What would happen if we all had AFFORDABLE portable Health Benefits?

[Lmoot]

I've just been stewing in my head, coming up with theories of the effect of decoupling health benefits from employer-employee relationships. My main theory in regards to the affect on job market:

1) People who can afford to live on part-time income (or like me, would prefer to work 2 part time jobs for flexibility and variety) but are working full-time for the purpose of health benefits, could leave their full time jobs or downshift their hours.

2) People who need or want full-time jobs, will have more opportunities at the jobs left behind by those who fit #1 above.

3) Full-time/ part-time rules and legislation would be greatly reduced, so employers and employees would have more control on the work-life balance needs of both the company and its employees.

What other things (positive or negative) do you think might happen?

[rab-bit]

It might help smaller employers who can't afford to offer health insurance.

[ctuser1]

There will be a lot more startups formed in the US. US may even become as innovative as it was before Reagan.

I did not pursue one such opportunity back in 2007 - because wifey got pregnant almost at the same time and I simply could not risk health insurance.

It might have worked for me, or might not have. But what I *do* know is that if 100 such other people like me tried, and 20 succeeded, that would have been many more new jobs for the US.

[John Galt incarnate!]

I've just been stewing in my head, coming up with theories of the effect of decoupling health benefits from employer-employee relationships. My main theory in regards to the affect on job market:

1) People who can afford to live on part-time income (or like me, would prefer to work 2 part time jobs for flexibility and variety) but are working full-time for the purpose of health benefits, could leave their full time jobs or downshift their hours.

2) People who need or want full-time jobs, will have more opportunities at the jobs left behind by those who fit #1 above.

3) Full-time/ part-time rules and legislation would be greatly reduced, so employers and employees would have more control on the work-life balance needs of both the company and its employees.

What other things (positive or negative) do you think might happen?

I too have ruminated about  portable health insurance.

At the minutest microeconomic level of a single employee the salient benefits of portable health insurance would be increases in output and its quality as the employee would have the option of leaving employment  they  stayed with mostly for its health insurance for employment that better suited them.

Would there be a measurable increase in aggregate output and its quality?

I'd like to know.

[John Galt incarnate!]

There will be a lot more startups formed in the US. US may even become as innovative as it was before Reagan.

I did not pursue one such opportunity back in 2007 - because wifey got pregnant almost at the same time and I simply could not risk health insurance.

It might have worked for me, or might not have. But what I *do* know is that if 100 such other people like me tried, and 20 succeeded, that would have been many more new jobs for the US.

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

[Cpa Cat]

I assumed that a country with universal healthcare would have a lower retirement age, but Googling determined this is not the case.

Canada, which has universal healthcare and therefore should theoretically eliminate this idea of working just for health insurance, has an average retirement age of 63.5 years.

The United States has an average retirement age of 59.88.

Canadians are (statistically-speaking) healthier and live longer than Americans, so this likely impacts their retirement age and causes them to work longer.

[ctuser1]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

I thought that is what my post above implied. Or did I communicate/imply the opposite without realizing it?

[Metalcat]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

Is this an observable effect in the many many countries where healthcare isn't tied to employers?

[Wrenchturner]

I assumed that a country with universal healthcare would have a lower retirement age, but Googling determined this is not the case.

Canada, which has universal healthcare and therefore should theoretically eliminate this idea of working just for health insurance, has an average retirement age of 63.5 years.

The United States has an average retirement age of 59.88.

Canadians are (statistically-speaking) healthier and live longer than Americans, so this likely impacts their retirement age and causes them to work longer.

Not sure I'm fully understanding you; are you saying the higher taxes to produce universal healthcare results in both better health and longer working lives?  Seems plausible.

[John Galt incarnate!]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

I thought that is what my post above implied. Or did I communicate/imply the opposite without realizing it?

No, I did not misconstrue your post.

Perhaps my post was a somewhat oblique concurrence.

Be that as it may, your personal experience precisely makes the case for the enhanced economic efficiency of portable health insurance.

[ctuser1]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

Is this an observable effect in the many many countries where healthcare isn't tied to employers?

The innovation/entrepreneurship part of it is observable by the number of startups per year! They have fallen a lot in the US.

Article on startup formation in US: https://www.washingtonpost.com/opinions/why-is-the-number-of-us-start-ups-falling/2016/05/19/53fe8e04-1ded-11e6-9c81-4be1c14fb8c8_story.html

No similar drops are visible in countries with socialized healthcare.

I was not able to find some article about a peer reviewed study that I remember reading: it cited healthcare as one of the many potential causes (without establishing a strong causal relationship). I was drawing that connection based on my personal experience and because it seems common sense to me.

I don't know any such research comparing economic efficiency. It is a nebulous concept - so may be difficult to properly control/study.

[Metalcat]

I assumed that a country with universal healthcare would have a lower retirement age, but Googling determined this is not the case.

Canada, which has universal healthcare and therefore should theoretically eliminate this idea of working just for health insurance, has an average retirement age of 63.5 years.

The United States has an average retirement age of 59.88.

Canadians are (statistically-speaking) healthier and live longer than Americans, so this likely impacts their retirement age and causes them to work longer.

Not sure I'm fully understanding you; are you saying the higher taxes to produce universal healthcare results in both better health and longer working lives?  Seems plausible.

It might also be a lot easier to work longer when you have much more career flexibility?

[John Galt incarnate!]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

Is this an observable effect in the many many countries where healthcare isn't tied to employers?

Given your work in  healthcare, and your typically trenchant  posts, I think you are supremely qualified to answer your question.

[Metalcat]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

Is this an observable effect in the many many countries where healthcare isn't tied to employers?

Given your work in  healthcare, and your typically trenchant  posts, I think you are supremely qualified to answer your question.

...not really.

I know so little about the US that it's very hard for me to make a comment of comparison.

I was really surprised when I learned that healthcare could have such an affect on people's career decisions in the US.
That sounds really suboptimal. I honestly can't even fathom it.

