In the US market, where union participation is also very low, it's weird to me that this is an important reason people stay in their jobs, may influence what kind of jobs you take (full time vs contracting?), but:
- 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.
It's really tough on people with a particular health condition and it can turn into an additional expense if a critical provider is suddenly out-of-network. Employers have definitely given me side eye when I've asked for details on the health insurance plan.
United Healthcare is pretty big in the US, they are also famous for forcing people to spend a lot of time on the phone, waiting on hold or advocating for care. I expect the ends up taking time that the employee would otherwise have been working as well as negatively impacting morale.
Not to mention that tying your insurance to your job is a *huge* pain. If you switch jobs or get fired you need to deal with coverage gaps, considering individual coverage for the duration, you may need to switch care providers depending on what your new coverage is.
And in the US a new worker can only join the healthcare plan during certain times of year! New workers often have to wait months with a health insurance gap before they can get on the new plan.
>- 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"
"how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.
I can only speak to my own experiences with salaried work. I'll also preface that I don't like healthcare being tied to employment.
All the job interviews that went to the point of discussing compensation, healthcare benefits were almost always included when negotiating what actual compensation would be. A difference of them covering several hundred dollars a month in premiums and them matching some % of HSA contributions is several thousand dollars a year in compensation differences. When multiple job offers are pretty close, that can make a difference.
Also, the few times employers have offered healthcare concierge as a benefit it was definitely mentioned in the overall compensation package.
It may just be a me thing, but when discussing a job offer I always ask for details about the health insurance. I want to see the premiums, what is covered, the networks, etc. All the details given to current employees when they go through open enrollment. And I can count on one hand the times where it was difficult to obtain from the recruiter or "HR lady".
That being said, nothing tells me the plans won't completely change in a few months of course. That's just the "game" and I also hate it.
Just give me the money directly and let me pick my plan from a marketplace that doesn't suck balls. If employers still want to give some incentives to be more competitive fine, but I shouldn't have to time my job switching to avoid coverage gaps.
> job offers generally do not want to get into details on the health insurance offering. it's not a main "competition" point
Health insurance has been a primary topic in every job offer I’ve had, my entire career.
If a company won’t discuss the insurance situation or provide details about the employee contribution, that’s a warning sign. This is a routine topic for negotiations and any company hiding this data is not a company you want to be working with.
It also kills many, many people, so, the profit motive needs to be permanently and forever abolished from healthcare. In the US doctors look at patients with dollar signs in their eyes and simply ask, "How much money can I squeeze out of this NPC?" leading to countless abuses, from unecessary and harmful procedures being forced on non-consenting patients (like infant genital mutilation) to denial of needed healthcare because it isn't profitable enough and has an opportunity cost.
This is less about private healthcare and more about how employer-provided healthcare is tax advantaged. Credits and tax breaks should go to the individual so they can choose and keep their insurance through different jobs.
Yes, the title gave me whiplash because I went in expecting an argument for socialized healthcare, then read a couple paragraphs and realized the article was actually presenting an argument against government meddling in the healthcare industry, then read further and realized it was actually using the problems created by government meddling in the healthcare industry to argue for more government meddling.
"the thing I miss most is the NHS. It’s been treated like a political football since I left and is apparently a shell of its former self — not because the idea is bad and can’t work but because conservative politicians, some of whom have received funding from private healthcare companies, have deliberately sabotaged it."
really it could not be because government is bad at managing massive programs and provides no incentive for high performance and efficiency....
You can deduct some of your medical expenses. I think it’s over 7.5% of your AGI.
But tax deduction or not isn’t what makes individual health insurance so expensive. When you have employer provided health insurance you’re in a completely different risk pool than people buying on the open market.
Good article in general but such a misleading headline and framing. The problem, as described in the article's body, is employer-provided health insurance, not private healthcare.
private healthcare is getting more and more expensive due to private prices available to bulk insurers but not for private person
even if this is not completely deliberate, effect is that you are "serf of whomever pays your insurance" or go bankrupt the moment you have any kind of emergency
in europe some private healthcare providers are showing their colors from different perspective, they outright refuse or cancel private contracts when you are above certain age
> effect is that you are "serf of whomever pays your insurance"
That's why in normal countries public healthcare is a thing and it competes with the private healthcare sector, forcing it to offer relatively affordable premium services.
