I seem to recall a study looking at small business formation, etc and it is stunted here compared to other Western countries. I consulted in this area in my career and employers would talk about employees who ‘retire in place’ as they wait for Medicare.
There is no question that fragmenting our risk pool creates a lot of waste and inefficiency. No way our insurance and pharmaceutical industries will let any significant change occur
Here is an article in The Economist from 17 July called "Quantifying Trumpcare", for those who do not subscribe:
JUST READING the Big Beautiful Bill, with its 330 pages of provisions, is an intimidating undertaking. Working out its consequences is yet more challenging. Nevertheless, researchers at the University of Pennsylvania and the Yale School of Public Health tried to calculate how many more people would die as a result of the law. Analysing the House of Representatives’ version of the bill, they came to 42,500 annually by 2034. That is more people than currently die of breast cancer. Adding in the impact of the end of the enhanced subsidies for people buying their own insurance, they reckoned there would be over 51,000 extra deaths a year. The White House has pushed back on the claims of deaths, calling them “egregious” and “deranged”.
The researchers’ method was straightforward enough. The Congressional Budget Office (CBO) estimated the impact of the bill on Americans’ access to care. The researchers then looked at studies on insurance coverage and mortality, then predicted 11,300 deaths a year from lost coverage.
Two lesser-known bits of the legislation account for the rest of the deaths. Joe Biden’s administration imposed minimum staffing standards on care-homes and made it easier for people to enroll on both Medicaid (health insurance for the poor) and Medicare (health insurance for the elderly). Both changes were yet to take effect fully and the tax bill scrapped them. Because they were aimed at helping very sick people, getting rid of them raises mortality rates a lot.
Given the enormity of the bill, any estimate of its effects will be uncertain and incomplete. The researchers could only look at some health impacts, and even then, numbers constitute their best guess. “It’s probably an underestimate,” says Rachel Werner, one of the University of Pennsylvania researchers behind the study. The study only looked at only some of the law’s provisions and the CBO’s forecast for the uninsured grew after the Senate rewrote the bill. And still, for all those that die, a much larger number will be sicker and live worse lives. ■
It would be interesting to compare the situation in the USA with Canada, the UK and European nations. Most other countries looking into the USA can't believe how expensive the US system is and how many people have difficulty accessing healthcare.
Fascinating! Thanks for the history lesson on where this got started. I would call this a government failure. By getting involved in this, through the IRS, government makes the health insurance market less efficient.
The reality is that a large employer insuring this risk is actually pretty inefficient. Law of large numbers…if you’re big enough it’s pretty straightforward to reasonably accurately predict the cost.
Great article! I had not considered what the effects of these insurance schemes had on economic mobility. People may be willing to move for a better opportunity but opt against because of insurance
I seem to recall a study looking at small business formation, etc and it is stunted here compared to other Western countries. I consulted in this area in my career and employers would talk about employees who ‘retire in place’ as they wait for Medicare.
There is no question that fragmenting our risk pool creates a lot of waste and inefficiency. No way our insurance and pharmaceutical industries will let any significant change occur
Here is an article in The Economist from 17 July called "Quantifying Trumpcare", for those who do not subscribe:
JUST READING the Big Beautiful Bill, with its 330 pages of provisions, is an intimidating undertaking. Working out its consequences is yet more challenging. Nevertheless, researchers at the University of Pennsylvania and the Yale School of Public Health tried to calculate how many more people would die as a result of the law. Analysing the House of Representatives’ version of the bill, they came to 42,500 annually by 2034. That is more people than currently die of breast cancer. Adding in the impact of the end of the enhanced subsidies for people buying their own insurance, they reckoned there would be over 51,000 extra deaths a year. The White House has pushed back on the claims of deaths, calling them “egregious” and “deranged”.
The researchers’ method was straightforward enough. The Congressional Budget Office (CBO) estimated the impact of the bill on Americans’ access to care. The researchers then looked at studies on insurance coverage and mortality, then predicted 11,300 deaths a year from lost coverage.
Two lesser-known bits of the legislation account for the rest of the deaths. Joe Biden’s administration imposed minimum staffing standards on care-homes and made it easier for people to enroll on both Medicaid (health insurance for the poor) and Medicare (health insurance for the elderly). Both changes were yet to take effect fully and the tax bill scrapped them. Because they were aimed at helping very sick people, getting rid of them raises mortality rates a lot.
Given the enormity of the bill, any estimate of its effects will be uncertain and incomplete. The researchers could only look at some health impacts, and even then, numbers constitute their best guess. “It’s probably an underestimate,” says Rachel Werner, one of the University of Pennsylvania researchers behind the study. The study only looked at only some of the law’s provisions and the CBO’s forecast for the uninsured grew after the Senate rewrote the bill. And still, for all those that die, a much larger number will be sicker and live worse lives. ■
It would be interesting to compare the situation in the USA with Canada, the UK and European nations. Most other countries looking into the USA can't believe how expensive the US system is and how many people have difficulty accessing healthcare.
Fascinating! Thanks for the history lesson on where this got started. I would call this a government failure. By getting involved in this, through the IRS, government makes the health insurance market less efficient.
Yes, that's a good example. The history lesson was helpful for me, and I didnt know how many people already knew this part of our economic history.
What really surprised me in the US is that the employer can be the insurer - i.e. they take on the claims payment risk.
The reality is that a large employer insuring this risk is actually pretty inefficient. Law of large numbers…if you’re big enough it’s pretty straightforward to reasonably accurately predict the cost.
True.
Great article! I had not considered what the effects of these insurance schemes had on economic mobility. People may be willing to move for a better opportunity but opt against because of insurance
Job-lock is a real thing. I know many people who have stayed put to avoid healthcare changes.
This is a great example of path dependence. I just can't see a world where we break free from employer-sponsored healthcare.
It's going to be tough, especially with the political aspect involved.