I have been paying close attention to the debate on health insurance for a few years. Lately I been hearing of more and more employers dropping health insurance or raising the deductibles for their employees. Judging from people I know, when their employer is not providing health insurance and people buy their own insurance they opt for high deductibles. This is IMO what needs to happen. Insurance should be only for what you cannot afford not for what you can afford. I think most Americans would be better off and have a better relationship with their insurers and health care providers if they had annual deductibles of $20,000 to $50,000. This would also cause some healthy price and spending consciousness. Today nobody is looking to save money on treatments and that has lead to absurd and spiraling health care spending.
I do not think employers would have taken on provision of health insurance for their employees if health care spending was 17% of the economy when they started. Spending 17% of the USA economy needs the attention of most all users with their individual situations and demands. Delegating the spending of 4% of the economy it to employers is much more sensible than delegating the spending of 17% of the economy to employers.
So aren't these trends likely to slow the rise in medical spending which is the only real problem with health care in the USA and if so is this just a needed adjustment?
One unrecognized fact that I have learned about health care is that health care beyond vaccinations, antibiotics and trauma care has very little impact on health. This idea has popped up again in the debate over how many lives would be saved if everyone had health insurance.
In theory universal health insurance save the person who due to a lack of insurance does not have a symptom checked until it is too late and so dies. Advocates of Government provided heath insurance like to cite a poorly done study that showed 40,000 premature deaths per year in the USA due to lack of health insurance but startlingly many more studies can find no additional deaths.
Everyone insured or uninsured gets the most effective basics; vaccinations, antibiotics and trauma care. Thankfully vaccinations, antibiotics are very cheap and affordable, they are cheap enough for public provision. Trauma care can be expensive but it is uncommon and has a big payoff, the patients are often young and most can completely recover and so can pay down a large bill over time.
Let me make a note everyone knows cancer survivors who are grateful that early treatment saved their lives but autopsies often find that people had cancer for over 30 years and died of something other that cancer. Also cancer treatment takes some lives, operations and hospitals are dangerous. We really do not know how many lives Cancer treatment saves because some cancer is slow growing and probably would not have killed and fast growing cancer often kills despite treatment. It is only in cases of moderately growing cancers that lives are saved. We do know which particular cases of cancer are slow growing which is why it is mostly treated
Some people may counter that if one life is saved then we should do it, but this is inconsistent and counter productive. It is inconsistent in that we know a lower speed limit could greatly reduce deaths due to auto accidents but we do not want that. It is counter productive in that if it makes us poorer we could loose lives for other reasons (one simple example is that driving is much more dangerous than flying and the richer we are the more likely we are to fly than drive on long trips).