I smell bacon...To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
krotoole said:But let's honest: anyone want to go back to 1970s medicine?
To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
I would take this in another direction besides union-bashing: Other countries have unions, but they don't have a situation where all of your health insurance is expected to come from your employer. I would submit that this unfortunate expectation that health insurance comes from employers is a bigger problem than unions here. If the U.S. didn't have this unique and dysfunctional model of tying health insurance to full-time employment, the unions wouldn't need to demand it from employers, would they? For that reason, U.S. unions are even at a competitive disadvantage to unions in other countries where the cost of employer-provided health insurance isn't a huge additional burden to the employer that grows by 10% a year or more.To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
+1So the real problem here: Sever the link between health insurance and employment once and for all. This is really hurting our global competitiveness *and* the prosperity of our middle class, for union and non-union shops alike.
This is a lot like the battle to balance the budget -- many of us believe that we need both tax increases and spending cuts to get there, but we refuse to accept it if it raises *our* taxes or cuts *our* preferred spending programs.No, today's medicine is amazing and I don't want to go back to 1970's medicine - but what good is is today's medicine if we can't afford it and it bankrupts us?
I think the unfortunate reality is that we will need to draw lines somewhere (like the expensive cancer treatment that has been passed on by the UK).
I've felt that a lot of large mega corps with huge employee bases do a lousy job of leveraging their volumes for group rates. It is really much easier for them to simply pass on increased costs to employees vs battling the healthcare providers/drug companies to lower costs.
Also, the other area the I find annoying is the so called family plans that have the same price tags regardless of how many kids you. That just seems fundamentally unfair to me.
Most megacorps self-insure - they hire an insurance company to administer claims and pay the actual claims + an administrative fee + a stop-loss insurance policy in case experience is particularly bad that year so I'm not sure your first point is valid.
While I understand your second point it is easier administratively and the reality is that kids health care costs don't cost a lot on average so the difference probably isn't very significant and they don't have to deal with kids being added and dropped.
Self insure yes, but they still they pay the bills and with their admin company do exert leverage over the healthcare providers, much more so than the individual subscriber does.
On the second point, most of these enrollments are computerized, so not really a big admin burden. On the cost of such coverage, when my son came off my plan this year, the cobra fee was $9K for a healthy 25 yo. Seems like there is no reality in that cost.
I've don't know that I've ever seen an employer group plan that charges by age (I haven't ever been in one that did). That would tend to make COBRA a horrible deal for most younger folks, but for some 50+ folks with health issues it's probably better than you'll find on the individual market for the same level of coverage -- possibly by a considerable margin.I noticed the same thing with my cobra rates that my healthy 23 yo would cost about the same as me or DW and we are each 56 (the diff between family rate and couple rate). Doesn't make sense.
To answer the question: unions. By interfering with the free market, they brought inefficiencies, forced unsustainable benefits like universal health insurance, and made overseas labor more attractive thus chasing jobs.
That would tend to make COBRA a horrible deal for most younger folks, but for some 50+ folks with health issues it's probably better than you'll find on the individual market for the same level of coverage -- possibly by a considerable margin.
brianinsf said:While not 50 when I went off Cobra last month my conversion plan went from around $340 per month on Cobra to $660 per month on the high deductible plan or $875 for the same coverage. The conversion rate was still better than I could get on the open market thanks to pre-existing conditions.
In the UK an independent panel assesses the efficacy of treatments. So there is rationing in the UK, but not to the extent that private health insurance rations care in the US by excluding many because of pre-existing conditions.
I see no reason to couple the quality of the technology with the payment/insurance system. They are independent. Yes MRIs are expensive, but IIRC in the good old days, if you wanted to see if you were pregnant you had to kill an actual rabbit. Today you get a stick for a few bucks at Kmart.
IOW I do think many would like to go back to the insurance system of the 1970s or the 1950s. The one with fewer, cheaper liability issues.
I would take this in another direction besides union-bashing: Other countries have unions, but they don't have a situation where all of your health insurance is expected to come from your employer. I would submit that this unfortunate expectation that health insurance comes from employers is a bigger problem than unions here. If the U.S. didn't have this unique and dysfunctional model of tying health insurance to full-time employment, the unions wouldn't need to demand it from employers, would they? For that reason, U.S. unions are even at a competitive disadvantage to unions in other countries where the cost of employer-provided health insurance isn't a huge additional burden to the employer that grows by 10% a year or more.
So the real problem here: Sever the link between health insurance and employment once and for all. This is really hurting our global competitiveness *and* the prosperity of our middle class, for union and non-union shops alike.
Most countries that have universal coverage systems either are very homogeneous societies, or were very homogeneous societies when the systems were formed and voted in. Also for the large share of these European systems, well funded and well coordinated resisitance by interested parties was much less that what one finds in the US today.Establish a single payer system, eliminate the middle man (insurance companies), make sure we have reasonable liability rules, and reinvest the waste we'll recapture into something more productive.
I think so. We've become used to the distorted market conditions created by the expectation that employers provide health insurance. Other countries didn't pursue that dysfunctional model and they faced the situation you described as a result -- decades ago in most cases.Here's one more to ponder. If all companies stopped offering employer based health insurance, and you became responsible for your own, which in the current market would leave you very vulnerable should you develop "a condition". Do you think this would make a difference in the way you think insurance should be administered?
Agreed. But all the cards seemed stacked against eliminating the link. In the 2008 Presidential campaign a candidate proposed eliminating the link and got bludgeoned very effectively. No one will be repeating that mistake again soon. Also, the issue doesn't fit neatly into either party's interest list. And, I think (at least now) that a lot of employers like things just as they are. They may whine about high health costs, but the present setup lets them attract and keep employees with an incentive that the employees cannot buy for themselves as cheaply. The whacky, inefficient delivery system puts large employers at a competitive advantage.We really must sever the link between health care and employment. It may be the single most important reform we can make.
You may well be right, but I'd expect the crash to be almost immediate if costs are indeed higher as I've read. Especially sad (unnecessary?) given every other developed country has already figured out how to deliver comparable universal health care much more cost effectively than our current private system, and we could model best practices. Taiwan did so, and their admin costs are 1/3rd ours! Evidently Switzerland moved from a private system most like ours to public health care, so it can be done.The new health care law will finally break the link between employers and health care. They'll drop employees and pay the cheaper fine, and pay the employees more if necessary to keep them. The employee will, if qualified by income, then turn around and get the "free" government subsidy. It will cost more than what is being done today, but at least people will be buying policies individually. When the system crashes we'll have established that precedent and we can pick up the pieces and build a rational system.