That said, I also grew up in the 90s when the "brain drain" of Canadian talent to the US was such a huge concern, so I always conceptualized the US as so much more industrious.

In the medical world, the US is seen as the land of big bucks and huge hassles.

[Lmoot]

I assumed that a country with universal healthcare would have a lower retirement age, but Googling determined this is not the case.

Canada, which has universal healthcare and therefore should theoretically eliminate this idea of working just for health insurance, has an average retirement age of 63.5 years.

The United States has an average retirement age of 59.88.

Canadians are (statistically-speaking) healthier and live longer than Americans, so this likely impacts their retirement age and causes them to work longer.

 Interesting. I wonder if it could be because they choose to work for longer since they are not counting the days to retirement, staying at a job they don’t like because health insurance would be unaffordable at their advanced age. I don’t know the statistics of this, but if they are in fact a healthier population, then maybe they have less or more delayed age- related health issues that make it difficult to work.

 As long as I enjoy my job, I don’t want to retire early. I would slow down drastically  Or change careers. Or work intermittently. That’s what I want to do now, but leaving benefits on the table is scary because of the way the government has caused us to rely on our employer not just for our wages, but for many other aspects of a healthy and dignified way of life. So if we want to work less, we are punished for it beyond our willingness to earn less income.  This all or nothing approach is so counterintuitive. Those that work full-time and can afford healthcare more likely, get it paid for or reduced. Those that don’t work full-time, maybe don’t qualify for subsidies, can’t afford it, and because they are not putting in 40 hours a week don’t get assistance.

Access to affordable healthcare should not depend on who you work for. Access to affordable healthcare should not depend on how many hours per week you want or can work. Access to affordable healthcare should not depend on whether or not you are not working, either on purpose or beyond your control. Access to affordable healthcare should not be available only under the stigma of a government hand-out (how demoralizing). Access to healthcare, which includes affordability in my opinion, should be an equal right. People should not have such drastic variances in what they pay (from person to person,  but also when circumstances change for an individual) because of something so obscure As who their employer is and what they do for work.

[bacchi]

Those that work full-time and can afford healthcare more likely, get it paid for or reduced. Those that don’t work full-time, maybe don’t qualify for subsidies, can’t afford it, and because they are not putting in 40 hours a week don’t get assistance.

Besides those in small businesses, contractors working on W2 ("employee" work status) can work full time but can't deduct health insurance premiums (well, they can, but only as an itemized deduction). I declined numerous contracting jobs because the agency wouldn't budge on W2 status.

Access to affordable healthcare should not depend on who you work for. Access to affordable healthcare should not depend on how many hours per week you want or can work. Access to affordable healthcare should not depend on whether or not you are not working, either on purpose or beyond your control. Access to affordable healthcare should not be available only under the stigma of a government hand-out (how demoralizing). Access to healthcare, which includes affordability in my opinion, should be an equal right. People should not have such drastic variances in what they pay (from person to person,  but also when circumstances change for an individual) because of something so obscure As who their employer is and what they do for work.

Word.

[Wrenchturner]

Interesting. I wonder if it could be because they choose to work for longer since they are not counting the days to retirement, staying at a job they don’t like because health insurance would be unaffordable at their advanced age. I don’t know the statistics of this, but if they are in fact a healthier population, then maybe they have less or more delayed age- related health issues that make it difficult to work.

I think it's because they are forced to pay "insurance" for their healthcare through taxes.  Not sure why Canadians are generally healthier, I doubt it has much to do with access to medical care since most health burdens these days are from lifestyle sources.  There does seem to be less severe poverty in Canada which would improve lifestyle-type health; less smokers, less obesity, less drug addiction.  Just a hunch.  My anecdotal experience is that the Canadian workforce is pessimistic and unambitious, but it's a chicken-egg situation.

Access to affordable healthcare should not depend on who you work for. Access to affordable healthcare should not depend on how many hours per week you want or can work. Access to affordable healthcare should not depend on whether or not you are not working, either on purpose or beyond your control. Access to affordable healthcare should not be available only under the stigma of a government hand-out (how demoralizing). Access to healthcare, which includes affordability in my opinion, should be an equal right. People should not have such drastic variances in what they pay (from person to person,  but also when circumstances change for an individual) because of something so obscure As who their employer is and what they do for work.

"Should" is not a driver for public policy.  Laws are written based on compromises.  There is a downside and moral hazard to your "should"s.  One example, wait times:

The image is a chart of wait times, in days, for MRIs in Alberta.  You can see the percentiles and their time frames and it's not great.  As I've said elsewhere, universal health care might produce a higher MEAN but no one wants to volunteer to be on the receiving end of triage.  I have yet to hear a good response for this specific point.  The reality is, there are only five MRI machines per million people in Canada, and 30 per million in the US, from data from 2004.  Who gets an MRI?  Not everybody!  Who decides who gets an MRI?  A lottery?  A business transaction?  We need a solution that doesn't depend on a "should".

Another point on MRI wait times:

Major findings from The Value of Radiology, Part II report (June 2019):

Approximately 5 per cent of CT and MRI patients, or 380,000 people a year, are forced to exit the workforce temporarily while they wait longer than the recommended maximum wait time.
Having workers off the job while waiting for diagnostics hurts the ability of firms to produce goods and services. This, in turn, hurts GDP, reducing government revenues by $430 million a year.
The cost of excessive wait times will likely increase. Growth in demand for CT and MRI services is expected to outpace the growth in supply over the long term.

https://www.globenewswire.com/news-release/2019/06/25/1873889/0/en/Radiology-wait-times-impacting-Canadians-in-more-ways-than-one.html

You can say the Conference Board of Canada is biased but the analysis comes from a report commissioned by the Canadian Association of Radiologists.

Oftentimes, losses like this are invisible and it makes the argument more difficult.

