pay out 80% of premiums collected, everything else is OH&P.
Turns out, if healthcare costs go up, then premiums go up. If premiums go up, then insurer profits go up.
Healthcare providers and health insurers have an aligned perverse incentive to have healthcare cost as much as possible, since that is what increases their profits.
This isn’t a hard relationship to uncover if you are familiar with the insurer profit cap portion of the ACA and also how money gets made.
2: Costs change nothing. But increased health care expenses do allow them to earn more (the 20).
OK, I can agree with that - but it doesn't change my point that cost reductions need to start with providers, NOT with insurance companies.
The gigantic UPMC is a non profit. Actually a TON of hospitals are non profits - every religious founded hospital is a non profit (Maimonides Medical Center, or every Mercy Hospital (Wikipedia counts 33 of them)).
60% of hospitals are non-profit.
I have a bridge to sell you.
If I am sick I can just get an appointment with my GP within the day and not pay a thing, they can refer me to specialists or blood tests if needed, which are also fast and free. The remaining healthcare costs for medications or dentistry are so low I don't even notice them.
Hope this will shed some light to you about what's happening in other countries.
> Funding for all short-term health care is 50% from employers, 45% from the insured person and 5% by the government.
…
> Premiums paid by the insured are, on average, €137 per month for basic health care
- https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands
Only an order of magnitude if you're in base-2.
That said, this doesn't quite track with the numbers for
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
and
https://en.wikipedia.org/wiki/International_dollar
But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier.
I'm not complaining since, first, this is a political decision and second, the level of service is outstanding.
For example: psychotherapy is paid for or, if your doc orders an MRI you get an appointment after tomorrow.
There's also no such shit as in network health providers (exceptions apply for some insurance models) or pre-existing conditions for the basic health plan (which is still pretty good and comprehensive).
While I do think that it's an overall good system it is expensive (and subsidized for people who can't afford it).
Also, health insurance is mandatory.
A typical family premium (two adults in their 40s and two children under 10) can vary from £700 to £1,800 a year.
The average price of a private healthcare policy in the UK is £1,032.84 per year (February 2022)
Google results ...
I did use the word "taxpayer". The UK's health service costs £2700 per head of population. Obviously what people contribute towards that varies.
Also my question remains unanswered. Is the Dutch health system topped up by government funding?
Nope. Look at how much the Netherlands actually spends on Healthcare, it's about 11.2% of GDP in 2021 [1]. Per capita GDP in 2021 was ~53k€.
((53k€*11.2%)/12) ≈ 495€
Only problem is, like most developed countries, close to a majority of people are net recipients (around 40%). Someone will have to pay their share too. Chances are, if you're posting on HN, that's you, as you'll be somewhere in the top 5% income bracket. I think if the OP does the math based on their actual numbers, they'd be more likely to find themselves in the ~1000€/month ballpark than the 150€/month they seem to think they are paying.
> But even then, counting all payers and not just the residents' sticker price, the USA is the high-priced outlier.
The Netherlands (11% of GDP) is not quite as extreme as the US (17%), but it's certainly nothing to write home about, especially as I don't get the impression that either health care expenditure as percentage of GDP or demographics are moving in a favorable direction.
[1] https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2...
Insurance companies are incentivised, under law, to have the highest healthcare expenses possible.
This is backwards logic. Those few large corporations have the bargaining power to negotiate lower premiums. Individual consumers have zero bargaining power.
What's the difference between my first and my second? I don't know. If you force me to guess, post-retirement and/or terminal care, possibly?
> like most developed countries, close to a majority of people are net recipients (around 40%)
Yes, and? Isn't much the same also true for private insurance?
You've got the potential for arguing about what "fair" looks like; I'm fine with it being funded like a progressive tax, based on income rather than risk factors, but that's not hugely important.
> I think if the OP does the math based on their actual numbers, they'd be more likely to find themselves in the ~1000€/month ballpark than the 150€/month they seem to think they are paying.
I would assume that zer0tonin pays whatever they say they pay. They're likely to have better insight into their own finances than random internet strangers like thee and me.
> The Netherlands (11% of GDP) is not quite as extreme as the US (17%), but it's certainly nothing to write home about, especially as I don't get the impression that either health care expenditure as percentage of GDP or demographics are moving in a favorable direction.
The direction of movement may or may not be favourable (given the pandemic I assume "not"), but the USA is kinda the outlier in developed nations for spending a lot without delivering particularly good outcomes:
https://commons.wikimedia.org/wiki/File:Life_expectancy_vs_h...
(Sourced from: https://ourworldindata.org/us-life-expectancy-low)
On the other hand individual consumers have ALL the bargaining power - they can simply pick a different insurance company, and insurance companies have to work very very very hard to get customers. They would compete on price because that's by far the most important thing to a consumer.
A company on the other hand cares about other stuff, how integrated in the system, how easy can we import members, manage members, how much marketing material do they give? Do we have to educate our employees, or will the insurance company do that for us?
Just tons of other stuff that isn't price. Individuals: It's 99% price.
Yes, that is true. But it doesn't change the fact that prices will have to change at the healthcare providers. Dr.s will earn less, people will be fired as positions are eliminated. There's no other way to reduce prices.
Where do you think all that "incentivized" money is going? It's going to people in healthcare will either take a pay-cut or will lose their jobs.
Are you hoping for non-profit drug and equipment makers as well? How far do you need this "non-profit" thing to go before you acknowledge it doesn't help at all?
I can acknowledge that it not just helps but that it is far more functional than the US system I've had to suffer through for many years. In addition to years of experience with the US and NHS, I also have many years of experience with Italian national healthcare which is also non-profit and better than the US system.
The US system is better for some diseases but only if you are rich. And an absolute failure if you aren't employed. Even if you can manage to stay employed with a serious illness you better have a healthy family member with a lot of energy who can fight the insurance company that really doesn't want the cost and burden of you and will make that clear in every action.
How far do you need this "for profit" thing to go before you acknowledge its very serious flaws and inadequacies?
This combo (system as you like to call it, although that leaves out a ton of stuff) also exists in the US as a non-profit. I said this already.
It doesn't help
What will help is doctors taking a paycut and mass layoffs.
The problems in the US are not on the payment side, they are on the service side: it's simply too expensive.
We need twice as many doctors, working half as many hours, for half as much pay.
That's what would fix the US.
I'm writing this from the UK where I use the NHS. I've also used the US system extensively and the Italian healthcare system extensively.
You need to get basic facts right if you want to be a part of the debate.
