Healthcare is the US isn't about caring for the average patient; it's the largest technology arms race seen since the Cold War era, with the structures you describe incentivizing hospitals to buy as much as possible to provide the hypothetical pinnacle of care for niche scenarios.
It's poorly masked. We deserve better. We also 100% deserve this content in an industry that produces only marketing back-patting and stiff academic presentations.
"Insurers don’t have to care about acquiring you as a customer, they care about acquiring your EMPLOYER as a customer. That means insurance companies compete on price and savings, not on customer experience." This, 100%. I worked in HR for six years and every year watched my boss have to have this big meeting with our insurance company so he could argue the best deal for us. Which was always just a little bit worse than the year before.
As for the HR knowledge aspect, that's true but hopefully is getting better - at least my last year or so we were encouraged to direct employees to the insurance helpline rather than us answering questions, which sounded like a good plan on paper except they didn't know the nuances of our plan because we were just one company customer out of hundreds. So we ended up still answering a lot anyway.
Thanks for the entertaining and informative history on this!
So the point you're trying to make is that you would like to entirely remove health insurance as a benefit from Employers? At the beginning, it sounded like you were interested in an entirely free market: e.g., private insurance companies competing on price and quality directly at the consumer level and totally removing the benefit from the Employer world. At the end, the argument landed somewhere in the "Nationalized Healthcare ain't that bad" world even though "there are downsides to having nationalized healthcare".
The idea of removing health insurance as a benefit of Employers and forcing health insurance companies to compete to build their own risk-pools at the consumer level is super interesting. There would almost finally be totally free price-discovery in healthcare. But, I don't think that's what you want. It sounds like you just want a Single Payer sans Employer Plans, which would devastate things like Oscar, Iora, CityBlock, FireFly. But, perhaps we want to be Canada?
I'm interested in a more competitive pricing system - that can either come from a more free market version of healthcare with actual competition, or from more top down price setting (which has included medicare advantage FWIW, there are lots of forms of top down price setting)
All for more competitive pricing. Top down price setting scares me. Provider fee schedules everywhere are either a MedicareRatePlus for commercial plans or MedicareRateMinus for Medicaid. It's always hard for me to wrap my head around how top down price setting enables any real regional price discovery.
Beveridge has been quoted as saying, when asked how he managed to persuade the consultants to participate in the NHS, that he "had to stuff their mouths with gold". How much have times changed wonder?
Healthcare is the US isn't about caring for the average patient; it's the largest technology arms race seen since the Cold War era, with the structures you describe incentivizing hospitals to buy as much as possible to provide the hypothetical pinnacle of care for niche scenarios.
It's poorly masked. We deserve better. We also 100% deserve this content in an industry that produces only marketing back-patting and stiff academic presentations.
"Insurers don’t have to care about acquiring you as a customer, they care about acquiring your EMPLOYER as a customer. That means insurance companies compete on price and savings, not on customer experience." This, 100%. I worked in HR for six years and every year watched my boss have to have this big meeting with our insurance company so he could argue the best deal for us. Which was always just a little bit worse than the year before.
As for the HR knowledge aspect, that's true but hopefully is getting better - at least my last year or so we were encouraged to direct employees to the insurance helpline rather than us answering questions, which sounded like a good plan on paper except they didn't know the nuances of our plan because we were just one company customer out of hundreds. So we ended up still answering a lot anyway.
Thanks for the entertaining and informative history on this!
https://melanietheconstantreader.substack.com/
So the point you're trying to make is that you would like to entirely remove health insurance as a benefit from Employers? At the beginning, it sounded like you were interested in an entirely free market: e.g., private insurance companies competing on price and quality directly at the consumer level and totally removing the benefit from the Employer world. At the end, the argument landed somewhere in the "Nationalized Healthcare ain't that bad" world even though "there are downsides to having nationalized healthcare".
The idea of removing health insurance as a benefit of Employers and forcing health insurance companies to compete to build their own risk-pools at the consumer level is super interesting. There would almost finally be totally free price-discovery in healthcare. But, I don't think that's what you want. It sounds like you just want a Single Payer sans Employer Plans, which would devastate things like Oscar, Iora, CityBlock, FireFly. But, perhaps we want to be Canada?
Genuine thoughts ^ & FWIW, I just found outofpocket.health - it rocks!
I'm interested in a more competitive pricing system - that can either come from a more free market version of healthcare with actual competition, or from more top down price setting (which has included medicare advantage FWIW, there are lots of forms of top down price setting)
All for more competitive pricing. Top down price setting scares me. Provider fee schedules everywhere are either a MedicareRatePlus for commercial plans or MedicareRateMinus for Medicaid. It's always hard for me to wrap my head around how top down price setting enables any real regional price discovery.
Beveridge has been quoted as saying, when asked how he managed to persuade the consultants to participate in the NHS, that he "had to stuff their mouths with gold". How much have times changed wonder?