[Lmoot]

Interesting. I wonder if it could be because they choose to work for longer since they are not counting the days to retirement, staying at a job they don’t like because health insurance would be unaffordable at their advanced age. I don’t know the statistics of this, but if they are in fact a healthier population, then maybe they have less or more delayed age- related health issues that make it difficult to work.

I think it's because they are forced to pay "insurance" for their healthcare through taxes.  Not sure why Canadians are generally healthier, I doubt it has much to do with access to medical care since most health burdens these days are from lifestyle sources.  There does seem to be less severe poverty in Canada which would improve lifestyle-type health; less smokers, less obesity, less drug addiction.  Just a hunch.  My anecdotal experience is that the Canadian workforce is pessimistic and unambitious, but it's a chicken-egg situation.

Access to affordable healthcare should not depend on who you work for. Access to affordable healthcare should not depend on how many hours per week you want or can work. Access to affordable healthcare should not depend on whether or not you are not working, either on purpose or beyond your control. Access to affordable healthcare should not be available only under the stigma of a government hand-out (how demoralizing). Access to healthcare, which includes affordability in my opinion, should be an equal right. People should not have such drastic variances in what they pay (from person to person,  but also when circumstances change for an individual) because of something so obscure As who their employer is and what they do for work.

"Should" is not a driver for public policy.  Laws are written based on compromises.  There is a downside and moral hazard to your "should"s.  One example, wait times:

The image is a chart of wait times, in days, for MRIs in Alberta.  You can see the percentiles and their time frames and it's not great.  As I've said elsewhere, universal health care might produce a higher MEAN but no one wants to volunteer to be on the receiving end of triage.  I have yet to hear a good response for this specific point.  The reality is, there are only five MRI machines per million people in Canada, and 30 per million in the US, from data from 2004.  Who gets an MRI?  Not everybody!  Who decides who gets an MRI?  A lottery?  A business transaction?  We need a solution that doesn't depend on a "should".

Another point on MRI wait times:

Major findings from The Value of Radiology, Part II report (June 2019):

Approximately 5 per cent of CT and MRI patients, or 380,000 people a year, are forced to exit the workforce temporarily while they wait longer than the recommended maximum wait time.
Having workers off the job while waiting for diagnostics hurts the ability of firms to produce goods and services. This, in turn, hurts GDP, reducing government revenues by $430 million a year.
The cost of excessive wait times will likely increase. Growth in demand for CT and MRI services is expected to outpace the growth in supply over the long term.

https://www.globenewswire.com/news-release/2019/06/25/1873889/0/en/Radiology-wait-times-impacting-Canadians-in-more-ways-than-one.html

You can say the Conference Board of Canada is biased but the analysis comes from a report commissioned by the Canadian Association of Radiologists.

Oftentimes, losses like this are invisible and it makes the argument more difficult.

I didn’t indicate my stance on who should pay for health care, or how much. Only that I believe it should be EQUALLY affordable, and not attached to an employer. How we get there is a whole other thing, but we should at least be willing to acknowledge that it’s a problem so we can identify what is not acceptable or fair.

The issues you mentioned are real concerns. However, most likely those issues arise from more people having access to healthcare. So it sounds like the choice you propose is between only some people having access to decent healthcare (or any healthcare), Or everyone having access to potentially subpar healthcare. It is absolutely a conundrum, I agree. But I am not prepared to say that I think a segment of our population should be excluded from access to affordable healthcare (or face financial ruin), just because it may have some negative impact on the rest of us. Get everyone covered, so that we can then laser focus on improving the quality of care across-the-board. Perhaps when everyone gets to experience the same thing will be what is needed for everyone to be invested and motivated in seeking a solution.

The issues you mentioned are already a thing, in poor areas, in rural areas, overpopulated areas, u derpopulated areas. When is the last time Canada and other similarly structured healthcare systems have had a major overhaul? Perhaps they need to look at their practices as well. We are in a unique position that if we do decide to reform our healthcare system, we can learn from other governments’ mistakes and be the progressive and innovative country that we became in just a couple hundred years, And create a better quality, more efficient system than exists anywhere currently.

MRIs are too expensive? Then we learn how to build them inexpensively, and create an industry that puts savings back in our pockets, and allows us to share andexport it, raising our GDP at the same time. We develop and pay into programs that teach and encourage innovation in medical technology Since clearly, as you state, it’s not just our issue alone. Imagine how critical and wealthy we would become as a country if we could solve a problem many countries face, But for whatever reason they are not at the precipice of a decision in healthcare reform, that we are right now in our history. I believe we are poised to do something great, because we have not had this much national energy around this issue. And that is what causes change in innovation, that friction.

[bacchi]

MRIs are too expensive? Then we learn how to build them inexpensively, and create an industry that puts savings back in our pockets, and allows us to share andexport it, raising our GDP at the same time.

Even with the outsized spending on health care in the US, it doesn't have the most MRI units per capita. That would be Japan, by far, which has a highly regulated medical system, a $200 USD MRI cost, minimal wait times, and where per capita MRI usage is 2x what Americans get.

Canada's health care system isn't ranked the highest and there are better government run systems, such as Germany, Switzerland, Netherlands, or Japan.


Even with Canada's problems, Canadians are happier than Americans are with their system (Question 1).

https://www.cihi.ca/en/commonwealth-fund-survey-2016

We can guess what the results of this question look like: "Q13  In the past 12 months, was there a time when you had a medical problem but did not visit a doctor because of the cost?" Hint: America is the highest, which isn't good.

[Cpa Cat]

I assumed that a country with universal healthcare would have a lower retirement age, but Googling determined this is not the case.

Canada, which has universal healthcare and therefore should theoretically eliminate this idea of working just for health insurance, has an average retirement age of 63.5 years.

The United States has an average retirement age of 59.88.

Canadians are (statistically-speaking) healthier and live longer than Americans, so this likely impacts their retirement age and causes them to work longer.

Not sure I'm fully understanding you; are you saying the higher taxes to produce universal healthcare results in both better health and longer working lives?  Seems plausible.

