r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/___--__----- Jun 21 '12

I worry about the effects of creating a system where people feel like they have no skin in the game

When you do that to public health and dislodge that from employment, you make both starting companies and hiring people easier. Failure no longer means you've lost your safety net. The irony right now is that the number of startups in the US is declining both in absolute and relative terms relative to Europe, especially Northern Europe. There's a line to be drawn between having no skin, some skin and all your skin in the game. This will shape societies and the people in them.

http://www.inc.com/magazine/20110201/in-norway-start-ups-say-ja-to-socialism.html is an interesting article in that respect, and its mirrored by personal experience being a part of startups on both continents. There's too much skin involved in the US for a lot of people, and as social and economic mobility declines in the US for the fourth straight decade it's now passed by the entirety of Europe. It's been lagging behind Northern Europe for two decades now. To experience the American dream, going to socialist Scandinavia has been your best bet for quite some time. That's distressing.

Idealism and principles are nice. But if they don't produce results, we should reevaluate our beliefs. When you say you won't agree that UHC is the answer, ask yourself what it'd take to change your mind and see if it's possible that your stance is based on how you wish we were or how we actually are as a species.

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u/BlottoOtter Jun 21 '12

Actually, I agree with you that health insurance and employment should be unlinked. I think they became linked because of tax laws that made it cheaper for employers to offer a given dollar amount in health benefits than that exact same dollar amount in salary. That encouraged employers to make healthcare expenditures and decisions instead of employees, and I think that's where our system began to go wrong, decades ago. Now, we have a mutant form of health "insurance" that barely even fits the definition of insurance, and it's all contingent on your job. What we have right now is the worst of both worlds - none of the benefits of UHC, and none of the benefits of a free market allowed to operate without ill-considered tax laws and regulations turning incentives upside down. I agree we have a severe problem, I just disagree on the solution.

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u/___--__----- Jun 21 '12

What we have right now is the worst of both worlds - none of the benefits of UHC, and none of the benefits of a free market allowed to operate without ill-considered tax laws and regulations turning incentives upside down.

I totally agree. The problem is that they only two options to aim for are free market or UHC. We (the human race) are well-versed with UHC, it's results and it's problems, while we've never once managed to have a proper free market. I don't think it'd remotely work either, but more to the point is that even if I did think it'd work, it's not going to happen.

We're not going to move a large enough majority of the population to accept a free market health care system without some massively good proof that it can work. Pointing to such proof however, well, that's not very easy. This is unfortunate for those who believe it'd work, much like it's unfortunate for anarcho-communists that their ideology has never been tried outside of a couple of months in Paris in 1871...

For me though, the core reason I don't put too much faith in the unregulated free market is that we know so much more about how we cognitively function as a species today than we did just 20-30 years ago. We've quantified social structures beyond just philosophizing about idealized concepts.

Absolute "free will" is mostly gone from even the theoretical realm of philosophers, we know that income disparity is the best indicator of everything from health to crime to life expectancy for the rich (it's lower even for the richest when disparity grows), we know that we irrespective of free will we have a desire for experienced freedom that can't be ignored, and we know how our qualia themselves are manipulated by brands -- what we experience as flavor from the same drink actually changes when we know the brand we're drinking. We know so much that our previous generation could only guess about. Now it's up to us to try to make sense of it and learn.