Obama tried and the entire Republican party started talking about gulags

Healthcare co-ops exist. But a good number of people get health insurance through their jobs, and those jobs usually contract with one of the big corporations.

Health insurance at its core is very simple. … But in the USA…

I wrote this lengthy post a few months ago about why the American health insurance system is not efficient in comparison to the auto insurance system:

So to answer your question directly, the costs for healthcare in the USA continue to spiral so far out of control that it causes distortions in the health insurance market, to everyone’s detriment. Specific issues such as open-enrollment periods, employer subsidies, and incomprehensible coverage levels all stem from – and are attempts to reduce – costs.

The auto industry has examples of “mutual insurance” companies, where the company at-large is partly or wholly owned by the policyholders (eg State Farm, Amica, Liberty Mutual USA). And that mostly achieves the objectives you’ve described for a non-profit automobile insurance pool. Sadly, this just doesn’t work in the USA for health insurance, for the aforementioned bottom-line reason.

Hospitals and doctors go through intense negotiations with insurers to come to an agreement on reimbursement rates, but the reality is that neither has sufficient actuarial data to price based on what can be borne by the market. So they just pass their costs on, whatever those may be, and insurers either accept it into their calculations, or drop the provider.

When prices for service are opaque, how can any insurance company – even the most benevolent – properly price their policies? To stay in business would require always overestimating than underestimating. The extra revenue becomes either profit or float. But this float can’t even be beneficially used or paid out, in case the next quarter has more expensive claims to pay. Which brings us full circle to opaque pricing.

In this environment, the only remaining prudent thing for a benevolent health insurance company to do is to hold huge reserves. But that is not competitive against profit-seeking insurance companies that can undercut the benevolent company, who had tied one hand behind their back. Benevolent companies rarely survive.

It’s incredibly simple. Complacency. Greed takes root, nobody cares enough, and greed takes further and further root. The US has constructed its society into one where it is entirely normalised for someone to see a homeless person, and say “they earned it”.

Healthcare–and, by extension, everything else–will only change, when the people work to make that change. Simple as. As of now, corporations make change instead. Perhaps, what’s transpiring proves a turning point, but I’m not willing to believe that yet.

No one gets rich from public healthful.

That’s why.

It’s important to recognize that the system in the US is more convoluted than you believe. It’s not like we have totally separate drug manufacturers versus distributors versus hospitals versus insurers. There’s a fair amount of overlap, and a lot of it is relatively secretive, so you don’t know where the kickbacks are. You don’t know who’s jacking up prices in general knowing that they’re going to lower prices for the company that they are partners with. All of which is to say, this is not a fair market, this is not a market where you can reasonably compete if you play by the rules, but even if they actually bothered to follow the rules, you’re already screwed because they have market dominance.

The only path forward is through government run single payer healthcare. You can call it NHS, you can call it whatever you want, but it has to be run by the government. You need the government to set price ranges for drugs and treatments so that the drug companies and the hospitals don’t f*** over everyone.

But I don’t think Americans are ready for that yet. Obviously Trump winning the election makes it incredibly unlikely, but I think even large numbers of Democrat voters are still trapped in American exceptionalism. They know they’re getting fleeced, but they aren’t yet willing to say that they should probably copy what’s happening north of the border or across either ocean. They have good stories, things about super long wait times or lack of doctor choice, pretending that those things don’t happen in the US, and then pretending that those things do happen in every other country that has universal health care, which is laughable. But it’s hard, because so many people are desperate to believe that the US is the greatest country in the world, and they are desperate to avoid recognizing that they’ve been getting f***** right in the ear for the last few decades.

It’s technically possible but it would take a truly massive sum of money to get off the ground, and nobody is going to put up the capital knowing they’re not going to get a return on that investment. People don’t get the kind of money required to do this by making decisions like that.

Because it’s not a fair market. Health insurance is a cartel market.

Let’s say you break your ankle - maybe a reasonable cost for resetting the bone would be 240$ - the hospital will set a list price somewhere like 1300$ for the operation and then Anthem/UHC/whatever will send a rep out to be like “Hey, what if, when it’s one of our people, you only charged 300$” suddenly the rep gets a bonus for getting a “good deal” the insured patient is happy to pay well below “market” price and the hospital might get a small kick back for being so generous.

In this scenario most people only ever feel the 300$ price - but uninsured people or people out of network get absolutely fucked.

Since the current system entrenches all the existing players none of the participants (except the patients who usually don’t even get to choose their insurer) want to change anything.

Insurance companies make money by indirectly extorting customers, be they individuals or businesses, through pricing schemes with healthcare providers. The American healthcare system is designed and priced around people having insurance, as you’ve noticed. This leads to insanely high bills for what should be simple things. An ambulance ride often costs over $1,000 without insurance, for example. In a nutshell, they’ve created a system where they are both the problem and the solution. Why don’t they start behaving more ethically? Well, from a money standpoint, why would you become less corrupt when you can collect more money by being corrupt?