I'm not a labor scientist, so I don't know if correlation equals causation. But it does seem plausible that if people are healthier longer, then they will work longer. Canadians are, on average, healthier 3 years longer than Americans are. They also, on average, work 3 years longer.

I think many Mustachians may suffer from bias here. They assume that if they did not have healthcare concerns, they would quit work sooner. Healthcare uncertainty is probably the #1 reason Mustachians delay retirement. But Mustachians aren't normal/average people. Anecdotally, most average people in America seem to quit working because they are physically unable to continue (because they're old and tired or old and sick). I suspect it's similar in Canada.

I am not saying anything about the impact of higher taxes. Whether or not Canadians pay more in tax than Americans is a complicated question. We often assume they do, but for many people, that is not the case. If you consider American healthcare/insurance costs as another "tax," it gets much cloudier.

As Bacchi mentions, Canada does not necessarily have the best or most efficient model for single payer healthcare, but it makes a good comparison because culturally, Canadians are similar to Americans and so we'd expect their behavior to be a good model for American behavior.
 

[Wrenchturner]

I'm not a labor scientist, so I don't know if correlation equals causation. But it does seem plausible that if people are healthier longer, then they will work longer. Canadians are, on average, healthier 3 years longer than Americans are. They also, on average, work 3 years longer.

I think many Mustachians may suffer from bias here. They assume that if they did not have healthcare concerns, they would quit work sooner. Healthcare uncertainty is probably the #1 reason Mustachians delay retirement. But Mustachians aren't normal/average people. Anecdotally, most average people in America seem to quit working because they are physically unable to continue (because they're old and tired or old and sick). I suspect it's similar in Canada.

I am not saying anything about the impact of higher taxes. Whether or not Canadians pay more in tax than Americans is a complicated question. We often assume they do, but for many people, that is not the case. If you consider American healthcare/insurance costs as another "tax," it gets much cloudier.

As Bacchi mentions, Canada does not necessarily have the best or most efficient model for single payer healthcare, but it makes a good comparison because culturally, Canadians are similar to Americans and so we'd expect their behavior to be a good model for American behavior.

I guess there are many different things at play here.  Canada and the US are fairly similar, but we do have differences in these averages.  I wonder how much of it is due to the wider deviation in the US, there are probably more people retiring early in the US but also more people working until death/exhaustion.  So if their average retirement age is lower, what exactly does that say?

I also know some old guys who want to work because it gives them something to do.  I've myself moved away from the idea of early retirement, I'm more interested in FU money and partial retirement.  Maybe Canadians hate their jobs less, or maybe they have enormous mortgages to pay down, who knows.

[Leisured]

To put things in perspective: I was a teenager in Australia in the sixties, a decade before Australia got universal heath service. I knew a farm labourer who had several children, and he told me he had consulted a doctor about a health problem, either for himself or a child, and the doctor had not charged him, because the doctor assumed the labourer could not afford the fee. This is noblesse oblige, and I suspect it was normal at the time for doctors to waive fees if the patient was poor. Doctors then and now are well paid.

Does noblesse oblige happen among American doctors advising a poor patient? Noblesse oblige is, or should be, a phenomenon in countries with no universal health care.

The downside is that poor patients will be reluctant to consult a doctor if they know the doctor will not charge them.

[Cpa Cat]

Does noblesse oblige happen among American doctors advising a poor patient? Noblesse oblige is, or should be, a phenomenon in countries with no universal health care.

The downside is that poor patients will be reluctant to consult a doctor if they know the doctor will not charge them.

No. The truly poor (especially children) qualify for Medicaid, a single-payer government insurance program.

If an American has no insurance (Medicaid for poor people, Medicare for old people, and private insurance for anyone else) and seeks medical care, they are charged for it. There is sometimes a cash discount price and there is often a way to put medical bills on a reasonable payment plan. Medical debt can also be bankrupted.

[OtherJen]

To put things in perspective: I was a teenager in Australia in the sixties, a decade before Australia got universal heath service. I knew a farm labourer who had several children, and he told me he had consulted a doctor about a health problem, either for himself or a child, and the doctor had not charged him, because the doctor assumed the labourer could not afford the fee. This is noblesse oblige, and I suspect it was normal at the time for doctors to waive fees if the patient was poor. Doctors then and now are well paid.

Does noblesse oblige happen among American doctors advising a poor patient? Noblesse oblige is, or should be, a phenomenon in countries with no universal health care.

The downside is that poor patients will be reluctant to consult a doctor if they know the doctor will not charge them.

I doubt it unless the doctor works at a sliding-scale community clinic designed specifically to serve the poor. Too much potential profit and liability in our healthcare system.

[John Galt incarnate!]

Does noblesse oblige happen among American doctors advising a poor patient?

Yes.

I've read of American doctors treating poor patients free of charge.

IDK how often.

There are   hospitals  in America  that treat children free of charge and a federal law that requires some hospitals to treat patients regardless of their ability to pay for treatment.

     



WIKIPEDIA

Shriners Hospitals for Children is a network of 22 non-profit medical facilities across North America. Children with orthopaedic conditions, burns, spinal cord injuries, and cleft lip and palate are eligible for care and receive all services in a family-centered environment, regardless of the patients' ability to pay.


WIKIPEDIA

The Emergency Medical Treatment and Active Labor Act (EMTALA)[1] is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Participating hospitals may not transfer or discharge patients needing emergency treatment except with the informed consent or stabilization of the patient or when their condition requires transfer to a hospital better equipped to administer the treatment.[1]

EMTALA applies to "participating hospitals." The statute defines participating hospitals as those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program.[2] Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals.[3] The combined payments of Medicare and Medicaid, $602 billion in 2004,[4] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, not just to Medicare patients.[5][6]

The cost of emergency care required by EMTALA is not directly covered by the federal government, so it has been characterized as an unfunded mandate.[7] Uncompensated care represents 6% of total hospital costs.[8]
 

[ctuser1]

It should be obvious, but still wanted to throw it in there since nobody else seems to have raised it.....

