- job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point

- except when subject to some kind of union negotiated contract, the employer can change their insurance options from year to year as they try to save costs, but it's not regarded as a mass pay cut when they do

- there's no standard metric on "how much do our employees pay on healthcare" (i.e. employee premium contributions, deductibles, copays), "how much time do employees spend on the phone with the insurance company", and certainly no way to feed in your last year's records of health-care to see "on plan Y you would have paid C"

Though I think the private health insurance system is a dumb waste of overhead and paperwork and misaligned incentives, I do think that people would be more willing to switch jobs if they could know their plan was at least as good as the one they were leaving, both in money spent and in employee satisfaction. Opacity, in part owing to lack of commitment from employers, makes this harder.

Another problem with this analysis is that the UK's national health system isn't the only example of a major developed country with a functioning health system. Many countries without the US's problems have private providers and private health insurance.

It's plainly obvious that the US has severe problems. Ideological polarization has fixated the discussion on a contest between public single payer and everybody-for-themselves private insurance. But the core problems have not much at all to do with insurance. They are, probably:

(1) Most Americans get their health insurance through their job, as a path-dependent consequence of bad 1950s tax policy. This in turn insulates insurers from their customers and breaks most of the mechanisms an ordinary market (like food, or transportation, or tax preparation) has from going off the rails.

(2) Americans pay doctors (and providers generally) anywhere from 2-5x more than other countries do. Providers account for the overwhelming majority of all health spending; compared to providers, drugs are almost a rounding error. This in turn is probably a consequence of policy decisions we made in the early 1990s, when the AMA lobbied Medicare to cap the number of residencies funded every year, which in turn generates artificial scarcity.

Remove the private actors, the adversarial billing, the friction with providers. It, at its best, ranges from bad to outright awful.

(I'd also love to do away with tax prep — the government knows what is owed, so why make folks prepare their own count and hope it matches?)

private healthcare - e.g if there's a lot of private clinics - people paid cash, then yeah healthcare costs would go down & most of the care was preventive not treatment. competition naturally will force prices down & since individuals payers won't be able to afford massive amounts, the market will adjust it's prices vs having one large payer (gvt) i.e public healthcare or many private large payers(current insurance industry).

right now - the issue isn't private healthcare - but the wrong incentives to bill insurance companies massive amounts of money. then insurance companies countering back - by having large bureaucratic processes to avoid paying those large bills. typical complex systems.

I have no idea who is supposed to benefit from this system, other than the private health insurance companies.

Americans are different - they see themselves as not Europe or Asians - and they are proud of that. The "rugged individual" is still an ideal many cling to as part of their identity.

But I can’t imagine it happening nationwide. Maybe cities can create their own public options, say a flat 3% income tax and you get health insurance.

So much progress isn’t made in the US due to the welfare queen myth. Heavily intertwined with racism, many imagine “lazy” people getting something they didn’t absolutely earn.

It’s pretty much a no-brainer cost reduction for everyone.

This doesn’t even mean you need to get rid of private insurance companies (see: Germany).

Obviously people will go with the first option, innovation won’t feed their kids.

Make that "many, many billions of dollars of profit". Then add on the probably-millions of jobs which the staggering inefficiencies of the current system support. (Everything from lobbyists for those companies, to the minions stamping "Denied" on health insurance claims, to the opposing medical billing staff who work for doctors & hospitals & such that need to get paid, to ...)

It'd be lovely if the leviathan could be slain, but don't hold your breath.

I would much rather live in the UK where private healthcare is good and reasonably priced than Canada where in most places it's simply not available.

Yes. That is the point. This is how capitalism works. Just look at the story of Tetris as the pefect example of capitalism in action. Some Soviet programmers invented it in their spare time when they had access to computers, as enthusiasts. What did capitalism add? Licensing and sub-licensing agreements. Or, to put it another way, just building enclosures.

The idea that capitalism fosters innovation is a fairy tale. Companies reach a point where the only way to satisfy the market's need for growing profits is by cutting costs and raising prices. All of the inflation we've seen from the pandemic has been the "raising prices" part. AI exists for dynamic pricing. Dynamic pricing is nothing more than raising prices. Nobody is using dynamic prices to reduce prices. Why would they?

But the big part of AI is in labor displacement. This suppresses wages. Those who kept their jobs aren't asking for raises and aren't saying no to extra unpaid labor. Because they're in fear of losing their jobs. That's not a side effect. It's the goal.

US healthcare, if you can call it that, is part of this economic coercion. Being expensive to access out of employment is a feature not a bug. Everybody wins. Employers keep people who want to live. Healthcare company profits go up. You, as the individual? Nobody cares about you. Get back to work.

The end state for all this is something that looks like South Asian brick kilns where workers have debt they can never escape. Westerners are being loaded up with debt for a reason: to enrich various companies and to make sure we can't leave our jobs.