Comment by Spooky23 | Hacker News Reader

Comment by Spooky23 | Hacker News Reader

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It’s not that simple. Pretax premiums could be wiped out with the stroke of a pen.

I worked at an entity with 300+ thousand employees and Probably another 200k retirees… I was able to pay full cost to retain my health insurance from them.

The benefits and out of pocket costs are incredible - my current CEO asked me why I do that rather that use the company insurance and I walked through it with him. It’s not possible to buy that coverage, between the legacy insurance plan and huge risk pool, only the largest entities can have the best insurance.

The “simple answer” is pretty easy. Put a 10% payroll tax with a $5M income cap, and build out Medicare with whatever benefits are doable under that cost structure. Let the market compete for extended benefits, which would work like a traditional insurance market.

The doctors and medical industries would be happy. People would gain newfound job mobility and freedom. Most people would save money vs the payments they make today. Rich people would be sad because taxes.

> People would gain newfound job mobility and freedom

Something tells me the people in charge most definitely do not want this at all…

> Rich people would be sad because taxes.

Something tells me the people in charge most definitely do not want this at all…

It is sad how many allegedly and vocally "free market" capitalists don't actually want a liquid and free labor market. The shame is that most of them also don't know what "free market" technically means anymore.

“Free market” means freedom to exploit resources without government oversight. It’s not in any way related to fairer labor regulations (those are usually undesirable for free market absolutists, by definition)

That's a fun "modern" twisted definition intentionally skewed from how Adam Smith, among others, would define "free market":

> For classical economists such as Adam Smith, the term free market refers to a market free from all forms of economic privilege, monopolies and artificial scarcities.

Employer-defined healthcare creates troughs of economic privilege, builds monopolies with respect to laborers, and enforces artificial scarcity in the supply of labor. It removes liquidity in the labor market if laborers aren't free to bid their labor to the highest bidder at any time simply because they can't risk their own health care. It's not a "free market" determined "solely" by supply and demand when the supply is artificially limited by the rent seeking inherent to employer-defined healthcare, no matter whether or not you think the solution is fairer labor regulations or how much you claim to hate government oversight. That's a market failure.

A free market is maximally competitive. The giant corporations of today are planned economies run to maximize returns to shareholders by eliminating competition.

Shareholder return is not a free market function, in fact for most businesses it’s in the interest of the shareholder to have zero competition, as competitive forces require expenditure in labor and dollars to improve the product at lower margin.

Apple is the best consumer example of this. In segments where there are no competitive forces, say Mac displays, they ship high margin, mediocre products for an extended lifecycle. You can buy a shitty LG for half the price of a mediocre Apple model. The same thing happened in the pre-retina cheap MacBook Air - that thing lived 3 years too long because where else are you gonna go?

What’s not “free” about the PC display market? Who’s preventing competition on it?

No one said anything about “fairer labor regulations”, only a “free and liquid market in labor”. Free movement of labor is, as much as free movement of goods and capital, a component of a free market. Restrictions on labor movement are market restrictions which make a market non-free.

A free and liquid market in labor has some overlap with what people concerned with fairer labor market regulations want, but in other areas is diameteically opposed to what they want.

Free markets are unrealizable abstractions that lots of people like to appeal to vaguely, but very few consistently favor as more than a rhetorical device.

So the only entities who might contribute to a less free market are governments? Nobody else?

I think they do know and that's why they don't want it.

Very few people seem to understand what a free market is, although it is very clear what it is.

> only the largest entities can have the best insurance

Exactly. The bigger the better.

I'm still baffled why local and state govts aren't easing into a public option.

Ditto the largest (self-insured) employers. It'd be so easy to extend benefits to their partners, local supporting businesses (eg daycares), and so forth.

> I'm still baffled why local and state govts aren't easing into a public option.

That's easy enough to answer: lobbying efforts by major insurance companies (and insurance company adjacent companies) prevented it. In many states such lobbying efforts prevented it entirely in the legislature adding direct laws and some state constitutional amendments that states explicitly weren't allowed to build a public option as a part of their healthcare exchanges. It was a big part of the uproar when the ACA was passed at the federal level, a big part of why many states' healthcare exchanges were sabotaged and broken on Day One, and a large part of why the ACA itself made too many compromises in how it established the state-driven healthcare exchanges.

Hmmm. If you happen to know any one or org working on this, I'd greatly appreciate it. TIA

Most lobbying problems root cause analysis some way or another to the great need for Campaign Finance Reform [1]. (A problem the US has been overtly struggling with since 1828. Made so much worse and deeper in the 2010 Citizens United Supreme Court decision and the rise of the "Super-PACs".)

[1] https://en.wikipedia.org/wiki/Campaign_finance_reform_in_the...

> I'm still baffled why local and state govts aren't easing into a public option.

Because socialism is well known for unsustainable costs and poor service.

Larger health insurance pools are better. Regardless of societial structure.

Right, like how Walmart and McDonald's are subsidized by taxpayers.

Businesses like Walmart and McDonald's should pay their own costs without relying on the crutch of the public purse.

If these businesses are so inefficient that they can't survive without handouts then it is good and proper and correct that they die off and be replaced by more efficient businesses.

Further: All wealth is the result of governmental largess. Who benefits -- oligarches or the middle class -- is the neverending food fight.

h/t economist Kevin Phillips.

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