It is not a doctor's job, neither is it practical for him or his staff to do background checks on the patient and determine if they are a deserving recipient(s) or not.

Physicians, in aggregate (as represented by their organization - AMA) have also proven uniquely unqualified to act in good faith in a non-discriminatory ways well past the days of Civil Rights movement. e.g: https://amednews.com/article/20080728/profession/307289974/6. They are still the most prominent anti-reform force in US (https://www.nytimes.com/2019/12/17/upshot/surprise-billing-democrats-2020.html). So I doubt the results will turn out to be good they were to be trusted with more financial authority on this matter.

Note: I say "in aggregate". Some of the most prominent voices against the current practices of AMA are themselves physicians.

Bottom line - it's baaaaaaaad idea to ask the fox to guard the hen house. If the physician's livelihood depends on fees from patients, it is probably not a good and scalable solution to ask them to engage in charity with that.

Certain solutions were relevant when medical care was basically limited to one doctor in a small village. It no longer is relevant in the age of tailored genetic therapies where there may be 2 specialists on that topic in the whole world!

[Metalcat]

It should be obvious, but still wanted to throw it in there since nobody else seems to have raised it.....

It is not a doctor's job, neither is it practical for him or his staff to do background checks on the patient and determine if they are a deserving recipient(s) or not.

Physicians, in aggregate (as represented by their organization - AMA) have also proven uniquely unqualified to act in good faith in a non-discriminatory ways well past the days of Civil Rights movement. e.g: https://amednews.com/article/20080728/profession/307289974/6. They are still the most prominent anti-reform force in US (https://www.nytimes.com/2019/12/17/upshot/surprise-billing-democrats-2020.html). So I doubt the results will turn out to be good they were to be trusted with more financial authority on this matter.

Note: I say "in aggregate". Some of the most prominent voices against the current practices of AMA are themselves physicians.

Bottom line - it's baaaaaaaad idea to ask the fox to guard the hen house. If the physician's livelihood depends on fees from patients, it is probably not a good and scalable solution to ask them to engage in charity with that.

Certain solutions were relevant when medical care was basically limited to one doctor in a small village. It no longer is relevant in the age of tailored genetic therapies where there may be 2 specialists on that topic in the whole world!

As a medical professional, I 100% agree.

It's absolutely insane to expect any professional to provide service for free within their business model.

I do it, we all do it, but it's not systematic or rational. We'll do it because we like the person and feel like doing it that day.
Do I really know who needs help most? Of course not.

If I want to do any degree of actually useful free work, I can volunteer my time to the appropriate organizations.

[LennStar]

I do not think anyone can persuade me that portable health insurance would reduce economic efficiency.

Yes, it should increase economic efficiency, I believe by a LOT!! And increase innovation to boot!

Is this an observable effect in the many many countries where healthcare isn't tied to employers?

There are too many other factors that play a role here as to be able to have an apple/apple comparison.

But yes, the studies that I read said that healthier workers mean longer working careers. For FIRE aspirants a strange thing, but here we are back to the apple/apple problem. Of course people work until they reach retirement age at 67 if they can!!!

Who gets an MRI?  Not everybody!  Who decides who gets an MRI?  A lottery?  A business transaction?  We need a solution that doesn't depend on a "should".

Those who need it for medical reasons.

[Telecaster]

"Should" is not a driver for public policy.  Laws are written based on compromises.  There is a downside and moral hazard to your "should"s.  One example, wait times:

The image is a chart of wait times, in days, for MRIs in Alberta.  You can see the percentiles and their time frames and it's not great.  As I've said elsewhere, universal health care might produce a higher MEAN but no one wants to volunteer to be on the receiving end of triage.  I have yet to hear a good response for this specific point.  The reality is, there are only five MRI machines per million people in Canada, and 30 per million in the US, from data from 2004.  Who gets an MRI?  Not everybody!  Who decides who gets an MRI?  A lottery?  A business transaction?  We need a solution that doesn't depend on a "should".

I've got an anecdote about MRI wait times.  Two of them actually, and a bonus.  My wife has a shoulder injury which causes her severe pain.   Her doctor recommend an MRI,  however her insurance company rejected the recommendation and refused to pay.   Fortunately, she changed jobs on Dec. 1, and her new employer's insurance did cover the MRI.   From the MRI her doctor was able to diagnose a torn labrum, which will require surgery.   

Next anecdote.  There is a health care provider here in Seattle called Virginia Mason, who is a health care provider for Starbucks.  Starbucks baristas would visit the doctor complaining of low back pain.  The doctor would schedule an MRI, which was typically inconclusive, and then recommend PT.   Ultimately, Virginia Mason decided just to skip the MRI and go straight to PT.  This lowered insurance costs and workers missed fewer days of work.  You would think this is a win-win, except that Virgina Mason made less money by performing fewer MRIs.  The solution was two negotiate with the insurance company for higher reimbursements.  However, most providers don't go through all that bother, they prefer to simply make money running MRIs.   Why not?  It can't hurt right?  But the delay in scheduling the MRI and follow up visits actually result in poorer health care outcomes. 

Long story short:  Having lots of MRI machines per capita is not necessarily a good measure of a health care system.

Final anecdote.  My sister has rheumatoid arthritis.  Her condition is treatable, however insurance company rejected her doctor's recommended course of treatment, until a the insurance company approved treatment was shown not to work. 

Point is, all medical systems must ration care in some form.  In this country, it is rationed by either people either not having insurance, or by placing a for-profit insurance company between you and your doctor.  And without ever even given giving you an exam, the for profit insurance company can and will dictate the course of your treatment.  Aetna's CEO Mark Bertolini made $51 million dollars last year, and he didn't make the big bucks by generously paying out claims.

