But beyond me, the fact that someone working minimum wage, unemployed, or at a startup using the Obamacare exchange pays more than an executive at a fortune 500 makes no rational sense. That's because the market has been silo-ed by employer instead of each individual insured.
The US would be in a much better state if everyone had to get their insurance from the exchange. One of the two political parties is constantly drumming the "competition" drum as a magical solution, but they're too scared to actually make the market competitive.
- Give everyone in the US a HSA (health savings account).
- Increase HSA contribution maximums significantly ($20K/year or more)
- Allow employers to give money, tax free, to employees via their HSA
- Allow employees to pay their insurance premiums via the HSA
- Ban employers from directly picking the employee's insurance or providing the insurance
- Employees (and everyone else) would pick insurance from the health insurance marketplace
- Medicaid would pay 100% of premiums, but Medicaid recipients still pick their own insurance
- The VA would move to a mixed model, help pay for regular insurance (via the HSA), and offer bespoke services specific to former enlisted personnel. Most common services would be received at regular healthcare providers, not VA hospitals.
Now instead of employers paying $1000/month for your health insurance they put that $1000 into your HSA, you then go onto the health insurance marketplace find insurance, and use your HSA to pay your premiums. Don't like your insurance company? Change. This is how you spurn competition.
Additionally if your employer doesn't help you with health benefits, you can contribute to your HSA yourself tax free and you won't be further punished (i.e. pay the same overall premium, with same tax benefits, as someone with a better employer, unlike now).
What you're describing is more open capitalism in health care where everyone is on an open playing field. I use to really believe in this at one point years ago, even when working in Health Insurance.
Today, I'm not even for this compromise. I think it should be taken out of our taxes in single payer. Insurance would still be contracted out to those private insurers (cause America). We might even be able to create a system where people chose which insurance provider they use, but it should be payed for by taxes .. it's there for everyone and everyone pays the same proportion of income and everyone gets the same level of coverage. If something is in short supply, then it's going to need a needs based + lottery system (just like organ transplants currently).
For profit and _non-for-profit_ (not to be confused with non-profits; most health care companies are non-for-profits which is a weird legal area) have no place when it comes to public welfare services. People don't pay individually for private security/police. We don't pay for fire. We don't pay a fee to visit a city park (and I'm against fee based national parks actually). The general good should be paid for equally by everyone to their abilities.
Sure they do. Rich people hire private security all the time. Heck, not-rich people do it too. Like your local Chuck E Cheese who hires a security guard on Friday night.
Same with fire protection. There are plenty of private fire protection companies.
Everyone gets those basic services paid for out of their taxes, but some people want more than basic service, and there is nothing wrong with that.
The OPs system would work great and you could modify it simply enough to account for your system too -- everyone pays a health tax, which is then redistributed as an HSA payment to every American, setting a base level of funding.
I'm actually a big fan of single payer, but not because of the social impacts, only because of the ease of administration aspects. But if you did OPs system and made sure everyone could participate, it would probably work just as well, because there would need to basically be a health payment cleaning house to make it work.
People need the health care that they need. Unless we're talking about small things like your own private bed in a hospital, there's no room in a just society for a "basic service" which does not provide the best possible care.
Unfortunately health care is still a finite resource, and you can't give everyone the best care. You either give some the best care and everyone else good care, or you give everyone pretty good care, but no one gets the best care.
Each has its merits, but my personal feeling is if no one gets "the best care", then we as a society will forget how to give such care, and medical innovation will become stagnant.
There is a reason that the health systems with at least some private participation (USA, France, Germany) also have the most innovation. We need a balance so there can still be a motive for innovation.
It's considered fair exactly the for reasons you have mentioned: you pay more for a premium product.
> there's no room in a just society for a "basic service" which does not provide the best possible care.
A regulated market that denies individual differences and enforces the same salary for different talents is incompatible with a "just society". In this case, healthcare workers with above-average talent would emigrate to a country where they can get a fair salary.
If you are worried about fairness, please consider the other side, the healthcare professional who provides the service.
Patients who pay basic fees are not entitled for the "best possible care". The provider of the "best possible care" can raise the price anytime. There is no economic justification for price rigging.
Gross.
Is it unfair because it’s health care specifically or because of something else? Premium service offerings abound: priority mail delivery; first class passage; reddit gold; ongoing memberships or subscriptions to movie theaters, golf courses, publications, and podcasts; “freemium” model web services, and Amazon Prime.
… there's no room in a just society for a "basic service" which does not provide the best possible care.
Basic service and best possible care are at different ends of the spectrum for whatever good or service we’re talking about. What did you mean by this remark?
It's also a huge reason people don't want transparent health records, even in the cases where it would help automate discovery and prevention of disease.
I don't think state-based healthcare is the correct abstraction either. It involves dealing with a central organization that is too big to fail. What happens when they screw something up? What do corrupt regulations look like when lives are at stake?
If you take health care has a right (art. 25 of the Universal Declaration of Human Rights does), then there is a simple solution for the above, known as single payer. Of course, it won't work in the US, because it isn't as biased against the poor as the "free market" health care.
Medicare for all is the only sense making option, truly. Insurance doesn't make sense in the context of healthcare.
Everything else is just a half measure. Healthcare makes zero sense as a market; it is completely busted.
It's insane when you think about it from a people/citizen or a rational point of you. It's great if you are a large company because you get tremendous tax breaks for providing healthcare options and of course it heavily ties down an employee to the company.
It's why companies love H1B visas. It ties employees to the company else they get deported.
In the US, our system is so geared to capital and companies that such nonsense is allowed. Anything that gives an advantage to corporations, owners, business.
If you or a dependent take a very specific expensive medication that isn't covered by a plan a new employer might offer, then you pretty much can't take that job unless you want to pay out of pocket.
Employers can change the plans they offer every year as well, so really even at the same company you might face the same dilemma at the next open enrollment.