My recollection is that health care and other, similar benefits were incentives employers could offer to attract and retain talent during a period when FDR had wage and price controls in place. That is: healthcare was exempt from wage controls, so you could offer a healthcare plan or an improved plan in lieu of a raise.
Then, employers noticed, "you mean offering them healthcare makes it harder for our employees to leave? And public perception of healthcare means it will probably always be a tax advantaged way to allocate our expenses?"
And here we are, eight decades and change later.
Note: I think public perception of healthcare as a moral good in principle is correct. It's just that there's a wicked mal-alignment of incentives which leverages that perception to cement a bad solution in place.
That's basically my understanding of how we got into that mess. There are still significant tax subsidies for employer provided health insurance and most people don't realize that the COBRA price is the actual cost of their "cheap" or "free" employer provided insurance for the same reason they think their "income tax refund" is actually "free money" from the IRS rather than their money that the government held onto without interest.
The average person is not very smart and half of the population isn't even that smart so of course they fall for these intelligence insulting tricks invented by politicians.
Most people are otherwise able to navigate their life just fine, but they struggle with systems that are ridiculously complex and opaque. Industrial society reduces your direct agency and forces you to rely on more sophisticated forms of influence.
"Note: I think public perception of healthcare as a moral good in principle is correct. It's just that there's a wicked mal-alignment of incentives which leverages that perception to cement a bad solution in place."
That is everywhere now. Birth, education, courtship/marriage, employment, ... all the way to death - everything is analyzed, pessimized, and stripmined for every last penny. "Enshittification" is all over HN and with good reason.
Unfortunately, the US has a huge number of people who would rather have insurance-run for-profit death panels than government-run non-profit death panels.
I'm not downvoting you, because I assume uour comment was in good faith.
The phrase "death panels" though is unfortunate. Nobody has death panels, nobody wants death panels, no health system anywhere private or public has death panels. It's just a scary phrase used in a political context.
Ultimately all health systems make choices at every level of care. Triage is a thing. Organ recipient lists are a thing. Hospital occupancy, and theatre usage are things.
In a perfect world we'd all get perfect medical care the instant we needed it. There'd be scores of doctors sitting around doing nothing just waiting for my call. There'd be an endless supply of organs, replacement parts, hospital beds, theatres and surgeons.
We don't live in that world. Hence our systems have imperfections. Not everyone gets an optimal outcome. There are no "death panels". There doesn't need to be. Limitations and resource constraints force decisions at all levels every day.
Now personally I think a well managed public health system us the most equitable. Failing that private insurance has a role to play in combination either public health. Employer paid health insurance has grouping advantages, but also means you lose your income and health at the same time.
Steps for affordable personal health insurance are good. There's some way to go yet, but its a step in the right direction. Having at least some part of the health system be available to the uninsured (ie non-profit) would also be beneficial.
So yeah, the US system, as it is, is great for those who can pay, terrible for everyone else. It favours the few with good jobs, and secure tenure. If you're in that group, well done.
Other countries with national health have their own resource constraints. Not all individual outcomes are optional. And being rich doesn't necessarily jump you to the front of the queue. There are good outcomes, and bad outcomes, but they don't align to wealth or status (in theory.)
In the US its hard to change the status quo because the country is governed by the rich, paid for by the richer. The system currently favors the rich. QED.
> The phrase "death panels" though is unfortunate.
The phrase "death panels" is intentionally sarcastic mockery of the kind of people who unironically repeat Republican lies, by way of pointing out how even if the lie was true, it would be less harmful than the current state of affairs. I would have thought that was pretty obvious, but I guess not.
Arguably this is just a description of private insurance, ironically. A group of people decides who gets treatment and who doesn't—except the scarcity here is "profit", not a real resource.
In 1945, President Truman proposed a national healthcare plan to Congress. In his plan, he outlined five main goals:
Address the lack of trained healthcare professionals in all communities.
Grow public health services.
Increase funding to medical research and education.
Lower the cost of individual medical care.
Bring attention to the loss of income when severe illness takes hold.
> Patients sometimes went along with this, being indifferent between spending $4 of someone else’s money or $2000 of someone else’s money. Everything in the US health system is like this, and the Amish avoid all of it. They have a normal free market in medical care where people pay for a product with their own money (or their community’s money) and have incentives to check how much it costs before they buy it. I do want to over-emphasize this one, and honestly I am surprised Amish health care costs are only ten times cheaper than ours are.
People voluntarily getting together to do stuff and not forcing anything on anyone is pretty compatible with capitalism (whether it's 'capitalist' by itself is a question of definition).
The main thing I take from the article is: you can lower costs dramatically, if you can avoid some of the more onerous regulations. And as a second point: if you can build up a reputation for being honest and trustworthy, you can bring down transaction costs a lot.
The point about Amish never suing doctors mixes both: they are capitalising on that point via reputation; but in principle you could also sign those rights away with a contract. But while we allow companies to sign these kinds of contracts with each other, regulations doesn't allow patients to sign those rights away.
i'm sorry but this is a very anti-capitalist solution — a collective, shared resource in a community that everybody has access to if they contribute to it, and the organization is structured in a way that all participants have the chance to participate in the decision making.
you can rationalize that it's not however you wish but that won't change the fact that the amish community is very much at odds with capitalism, and the way they do healthcare is very anti-capitalist.
> People voluntarily getting together to do stuff and not forcing anything on anyone is pretty compatible with capitalism (whether it's 'capitalist' by itself is a question of definition).
this is how anarchism works, too. anarchism is an anti-capitalist political theory and one of the fundamental premise is free, voluntary association. people always see the words "free market" and conflate free market with capitalism when a free market can be a component of any economic structure.
it's okay if you agree with anti-capitalist solutions, i swear that the capitalist gods won't smite you. i appreciate scott alexander's slimely writing skills to get capitalists to think that an anti-capitalist solution is a good idea.
> i'm sorry but this is a very anti-capitalist solution — a collective, shared resource in a community that everybody has access to if they contribute to it, and the organization is structured in a way that all participants have the chance to participate in the decision making.
That's pretty silly. By the same token, you would have to argue that companies are anti-capitalists, because they are largely run on a command-and-control model. Or families are anti-capitalist.