In the libertarian thread, I pointed out that health outcomes in the US are objectively worse than other developed countries, yet it costs twice as much.   The above anecdotes are part of the explanation.    Tests and procedures are performed whether they are needed or not,  and insurance companies  over rule doctors.   I'm fine with our system costing twice as much, but at that price it better be as good or better than any other country.   Instead our health care system is like the JV team. 

[Wrenchturner]

Those who need it for medical reasons.

Unfortunately this is not always apparent until assessing in retrospect.  Also, maybe I'm willing to pay for the peace of mind!  Those people fly somewhere where they can get an MRI and this is a loss for the origin country.

[RetiredAt63]

Also re MRIs. When i had my MRI the technician told me the issue (for Ottawa and possibly all of Ontario) was not the number of machines but the number of trained technicians. The machine can run 24/7, if they can get staff and patients for all those hours. Not everyone wants to have an MRI at 3AM.  ;-)

[SunnyDays]

It’s my understanding that Americans earn quite a bit more than Canadians for the same job, so we Canadians end up working just as long.  Taxes are pretty high here as well, and also people don’t save any more on average than Americans, so our working lives tend to be the same length.

[LennStar]

Those who need it for medical reasons.

Unfortunately this is not always apparent until assessing in retrospect.  Also, maybe I'm willing to pay for the peace of mind!  Those people fly somewhere where they can get an MRI and this is a loss for the origin country.

Yes, unfortunately nothing is sure in medicine. But generally, if the doctors say you need it, you probably really do.

If you want to pay for peace of mind, you can still do it. Just don't expect it to be paid by the single payer insurance.

Is that perfect? No! There are some insurers who pay for homoepathica - for peace of mind you could. Which treatment should be paid and which not is, like the rest of society, a constant struggle. (Not to mention that we constantly learn how stupid old treatments were and that we can do better.) That's life.

[John Galt incarnate!]

Mark Halperin is an astute and seasoned pundit.

He was mocked for predicting a win for Trump.

Halperin focuses on  "disqualifying" policy positions, positions that render a candidate unelectable.


Open borders, single-payer healthcare, and providing free health care to illegal aliens are disqualifying according to Halperin.

He said so with reference to the candidacies of Sanders, Warren, and Buttigieg.

If he's right single-payer/portable healthcare isn't on the horizon.

[ctuser1]

Mark Halperin is an astute and seasoned pundit.

He was mocked for predicting a win for Trump.

Halperin focuses on  "disqualifying" policy positions, positions that render a candidate unelectable.


Open borders, single-payer healthcare, and providing free health care to illegal aliens are disqualifying according to Halperin.

He said so with reference to the candidacies of Sanders, Warren, and Buttigieg.

If he's right single-payer/portable healthcare isn't on the horizon.

Mathematics is usually more powerful than any punditry!

At least that has been my experience.

Most group plans now cost > $20k. (my employer's plan certainly does, by quite a margin!). 50% of the population is lulled into complacency because they are covered by the group plans and don't get to see the direct impact of the escalating cost.

I did some spreadsheet-crunching a couple of years ago. By 2035, if current trends persist, my employer's group plan would cost it $50k/year/employee in 2016 dollars (i.e. inflation adjusted)!!

I am not sure how many of the 50% "group coverage" insured will continue to have insurance offered by employers at that cost level!! Something *will* give before that, despite all punditry.

The breaking point could come earlier if the Millions-of-$$ gene therapies become commonplace. There is a very good chance of that happening 3 to 5 years out.

(Note: I did not mention the poor outcomes stuff. Trends are downwards there too. But people usually don't worry about the poor outcomes unless it happens directly to them - which won't be a large constituency.)

[Lmoot]

Mark Halperin is an astute and seasoned pundit.

He was mocked for predicting a win for Trump.

Halperin focuses on  "disqualifying" policy positions, positions that render a candidate unelectable.


Open borders, single-payer healthcare, and providing free health care to illegal aliens are disqualifying according to Halperin.

He said so with reference to the candidacies of Sanders, Warren, and Buttigieg.

If he's right single-payer/portable healthcare isn't on the horizon.

Did he say this before or after Republican reps’ constituents dragged them for threatening to take away their precious Obamacare; which only became precious after they realized what they’d be losing if republicans had their way with healthcare? I think that won Dems more trust points when it comes to healthcare. Lack of appropriate healthcare, and paying for it, is something people across the board can relate to. Unless repubs come with a plan to improve costs and coverage, they’ll be on the losing end (just like the last time they didn’t have an adequate plan to tear down Obamacare).

[ChpBstrd]

I think economic efficiency would increase because people could be more mobile in their careers and establish more small businesses, because employers would no longer have to hassle with benefits plans, because consolidation would occur, because marketing costs would decrease, and because fewer people would die from treatable medical conditions.

However, overall economic output would decrease because more people would retire earlier, more people would choose to work part time, and the portion of GDP that is wasteful activity around healthcare payments would decrease. A sudden shift to a more normal healthcare payment system would lead to a brutal recession because so many jobs and so much of GDP in the US is applied to tasks like reworking insurance claims.

So in a different way, it comes down to human well-being versus money.

[Scandium]

Insurance companies would loose a ton of money, and brown people would get a benefit. So therefore it will never happen. Those two coalitions on the right are strong enough to see to that.

[mm1970]

"Should" is not a driver for public policy.  Laws are written based on compromises.  There is a downside and moral hazard to your "should"s.  One example, wait times:

The image is a chart of wait times, in days, for MRIs in Alberta.  You can see the percentiles and their time frames and it's not great.  As I've said elsewhere, universal health care might produce a higher MEAN but no one wants to volunteer to be on the receiving end of triage.  I have yet to hear a good response for this specific point.  The reality is, there are only five MRI machines per million people in Canada, and 30 per million in the US, from data from 2004.  Who gets an MRI?  Not everybody!  Who decides who gets an MRI?  A lottery?  A business transaction?  We need a solution that doesn't depend on a "should".

Oh hell, wait times to see a GP in my town is MONTHS.

Very few are taking new patients.
Those that are - earliest appointments are 2-3 months out, if you are lucky.

