> Yes, we pay more per-capita for our public healthcare system than some countries do for universal coverage, but we don’t cover everyone. Just for the public parts.
> Once you actually tally up how many people are having their healthcare paid for by public dollars—local, state, and federal workers plus retired; the military, active and retired; Medicare (old people); Medicaid (poor and disabled); CHIP (poor kids); the families of some of those categories; et c—it’s really not the case that moving to entirely public-funded would even be as big a leap as one might suppose. A whole lot of people already have government-funded healthcare.
Government funded but it's not a social safety net or mandate in a conventionally sense: it's an insurance subsidy. It effectively incentivizes depressing your own personal income to achieve high-subsidy plans (namely, the silver plan in most if not all states) resulting in abnormally high subsidies. It's just a form of tax planning today. See people taking "early retirement" with substantial assets (>1mm, which isn't much for HN but substantial in much of the country) at 40, reducing disbursements, and effectively costing the taxpayer ~36k/year in subsidies.
In an idea world, your assets would be subject to seizure under means testing on assets, not just income, before subsidies are provided. Seriously, go check out reddit /r/fire. They talk about it (and how a reduction in ACA subsidies in 2025 will force them out of retirement at the advanced age of 45).
> What we really lack, that every single other OECD state I’ve looked at has as a feature of their healthcare systems, is more-aggressive price controls, either set directly or via partial or complete monopsony. We’ve sniffed around at it, but never taken a full bite.
I'm going to be real: this is just wrong. Price controls only works in two circumstances:
* You are willing to tolerate reduced availability of goods and services
* You are actively willing to prohibit others from purchasing goods and services with their own money
1 is complete anathema to the US consumer market. If price controls were to be implemented, the elderly would likely get care first, which is unlikely to yield practically the needed result relative to current costs curves -- keeping the working population working with preventative and minimizing the cost on the elder bracket. In my opinion, this mispricing is in part due to the ACA, but that's neither here nor there.
2 would require Norway style controls of Ozembic and similar. I don't think Americans would ever tolerate "your money, you aren't allowed to buy it". Prices are high because Americans can pay in dollars more than other nations and are willing to do so.
There is a very real perception that medicine can fix poor health choices and we should spend arbitrarily large amounts of money to fix it. It's a fantastic business to be in -- people insist "healthcare is a human right" and are willing to tax others to pay it.
Yes, because the US is currently experiencing an adverse selection bias where healthy avoid enrolling until an issue occurs. See this: https://www.aeaweb.org/articles?id=10.1257/app.20170117
> Once you actually tally up how many people are having their healthcare paid for by public dollars—local, state, and federal workers plus retired; the military, active and retired; Medicare (old people); Medicaid (poor and disabled); CHIP (poor kids); the families of some of those categories; et c—it’s really not the case that moving to entirely public-funded would even be as big a leap as one might suppose. A whole lot of people already have government-funded healthcare.
Government funded but it's not a social safety net or mandate in a conventionally sense: it's an insurance subsidy. It effectively incentivizes depressing your own personal income to achieve high-subsidy plans (namely, the silver plan in most if not all states) resulting in abnormally high subsidies. It's just a form of tax planning today. See people taking "early retirement" with substantial assets (>1mm, which isn't much for HN but substantial in much of the country) at 40, reducing disbursements, and effectively costing the taxpayer ~36k/year in subsidies.
In an idea world, your assets would be subject to seizure under means testing on assets, not just income, before subsidies are provided. Seriously, go check out reddit /r/fire. They talk about it (and how a reduction in ACA subsidies in 2025 will force them out of retirement at the advanced age of 45).
> What we really lack, that every single other OECD state I’ve looked at has as a feature of their healthcare systems, is more-aggressive price controls, either set directly or via partial or complete monopsony. We’ve sniffed around at it, but never taken a full bite.
I'm going to be real: this is just wrong. Price controls only works in two circumstances:
* You are willing to tolerate reduced availability of goods and services * You are actively willing to prohibit others from purchasing goods and services with their own money
1 is complete anathema to the US consumer market. If price controls were to be implemented, the elderly would likely get care first, which is unlikely to yield practically the needed result relative to current costs curves -- keeping the working population working with preventative and minimizing the cost on the elder bracket. In my opinion, this mispricing is in part due to the ACA, but that's neither here nor there.
2 would require Norway style controls of Ozembic and similar. I don't think Americans would ever tolerate "your money, you aren't allowed to buy it". Prices are high because Americans can pay in dollars more than other nations and are willing to do so.
There is a very real perception that medicine can fix poor health choices and we should spend arbitrarily large amounts of money to fix it. It's a fantastic business to be in -- people insist "healthcare is a human right" and are willing to tax others to pay it.