Changing insurance providers, or even just certain coverage choices, isn’t easy. We have what are called “enrollment periods” in the US when you can do this, and the only other times are under major life changes such as marriage or having a child. As another user noted, most people get insurance through their employer. The company (usually) pays the lion’s share of the premiums; otherwise, the plans would be completely out of reach to employees. My plan would be four times as expensive to me if I was paying for it out of pocket.

As a result, starting something like what you want on a national level would be extraordinarily expensive, hard to compete with established players, and likely legally troublesome. Don’t get me wrong, we need reform pretty badly, but those reasons are why it hasn’t really taken off.

American capitalists are really, really good at cracking down on any civil attempt at unionising and/or improving society at the cost of the ultra rich.

You could recite the extensive history of violence, but honestly the greatest achievement is in the propaganda. Solidarity seems to be commonly understood - by all classes - as having to take the bill for somebody even poorer than yourself, and nobody seems to be comfortable with the idea that they might themselves one day benefit.

Americans can’t have good things before they start fighting back. Read up on union history. Organize. Educate. Teach people what solidarity is and what the Battle of Blair Mountain was. Learn what was taken away from you, and help others understand as well. Begin locally.

Either that, or keep watching the fascists take over day by day, as they have been doing for decades.

There are some alternatives that are usually affiliated with a religion. CHM is one such organization. Members all pay a recurring fee like they do with insurance, and all have access to the pool for their healthcare.
I have never used one so I cant speak to the efficacy, but it seems to answer your question.

They have co-ops and there are ‘less greedy’ insurers out there but at the end of the day it’s slathering this idea on top of the existing framework when the framework itself is probably the real issue. Doctors/facilities need to defray costs of potential malpractice for example, and that adds to cost as opposed to a more efficient universal fund if they were all employed by a single entity (like a governmental department), small stuff like that, economies of scale for operational expense, having to compete to buy real estate for facilities, all adds up

Feel free to crosspost to !AskUSA@discuss.online

A public system specifically would mean it’s run by the government. So that would need to be created by the government. Which means you’d need all relevant voting systems to vote in favour of it, which isn’t likely… especially given the last presidential election.

I imagine the biggest challenge of creating a non-profit health insurance thing is one of two things.

Firstly, anyone who has that much money would probably rather open a charity.

Secondly, people actually DO commit fraudulent claims, or try to claim things that they don’t need or that the health insurance company decided that they won’t cover. If the company doesn’t try to filter these out, it’d be losing more money than it expected to…and it’d go out of business.

Another factor is that being in the insurance business is already a losing model if you want to do good in the world. Hospitals will charge jacked up rates because they don’t have to worry about what a person can pay. They try to extract as much as they can out of the big insurance corporation, since the patient doesn’t care what the insurance company has to pay. So this non-profit insurance company would be paying as much as any other insurance company, more than any patient would be paying, and so it’d be losing money even just paying out all of its valid and covered claims, let alone the fake and unnecessary ones.

So, maybe you want to partner with the hospitals because, why should you pay as much as the evil companies, right?

Well, that sounds great from a consumer sense. But from a business perspective, that’d be suicide for the hospital – why would any other insurance company do business with that hospital if they’re giving one company discounts unfairly?

Or…maybe they do give discounts. But then they make less money and can’t pay the doctors as much (who can leave for work elsewhere), or buy the newest equipment, etc.

But if they do want to give discounts and just charge the company what things actually cost…at that point, you might as well be a charity.

And even then, you still need to budget for validating the claims that come in, because how do you choose who gets covered, and within that group, who gets priority?

Insurance company profits are already capped by law. I don’t think your ideal insurance company can possibly be that much better for the customer than the already-available options are.

The companies must spend at least 80 cents of every dollar they collect in premiums from small businesses and individuals on health care, and 85 cents per dollar for large employers. The remaining 15 to 20 percent is all they are allowed under the Affordable Care Act to spend on administrative costs like overhead and marketing and to keep as profit. Any additional revenues are to be returned to consumers in the form of rebates.

Note that the remaining 15 to 20 percent has to cover all the costs of actually running the company. It isn’t just profit.

Furthermore, insurance companies do have to compete with each other on price. Denying a lot of claims helps them offer cheaper policies. Employers who provide insurance want the cheapest policy that their employees will tolerate and healthy people want the cheapest policy that they expect to protect them from sudden, catastrophic expenses. (I’m relatively young and healthy and I have never even seriously considered picking a policy other than the cheapest one whenever I had a choice.)

In this context, if your business plan is to spend more money per customer than the existing insurance companies do, and your target market is people unhappy with their current insurance companies (these people probably have expensive problems) then you’re not going to do too well…