OB/GYNs are even worse - much harder to get into.

Some of that is related to insurance - the independent docs are much less likely to take all forms of insurance.  The ones that take all insurance...are fully booked.  I guess I'm lucky I got my doc 23 years ago.

[ericrugiero]

I'm not really in favor of a single payer (government) health care system because our government tends to waste so much money through inefficiency.  But the OP has a good point in how valuable an affordable portable health benefit would be.  My ideal solution would include this:
- Employers no longer provide health care options but instead give everyone a raise equivalent to their current health care cost.  (Yes, this would be hard to accomplish)
- Individuals shop for health insurance in a competitive open market.  Competition drives the cost down. 
- Money directly deposited into insurance premiums would be pre-tax to not cost the individuals in higher taxes. 
- Every bill must be itemized and clearly written.  (I've gotten lots of bills that were wrong and intentionally confusing so people wouldn't question them.)
- Hospitals and other medical professionals are required to have their costs for procedures published and accessible so clients can shop around.  (example: Having a baby costs 10,000 which includes 1 night in hospital and ….  C-Section is $15,000.  Additional night stays are $1,500/night)  Medical bills are the only time I ever spend thousands of dollars on something with no idea of what it will cost and no real way to control the costs. 
- Figure out how to reduce frivolous lawsuits.  How do other countries handle this so their medical malpractice isn't so expensive?  Our current system costs us all in malpractice insurance and in needless testing that doctors prescribe to cover their back side. 

Some of these would be difficult to implement but they would be a massive improvement. 

I do think high deductible plans with lower premiums and the money saved from premiums going into an HSA has actually been a good improvement (despite the amount of complaints about this system).  This encourages people to shop around and the competitive market will drive the cost down.  The biggest problem is some people won't put the savings into an HSA and therefore they won't have money to cover their deductible.  Anecdotally, when we switched to HDHP it saves me money in the years when we don't meet our of pocket max and cost me a few hundred dollars if we do meet the out of pocket max.  Plus, the HDHP allows me to have an HSA which is a big benefit.  I would not switch back if I could. 

[ericrugiero]

Insurance companies would loose a ton of money, and brown people would get a benefit. So therefore it will never happen. Those two coalitions on the right are strong enough to see to that.

You have a point about insurance companies fighting against something that would cost them money.  They have enough money to influence politicians on both sides.   

What coalition on the right is specifically AGAINST brown people benefitting?  There is debate over special treatment and benefits for brown people but I don't know anyone who is specifically against anything just because they would benefit.  (I'm not including groups like the KKK because they are extreme, not representative of the "right" and are not strong.)

[Scandium]

Insurance companies would loose a ton of money, and brown people would get a benefit. So therefore it will never happen. Those two coalitions on the right are strong enough to see to that.

You have a point about insurance companies fighting against something that would cost them money.  They have enough money to influence politicians on both sides.   

What coalition on the right is specifically AGAINST brown people benefitting?  There is debate over special treatment and benefits for brown people but I don't know anyone who is specifically against anything just because they would benefit.  (I'm not including groups like the KKK because they are extreme, not representative of the "right" and are not strong.)

Oh please. They're not dumb enough to say it, but the constant objections that "lazy, urban poors" would be "freeloading", and getting things for free that they don't deserve? We all know what they mean: minorities would get benefits, and we can't have that! (this is evident since they have no problem with subsidies to farmers or oil extraction). Now to be fair some just hate poor people, I'll give you that.

[bacchi]

- Figure out how to reduce frivolous lawsuits.  How do other countries handle this so their medical malpractice isn't so expensive?  Our current system costs us all in malpractice insurance and in needless testing that doctors prescribe to cover their back side. 

A few states have tort reform and medical costs are not lower. You know what happens in those states? Doctor salaries go up, due to lower malpractice premiums, but the savings aren't passed to the consumer.

A better solution is to decrease the medical union stranglehold on new doctors and to increase the number of residencies. To do the latter requires MORE medicare funding.

[ericrugiero]

Insurance companies would loose a ton of money, and brown people would get a benefit. So therefore it will never happen. Those two coalitions on the right are strong enough to see to that.

You have a point about insurance companies fighting against something that would cost them money.  They have enough money to influence politicians on both sides.   

What coalition on the right is specifically AGAINST brown people benefitting?  There is debate over special treatment and benefits for brown people but I don't know anyone who is specifically against anything just because they would benefit.  (I'm not including groups like the KKK because they are extreme, not representative of the "right" and are not strong.)

Oh please. They're not dumb enough to say it, but the constant objections that "lazy, urban poors" would be "freeloading", and getting things for free that they don't deserve? We all know what they mean: minorities would get benefits, and we can't have that! (this is evident since they have no problem with subsidies to farmers or oil extraction). Now to be fair some just hate poor people, I'll give you that.

The people I know who would be opposed to the poor among us freeloading are not racist (they don't care about the color of the person freeloading, they don't want anyone to freeload).  They also genuinely do want to help the poor people.  They just want them to help themselves as well.  (They are more interested in teaching them to fish than giving them a fish)

I realize this isn't true about everyone.  But it has been my experience and I believe it is true for a large portion of the people you are talking about. 

Now back to the regularly scheduled discussion about affordable portable healthcare (which I believe was intended to be non-political). 

[LennStar]

PSA: You can have single payer AND competing insurers.

- Employers no longer provide health care options but instead give everyone a raise equivalent to their current health care cost.  (Yes, this would be hard to accomplish)

In Germany health costs are paid with the wage. You "only" need a law for it.
 

- Every bill must be itemized and clearly written.  (I've gotten lots of bills that were wrong and intentionally confusing so people wouldn't question them.)

I have never seen a medical bill. Those go directly to the insurer, who has specialized people looking through them for fraud and consitency.

- Figure out how to reduce frivolous lawsuits.  How do other countries handle this so their medical malpractice isn't so expensive?  Our current system costs us all in malpractice insurance and in needless testing that doctors prescribe to cover their back side. 