It’s not connected at all in the US since 2011. The only thing employer provided health insurance gets you is the ability to pay for it with pre-tax income (which is a significant saving). Otherwise, you can go to healthcare.gov and buy it without an employer.
You can get healthcare outside of employers and it's incredibly expensive. The cost of private healthcare (either employer sponsored or not) is what is responsible for what the article is talking about, it's certainly not just employer provided plans. Are you saying that if employers didn't provide health insurance that it would help the situation somehow?
Yes. Employers get huge tax incentives for providing insurance, while individuals don't. This ensures that the only economical way to buy health insurance is through an employer, which means you are not free to change plans without changing employers (or change employers without changing plans).
It is also frustrated that this was meant to be a temporary hack during WWII that never went away. People should just get $$ into their HSA from their employer and but whatever plan they want.
It's funny that he (accurately) quotes the Cato Institute as being opposed to employer-provided health insurance... and then implies that the sole alternative is the NHS. Um, I'm pretty sure that's not what the libertarian Cato Institute was suggesting!
With all respect: what exactly is the alternative you're imagining? The market emphatically did not provide accessible private health care to individuals, largely because of the wellness trap (no one buys insurance until they need it). It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA.
Employer health care may have bad externalities, but it has the extremely important (but... maybe invisible to the median libertarian) property that it constitutes collective bargaining. You can force insurers to cover folks they wouldn't want to otherwise by bringing more customers (employees) to the table.
It's so weird that even now, with the ACA having been proved out over decades, that we have to have these weird free market arguments. It didn't work, guys. It's not a good that works well in an efficient market sense.
> It existed only as extremely expensive boutique products until the government put its regulatory thumb on the scale and passed the ACA.
100% untrue. There were affordable catastrophic coverage plans available, and many were made illegal by the ACA and the requirement to provide boutique services for "free" (i.e., forced to pay for even if you don't use).
I'd love to decouple insurance form employment and I'd also love to do away with the private insurance system in the US. I've always had insurance and the experience has been as uniformly poor, regardless of provider, as it is continuous. Any positive interactions and outcomes have felt like happy accidents, not the system working.
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?)
I think the article is looking at the wrong abstraction.
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.
We could easily do this and it would actually be significantly cheaper.
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.
> 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.
That “lazy people” getting something they didn’t absolutely earn is a core right wing narrative that has been very successfully propagandized for decades. People are still going to need work to pay for everything else. No one is going to stop working once the crushing weight of medical debt is lifted. It’s easy to debunk but I don’t see much effort going into this right now.
One thing that's never been clear to me is how either system plans on scaling healthcare. You have X doctors who can see (just a guess) 30X patients. Unless the number of doctors increase, some patients are going to be left out. In the current system it's those without employment. I'm other countries there's a waitlist. How can we make sure there's enough staff to provide adequate healthcare for everyone?
The U.S. has waitlists too? The U.S. makes people wait based on how much money they have, socialized healthcare systems make people wait based on an assessment of need. The latter is obviously better, even though it is not perfect. You’ll find that most everyone living with socialized healthcare believes it to be adequate when compared to the U.S. system. Adequate does not mean without flaws, adequate doesn’t mean available on demand, adequate means has good outcomes. Very few countries with a similar economy have as poor healthcare outcomes as the U.S.
Forced labour? Poland has doctors on 32 hour shifts. Worker comes on monday morning, leaves tuesday evening. The night is spend on ER, with a few naps between patients. Perfectly legal!
The whole thing is a racket. The amount of doctors is artificially constrained by the AMA. It's also why the US medical school system is so competitive compared to other countries. For example, in England one does not need an undergrad degree then medical school. One just goes straight into medical school at university. It's a 5-6 year long program compared to the US's 8 year program.
Of course, doctors do not earn nearly as much in England as the USA, thus good luck ever getting something like to change in the USA. In America, most people go to medical school for the prestige and the paycheck, and our system utterly reflects both.
I'm not sure which country you're from, but many EU countries do have private health insurance. The Netherlands, for example, has a system of subsidized private insurance, and a mandate that everyone buy a policy.
(If Americans are thinking, "huh, that sounds like Obamacare / the ACA marketplace!" then you're right.)
