The Problem(s) with Healthcare

Why do companies even provide healthcare insurance?

It doesn’t seem to make any sense that whether or not you have good healthcare should be at all dependent on whether and where you are currently employed. I can easily leave my job without worrying about getting new car insurance, but leaving my job may mean I need to switch my doctors and/or expect my costs to drastically increase. In my opinion, this gives employers a lot of leverage in employment situations, in a way that isn’t good for society. People staying in a job just for healthcare aren’t thriving, aren’t working on something they are passionate about, and aren’t contributing as much as they could be.

Why is healthcare so expensive?

This is the 3.5 TRILLION dollar question. The U.S. famously spends more per capita on healthcare to produce worse results than other industrialized nations. There seem to be quite a few contributing factors, here.

  • Customers aren’t incentivized to care about price
  • Customers may be in a state of distress or emergency
  • There is a lack of transparency around cost
  • The system bills for services and not for outcomes
  • Incentivize consumers to care about cost — Costs won’t drop unless the people paying for the service care what it costs, and have options.
  • Make costs transparent — The Surgery Center of Oklahoma does not accept insurance and has publicly available prices for all services offered. They seem to be beloved and successful, and could serve as a lesson going forward. Forward Preventative Healthcare similarly has a transparent cost model, and does not accept insurance.
  • Focus on outcomes over services — The Surgery Center does not up-charge due to complications or if the proposed solution didn’t work. They see that as a failure of their doctors to properly evaluate the issue and prepare for the procedure. Employer plans are also shifting to favor outcomes, focusing on value-based care instead of volume-based care. By incentivizing providers to focus on outcomes, rather than how many billable actions they can fit into a visit, care should improve and unnecessary spending should decrease.
  • Consider disconnecting insurance from employment — I’m hesitant to recommend anything too drastic, here, as the lesson from the 1942 Congress is that there are unintended consequences. It seems a single-payer government option alongside private insurance options (disconnected from employers) would be a strong option consistent with America’s values. This would mirror our education system, but hopefully with much clearer success criteria.

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