We have the "Medizinischen Dienst der Krankenkassen" (Medical Service of the Insurers) They do several things like determining the grade of care needed. But you can also "call the police" of them if you think you have been mistreated. Since the insurers pay for that service that could save them money, it works relativly good (although, of course, doctors are evaluated by doctors, and there is a certain esprit de corps.)
It may not be perfect but I can't think of a better system that isn't extremely complicated.

They also genuinely do want to help the poor people.  They just want them to help themselves as well.  (They are more interested in teaching them to fish than giving them a fish)

How do you teach a sick person to get health insurance??

[shenlong55]

Insurance companies would loose a ton of money, and brown people would get a benefit. So therefore it will never happen. Those two coalitions on the right are strong enough to see to that.

You have a point about insurance companies fighting against something that would cost them money.  They have enough money to influence politicians on both sides.   

What coalition on the right is specifically AGAINST brown people benefitting?  There is debate over special treatment and benefits for brown people but I don't know anyone who is specifically against anything just because they would benefit.  (I'm not including groups like the KKK because they are extreme, not representative of the "right" and are not strong.)

Oh please. They're not dumb enough to say it, but the constant objections that "lazy, urban poors" would be "freeloading", and getting things for free that they don't deserve? We all know what they mean: minorities would get benefits, and we can't have that! (this is evident since they have no problem with subsidies to farmers or oil extraction). Now to be fair some just hate poor people, I'll give you that.

The people I know who would be opposed to the poor among us freeloading are not racist (they don't care about the color of the person freeloading, they don't want anyone to freeload).  They also genuinely do want to help the poor people.  They just want them to help themselves as well.  (They are more interested in teaching them to fish than giving them a fish)

I realize this isn't true about everyone.  But it has been my experience and I believe it is true for a large portion of the people you are talking about. 

Now back to the regularly scheduled discussion about affordable portable healthcare (which I believe was intended to be non-political).

So then they should be spending their time actually teaching them to fish instead of wasting time and energy stopping others from giving them fish in the mean time.  I honestly think that the belief in this false dilemma is a serious problem in our politics.

[ctuser1]

The people I know who would be opposed to the poor among us freeloading are not racist (they don't care about the color of the person freeloading, they don't want anyone to freeload).  They also genuinely do want to help the poor people.  They just want them to help themselves as well.  (They are more interested in teaching them to fish than giving them a fish)

I realize this isn't true about everyone.  But it has been my experience and I believe it is true for a large portion of the people you are talking about. 

Now back to the regularly scheduled discussion about affordable portable healthcare (which I believe was intended to be non-political).

I'd request you to contemplate the fact that "right wing" voting pattern has a very strong positive correlation with usage of welfare and government subsidies.

Look at the blue and red states. Which ones have more welfare recipients on average (when you include social security and medicare, which *are* welfare programs)? Which ones gives less in taxes to Feds than they get in federal expenditure?

Do you think your neighbors would be okay with that if they *really* cared about freeloading? Wouldn't they be concentrating on getting their neighbors and state residents off freeloading before they mouthed off about urban poor if they were serious about this whole freeloading business?

I live in a very blue northeast state. We have one of the lowest welfare usage in the country, and we send $3 to the feds in taxes for every $1 we get, which goes to subsidize red states like AL or KY which get way more than they send.

And yet, we have a small but significant portion of white working class even in our state - many (possibly most) of them on expanded state medicaid - who are rabid right-wing and passionate about "freeloading". Apparently their medicaid usage is not freeloading, but only that used by the "other" people.

It is not difficult to guess the underlying reason!

(edited to add)
If the right wing were not motivated by “you-know-what” factors, they would also have zero reservations about immigration. With falling birth rates, the future prosperity (i.e. keeping the American dream alive for the next generation) depends on having more workers, ie more immigration. But of course the right has a consideration that is stronger than the American Dream for the kids.

I sometimes wonder what that consideration might be!!

[MasterStache]

I am RE'd but my spouse continues to work. We've discussed many times about when she would join me in early retirement. And every discussion ends with ensuring our kids, in particular our son who was recently diagnosed with ASD, have their own insurance before she calls it quits. We aren't worried about having enough. We are more worried about the cost and availability of quality healthcare.

[ctuser1]

I am RE'd but my spouse continues to work. We've discussed many times about when she would join me in early retirement. And every discussion ends with ensuring our kids, in particular our son who was recently diagnosed with ASD, have their own insurance before she calls it quits. We aren't worried about having enough. We are more worried about the cost and availability of quality healthcare.

I feel for you!

I am not sure if you have researched the following or not, if not please consider:
1. Research conservatorship or guardianship as appropriate for your state.
2. Use SSI/medicaid when he turns 18, for his healthcare and other expenses. There are specific rules what SSI can be used for - so be careful there.
3. Not as well known, but there are usually many local programs (at least in the blue states) that take care of them after they age out of the school system at 20. Please research into that. e.g. NY State used to be known for such programs. Perhaps you can consider moving to upstate NY if possible, to get the killer combo of low cost of living and good social programs. CA/MA/NJ are also considered good. CT (where I live) is okay.
4. Switch over to SSDI-DAC based on the Social Security credits of either you or your wife. It may be beneficial for one of you to claim social security early for this.
5. As soon as #3 happens, typically the disabled adult is pushed above SSI income limits and your medicaid benefits are jeopardized. He/she also won't be eligible for medicare for 2 years yet. There are, I think, 20 odd states where they allow you to maintain medicaid during this period. All these require very careful planning.

[Hula Hoop]

This is how it works in pretty much every other developed country in the world besides the United States - so just look at one of them to see how it works.

We're covered by the Italian national health system so I never even think about how FIRE-ing - or even switching careers would effect our health coverage.  It woudn't.  We thought about getting supplemental private health insurance but that seemed like a very un-mustachian waste of money.  Only wealthy types here get supplemental private insurance.