The Dutch system and the U.S. system are not comparable. Health insurance in the U.S. is a “free market” that the government dabbles in with a little policy here and there. Health insurance in The Netherlands is controlled by the government, it is heavily regulated.
Painting in such broad strokes, the German system also sounds like the ACA, but it's really not: the high level description really erases key differences.
In Germany there is nothing like bronze/silver/gold plans. All statutory health insurance covers what is required to be covered by regulations, with just a few bonus services, at the regulated tariff plus just a few percentage points of variation. So the 90% of people in Germany who have statutory health insurance [1] have essentially the same coverage. The tariff is a percentage of income (up to a cap), not a flat fee.
[1] not everyone is required to have statutory health insurance, for example employees above an income threshold and self-employed people
The European/"Socialist" solutions are never obvious to Americans.
It is like parliamentarianism, campaign financing regulations, gun control, multiple political parties, etc. Americans call these things "Socialism" and then freak out about them and refuse to see any good on them.
... and "Chat Control" and Digital ID and forcing digital currency and persistent digital surveillance and conceding your national sovereignty to a council that can pass binding laws without your consent and ....
Let's not pretend either system is perfect, or that the _underlying principles_ that both systems hold are the absolute correct way to organize a society.
Americans have be primed with _decades_ of rugged individualism and the idea that collective action is inherently weaker/flawed (just don't think about Social Security). It might have been reasonably true 100 years ago that everyone could pay for their own health care, but we're now in a world where the average person is perpetually on medications that are expensive to produce, and will demand increasingly expensive medical interventions throughout their life (heart health, cancer care, etc.). Combine that with AI probably wiping out a ton of industries/jobs - something has to change. I'm not going to pretend to have a solution, but I think it is disingenuous to suggest any EU nation has it figured out either and is obviously correct.
Just a minor clarification: The Money freaks out, calls these things "Socialism" and then dumps billions on red-baiting campaigns and political donations to defend the (highly profitable) status quo. Most citizens would just like some healthcare.
Wanna see less innovation in healthcare under a single payer? Come to Canada, you will be on a queue for an MRI for at least 8 months (if you even get one).
I don’t think it’s just healthcare, you have mortgages for inflated housing prices, expensive groceries and bills, and other expenses that make most people go to the route of boring stable job rather than innovative startup that might be out of business in a year and/or paying peanuts. Look at Canada for example, you can have a boring government job looking at excel sheets in the few hours you “actually” work in that week and still make $140k a year plus generous benefits, meanwhile you can grind your ass in a startup doing embedded firmware development and paid $70k a year with barely any benefits, hell, I have seen “senior robotic engineers” with a job descriptions enough to launch rockets and the pay is $60k!
Obviously people will go with the first option, innovation won’t feed their kids.
> ... my vote ... is for universal healthcare. The only real downside to it is that a bunch of companies that have entrenched their positions taking advantage of ordinary people will be denied a little profit.
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.
Nothing is free. We want both low cost and high quality healthcare.
This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D).
Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US).
There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways.
Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop).
I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.
Americans have been propagandized like crazy and don't really understand what can actually be done. "Single-payer" is treated as a synonym for "universal health care." "Private" is seen as mutually exclusive. People will say we should/shouldn't have something like Europe, then describe a system that only a handful of countries have.
Yeah, I find it discouraging that "single-payer" and "fully socialized" are treated like synonyms.
The "Bismarck model"[0] describes a family of healthcare models where people pay into a central healthcare fund, and that fund then pays medical providers -- which can be private businesses.
All doctor's offices in Canada are in fact private businesses. It's not actually a fully socialized system.
It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding.
Take your dissatisfaction with the way the government manages payments to the voting booth instead of advocating dismantling what is on the whole a quite equitable system that has a history of actually producing very good health outcomes.
I actually have on the whole extremely pleasant experiences here in my corner of Ontario. And then I hear horror stories.
The system is underfunded and inconsistent. The province is to blame for that.
> Take your dissatisfaction with the way the government manages payments to the voting booth
And vote for who? I have yet to hear a compelling solution from any party. At most, politicians advocate for throwing more money at the problem.
> The system is underfunded
Hot take: the system will always be underfunded. The demand for healthcare is nearly infinite in practice. What stops people from going to the doctor for every sniffle is either cost (in a private system) or waiting times (in a public system). If you had infinite resources to offer services, there are some folks who would be going in for MRIs every year "just in case" and getting prescriptions for every flu they have.
