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Brian Villanueva's avatar

We've convinced ourselves that everyone "deserves" to have high quality homes, health care, education, etc... It's demeaning to have "substandard" levels of quality, so we regulate them until providing bare bones versions is illegal.

Housing: We used to have boarding houses, SROs, hostels, etc... But middle-class activists got rid of those options via zoning codes. Unfortunately, middle-class+ legislators never got around to actually providing a cost effective alternative.

Health Care: Health insurance used to all be "catastrophic" only. Minor stuff was on you, but if you had a car accident or got leukemia, they'd step in to cover (most usually) of the costs. But we decided making sick people worry about price was icky, and after all, everyone deserves health care, so we did away with those. Obamacare was the final nail in the coffin of those plans. And not surprisingly, health care costs skyrocketed.

Education: Why couldn't we have small, public schools that replicate the 1-room schoolhouse (or 2-3 room if you like) model of 100 yers ago? We know it works. Less overhead. More parental involvement. More accountability both ways. But rules about school construction and red tape have effectively made that impossible. Oh, it still exists, but only for parents that can afford private or home education.

We need to learn to tolerate more diversity of quality in many things. One size fits all generally fits almost no one well.

Richard's avatar

Health insurance costs are driven by health care costs. One should not conflate the two. The margin is fairly thin. All sane employers try to reduce that margin in their negotiations with the insurance industry. CMS appears to do the same. Adding mandatory benefits greatly increases costs as more providers get to play. Initially, Obamacare did this big time but seem to have backed off a bit. Raising deductibles and copays has a pretty dramatic impact on premiums but that just offloads some of the costs to households. But the big influence on costs is financialization of the health care industry including medical practices, hospitals, nursing homes, physical therapy practices, pharmacies and even veterinary practices. Another large influence is the aging of the population for which there is no solution. The big influence on premiums is all the people getting free stuff. Basically Medicaid and the EMTALA. This drives up the costs for everyone else as providers seek to recover their losses. Medicare is a benefit paid for by a career's worth of mandatory deductions. This is buried in the FICA deductions so many don't realize it exists. There are also ongoing premiums for Parts B and D. And for tall poppies, there is IRMA. Health insurance has always subsided the sick at the expense of the healthy. It is a design feature. If you are healthy and subsidizing the sick, you are the winner. This feature is perverted when health insurance covers predictable, routine stuff.

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