Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger

Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?

There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is very much in the pocket of the health care industry. As such, the markets were a compromise measure enacted by congress to make it easier for people to choose health care. Before Obamacare, it was sort of a black box where only HR people could figure out pricing structures and health care providers didn't really compete in any way with each other.

Obamacare did do some good things that needed to be done, but essentially, everything about it was a bandaid intended to kick this shitty system down the road to the next person who had to deal with it. But hey, at least health care companies can't just turn you down because you have Diabetes or are too fat anymore.

There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.

The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player.

http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.

Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with.

The difference is that with most socialised systems there are two system in parallel:

A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years".

And a private system, whose priorities are, like in the US, based on how deep your pockets are.

For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator:

If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up".

If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers).

The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.

Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government.

Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.