Yup. Recently drove 6 hours (each way, twice) to get to a Canadian private clinic to get treatment. This saved approximately a year (or more) of waiting in the public system for a routine outpatient procedure that takes 30 minutes to perform. I was lucky this option was even available within driving distance though.
Canada's public healthcare system is massively overloaded and it seems to be getting worse.
I really didn't appreciate how much of a problem this is in my 20s and 30s (while I didn't need much healthcare) and it was easy to assume the bellyaching from older folks was overblown. Time makes fools of us all.
This is like the Canadian version of "no true Scotsman". When the province in question has 1/3 of the population of the country, what's the difference?
Yeah, so long as you can mooch off US healthcare innovation like COVID vaccines and weight loss drugs. There is a difference between going to doctor and getting effective treatment, as anyone who dealt with cancer in Soviet Union can testify.
I'm guessing you aren't aware how much of that innovation comes from academic research instead of direct private investment by pharma companies, or that there is a thriving pharmaceutical industry in places like Europe. Ironically your chosen examples are based on innovations pioneered by a German biotech (BioNTech) and a Danish pharmaceutical company (Novo Nordisk). What relevance the Soviet Union might have 34 years after it's collapse is something of a mystery.
- 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.
There are countries where private health insurance works great. The problem in US is how it is regulated.
United Healthcare is pretty big in the US, they are also famous for forcing people to spend a lot of time on the phone, waiting on hold or advocating for care. I expect the ends up taking time that the employee would otherwise have been working as well as negatively impacting morale.
It is just a really awful system overall.
"how much companies/employees pay for healthcare" is a poor metric too, because it would depend on the demographics of the company. You'd expect a startup of 30-somethings would have lower premiums than a company of boomers, even for the same coverage.
All the job interviews that went to the point of discussing compensation, healthcare benefits were almost always included when negotiating what actual compensation would be. A difference of them covering several hundred dollars a month in premiums and them matching some % of HSA contributions is several thousand dollars a year in compensation differences. When multiple job offers are pretty close, that can make a difference.
Also, the few times employers have offered healthcare concierge as a benefit it was definitely mentioned in the overall compensation package.
But for many normal jobs it’s very normal to use health care coverage as a negotiation or decision point.
That being said, nothing tells me the plans won't completely change in a few months of course. That's just the "game" and I also hate it.
Just give me the money directly and let me pick my plan from a marketplace that doesn't suck balls. If employers still want to give some incentives to be more competitive fine, but I shouldn't have to time my job switching to avoid coverage gaps.
Health insurance has been a primary topic in every job offer I’ve had, my entire career.
If a company won’t discuss the insurance situation or provide details about the employee contribution, that’s a warning sign. This is a routine topic for negotiations and any company hiding this data is not a company you want to be working with.
really it could not be because government is bad at managing massive programs and provides no incentive for high performance and efficiency....
But tax deduction or not isn’t what makes individual health insurance so expensive. When you have employer provided health insurance you’re in a completely different risk pool than people buying on the open market.
private healthcare is getting more and more expensive due to private prices available to bulk insurers but not for private person
even if this is not completely deliberate, effect is that you are "serf of whomever pays your insurance" or go bankrupt the moment you have any kind of emergency
in europe some private healthcare providers are showing their colors from different perspective, they outright refuse or cancel private contracts when you are above certain age
That's why in normal countries public healthcare is a thing and it competes with the private healthcare sector, forcing it to offer relatively affordable premium services.
using what money? Most people get their money from their employer.
It's funny that he (accurately) quotes the Cato Institute as being opposed to employer-provided health insurance... and then implies that the sole alternative is the NHS. Um, I'm pretty sure that's not what the libertarian Cato Institute was suggesting!
Employer health care may have bad externalities, but it has the extremely important (but... maybe invisible to the median libertarian) property that it constitutes collective bargaining. You can force insurers to cover folks they wouldn't want to otherwise by bringing more customers (employees) to the table.
It's so weird that even now, with the ACA having been proved out over decades, that we have to have these weird free market arguments. It didn't work, guys. It's not a good that works well in an efficient market sense.
100% untrue. There were affordable catastrophic coverage plans available, and many were made illegal by the ACA and the requirement to provide boutique services for "free" (i.e., forced to pay for even if you don't use).
