re: article detailing the lengths health insurance companies will go to deny coverage

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Our system is so buried in greed and broken beyond repair and I don’t think we will see any significant enough reform in our lifetimes to make a difference.

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i said this forty years ago and it has turned out to be accurate. in fact, the topic of health care reform (the financing of it) is death to a politcian. they will be scorned and called a socialist, etc, etc.

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End employer-based health insurance. It shouldn't matter if I get fired or switch jobs or retire, I should be able to keep my policy if I want, and pay for it obviously. It shouldn't be tied to employment at all. This bullshite started in WWII when companies were booming but there weren't enough people to fill the jobs. There's only so much cash the companies could pay in salary and still be successful businesses, so that's when they started adding benefits like health insurance. Today's health insurance environment is a legacy of a hiring gimmick.

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yep, all true. Really illustrates IMO one of the best examples of path dependency in business and unintended consequences.

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HSA's should be mandatory, just like Social Security, something that comes out of your paycheck and into an HSA account

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Singapore does something like this, sure. You could skin the cat this way.

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All of your healthcare expenses get paid out of that

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The one downside of heavy reliance on HSA's is they disincentivize care, which to an extent can be good, as you don't want people showing up to the er for random scrapes or coughs, but it can also mean that a person ignores that slight chest pain instead of seeing a doctor or ignores that lingering issue and it becomes much worse. But you could probably mess with things to make it work.

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Transparency in costs to the consumer becomes a thing, which is necessary in capitalism.

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This now gets to one of the issues in healthcare IMO. It doesn't operate like normal markets. Or at least a large chunk of it doesn't...

You can't really tell the ambulance driver to shop around for the best cost/quality ER, or have the expertise to know if that drug stack or imaging and extra tests your doctor ordered are necessary or the best price. There is an issue of major asymmetry or lack of baseline competence in the expertise to make informed decisions. Not everywhere, no. And where applicable I agree. It could help. I don't know it is the full panacea, but i am of the opinion that it will take a ton of reforms for that to happen, or somehow do the impossible and tear it all down to the studs and start over(which will never happen IMO).

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The one downside of heavy reliance on HSA's is they disincentivize care,

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They also "incentivize" you to stay healthy.

I have a HSA. I don't want to use that money on health related expenses. It is an investment account for me. I want the money to sit in that account and compound so I can use in retirement. So I go the gym, eat healthy, etc etc. in an effort to avoid the doctor/hospitals.

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not to get your alarm up haha.... but you are backing into one of the arguments reformists often make for preferring single-payer reform. Cause if there is only one game in town, you can't really pull the, "we will just ignore your consumer base" card.

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But we're still in the algebra equation. If a single-payer cuts too much, what must the provider do to offset? Less staff? Lower pay? Shittier staff? Older shittier equipment? Longer wait times?

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what i'm saying is share in the cost of preventative medicine, even reward it along with good health, to help save money on chronic, long term healthcare expenditures on the back end.... preventative care is cheap, chronic care is expensive

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How does preventative medicine prevent chronic care? Whether chronic care starts at 40 and someone finally dies at 65 vs starting at 60 and going until 85, there are always a percentage of people who will linger and need chronic care. Won't the costs simply be shifted for some to a later time in their lives?

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Weird how plenty of other first world western nations can run universal healthcare but we can’t.

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pretty much... everyone has that "America is the greatest country, we can do anything, etc" until it comes to universal healthcare, and then it's a bunch of excuses and tired hypotheticals...

i honestly think most people are scared that it WILL work, and then how do they rectify something like that with their love of freedom, etc.... it creates a conundrum that they'd rather not face

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If a single-payer cuts too much, what must the provider do to offset? Less staff? Lower pay? Shittier staff? Older shittier equipment? Longer wait times?

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For sure. That's the balancing act that comes into play.

It's a lot more of a straightforward relationship, but there are certainly examples one can point to where countries have not done the best job balancing those things. But there is also no reason a country doesn't simply decide to pay more if it so chose. And why a lot of countries that have single-payer also have private insurance still, like Germany.

But its not like our relationships don't have their own perverse incentives and outcomes. Ours is a system that incentivizes lots of specialization and not a lot of general care. Does a bad job curbing hospital excesses, has tons of unnecessary care, bloat, uncompensated care that pushes up paying people's prices, and questionable distribution of resources at times.

And the hospital monster, as my SO can attest to, is a whole beast unto itself. Non-profits operating like for-profit, profit-driven decisions that call into question patient care, hidden fees, lack of price transparency as you touched on, insurance/provider collusion.

Basically spin the healthcare globe and drop a finger and there are issues needing majorly addressed IMO.

And one you can solve a number of ways. Not just single-payer.

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I am all for a trial balloon. Let a state or states do single payer. Prove to us it can be done in the US.

Vermont looked into it. Couldn't afford it.

California ditto. Couldn't afford it.

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The problem Vermont and California run into is that states cant run deficits, and transitioning 20% of your economy in one year wont be cheap, so you have to do enormous one year tax hikes that will tank the economy, and piss people off.

Id be all for passing some law to allow a pilot state to run a temp deficit, say 3 years, to do it though.

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And one you can solve a number of ways. Not just single-payer.

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Please expound.