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Old 11-07-2011, 01:18 PM
stephanie stephanie is offline
Join Date: Dec 2007
Posts: 3,921
Default Re: Where Fun Goes To Die (Harold Pollack & Donald H. Taylor)

Originally Posted by Don Zeko View Post
I think it's worth teasing out what the problems with the health care system are in order to evaluate whether the employer-based model is exacerbating them or not.
Good idea.

Problems with the health care system include:

(1) severe inequalities -- this is probably aggravated in some ways by handling it through the employer-based system, although it is in other ways better than a pure free market system (which I don't think anyone involved in this discussion is proposing).

(2) Extra costs due to handling it through insurance companies -- a feature of the employer-based system, and would remain a feature of a free market system.

(3) People are insulated from the costs of services and there is no incentive to negotiate -- this is aggravated by the employer-based system, however, I don't think the free market system is the panacea that supporters think it would be, for reasons I've gone on and on about in the past and referenced in passing above. I would also note that part of the issue here is that we aren't directly facing the question of how much health care choices should be based on cost -- dealing with it through the employer-based system and not a national single-payer system is part of the reason we aren't.

Other concerns directly related to employer-based include the fact that locks people into jobs (prevents mobility and especially entrepreneurship), it places an extra burden on employers that employers in other countries don't have and which the employers may not be the best suited to consider and it means that employers have a lot less freedom to pay people based on what they contribute, as a large part of the cost per employee is based on fixed health care costs (which may be arbitrarily higher or lower depending on whether the employee is covered from some other source or the size of the employee's family). Costs also vary a lot as pools vary depending on the size of the employer.

So we have one big problem, cost inflation, which I think is fair to partially blame the employer model for. Then you have other problems that aren't the biggest deficiencies of the system, but are pretty unambiguously caused by the employer model, like the "job-lock" phenomenon where people are engaging in less-than-optimal career decisions simply to maintain health insurance coverage.
Yes. Cost inflation can be attacked through a free market approach, which I don't think would work in reality or exist even without the employer model, as we'd still have a mostly insurance-based system, but which would likely have some effect. Or it can be attacked as in other countries, by the power of the payer (gov't) to negotiate.

But then you have other problems that the employer model ameliorates, most notably the adverse selection death spiral. But here I'm circling back to my original point, and the fact that we don't actually disagree on anything here. I just want to make sure that we don't lose sight of the benefits that do stem from the employer-based system, even though I certainly agree that there are far better ways to get around the problems of the health insurance market.
Yeah, I'm still confused what we are disagreeing about, as I obviously wasn't saying we should go to the free market. I was pointing out that the popularity of the employer-based system (despite wonks on the right and left attacking it) demonstrates that the idea that people don't like the interference with the free market is false. Why people freak about changing from the current model to single-payer (or a more regulated version of the current model) is not the rightwing spin about that, it's because people who benefit from the current system because of the difference between it and what they'd get in an unregulated free market believe they may lose some of their benefits. It's essentially another version of "gov't hands off my Medicare." It's also why it's such a hard political problem and why the reaction was what it was, and that was predictable. Single payer would almost certainly be easier to adjust to EXCEPT for the costs incurred by those who work in the insurance industry.

Last edited by stephanie; 11-07-2011 at 01:21 PM..
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