I would say that the ACA is on the free market-ish side of the design space: individuals purchasing (subsidized) insurance from private companies.
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.
The term “private healthcare” is mostly referring to the fact that there is no such thing as non-private healthcare for the majority of Americans.
We're up to about a third now.
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 interesting: 3 states (Vermont, Colorado, and Massachusetts) did recently try to make state-level single-payer systems. https://www.thirdway.org/report/single-payer-health-care-a-t...
Of course, doctors do not earn nearly as much in England as the USA, thus good luck ever getting something like to change in the USA. In America, most people go to medical school for the prestige and the paycheck, and our system utterly reflects both.
(If Americans are thinking, "huh, that sounds like Obamacare / the ACA marketplace!" then you're right.)
In Germany there is nothing like bronze/silver/gold plans. All statutory health insurance covers what is required to be covered by regulations, with just a few bonus services, at the regulated tariff plus just a few percentage points of variation. So the 90% of people in Germany who have statutory health insurance [1] have essentially the same coverage. The tariff is a percentage of income (up to a cap), not a flat fee.
[1] not everyone is required to have statutory health insurance, for example employees above an income threshold and self-employed people
It is like parliamentarianism, campaign financing regulations, gun control, multiple political parties, etc. Americans call these things "Socialism" and then freak out about them and refuse to see any good on them.
Let's not pretend either system is perfect, or that the _underlying principles_ that both systems hold are the absolute correct way to organize a society.
Americans have be primed with _decades_ of rugged individualism and the idea that collective action is inherently weaker/flawed (just don't think about Social Security). It might have been reasonably true 100 years ago that everyone could pay for their own health care, but we're now in a world where the average person is perpetually on medications that are expensive to produce, and will demand increasingly expensive medical interventions throughout their life (heart health, cancer care, etc.). Combine that with AI probably wiping out a ton of industries/jobs - something has to change. I'm not going to pretend to have a solution, but I think it is disingenuous to suggest any EU nation has it figured out either and is obviously correct.
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.
This means we need to have ways in incentivize innovation (AI diagnostics, robotic procedures, drug discovery, deeper R&D).
Free Markets (with government controls against monopoly) are generally better than governments at delivering cost and quality improvements, but healthcare in most countries is somewhere between “100% not a market” and “70% not a market” (the US). In many cases, governments also actively create and enforce monopolies (eg AMA or local hospitals in the US).
There are a million other things but part of what is required for markets to work is skin in the game, which the UK, Canada, and the US all do bad jobs of in their own ways.
Some say medicine has no elasticity. I don’t think that is true for 90% of spend (for gunshot wounds, maybe, but most spending is on chronic diseases where multiple providers and approaches are available and people could price shop).
I would like to see more countries experiment with more free market healthcare. It’s remarkably effective for many pieces of healthcare.
The "Bismarck model"[0] describes a family of healthcare models where people pay into a central healthcare fund, and that fund then pays medical providers -- which can be private businesses.
[0]: https://en.wikipedia.org/wiki/Bismarck_model
It's just there's a single payer. Those businesses bill the provincial government instead of you. Most of the dysfunctions in the Canadian system come down to provinces screw around with billing and payment and funding.
Take your dissatisfaction with the way the government manages payments to the voting booth instead of advocating dismantling what is on the whole a quite equitable system that has a history of actually producing very good health outcomes.
I actually have on the whole extremely pleasant experiences here in my corner of Ontario. And then I hear horror stories.
The system is underfunded and inconsistent. The province is to blame for that.
It may outperform the US, but it doesn't outperform normal countries.
And vote for who? I have yet to hear a compelling solution from any party. At most, politicians advocate for throwing more money at the problem.
> The system is underfunded
Hot take: the system will always be underfunded. The demand for healthcare is nearly infinite in practice. What stops people from going to the doctor for every sniffle is either cost (in a private system) or waiting times (in a public system). If you had infinite resources to offer services, there are some folks who would be going in for MRIs every year "just in case" and getting prescriptions for every flu they have.
Canada's public healthcare system is massively overloaded and it seems to be getting worse.
I really didn't appreciate how much of a problem this is in my 20s and 30s (while I didn't need much healthcare) and it was easy to assume the bellyaching from older folks was overblown. Time makes fools of us all.