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What happens to Health Insurance Industry if we get universal healthcare?

blackjack50

blackjack50

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I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?


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blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?


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If you are talking about what happens in the event health care is nationalized then I imagine they would move to the new public and private sector jobs that would be made for implementing care. That seems to be the trend in nations that transitioned to such systems.
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?
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What definition are you using for universal health care?

Wikipedia & Google seems to think that phrase means that everyone has coverage.

That sounds like it would mean that the insurance industry would have more clients rather than fewer.
So the people employed would be busier rather having their jobs disappear.

What do you mean when you use the phrase "universal health care"?
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?
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It's country dependent, but in most countries with universal healthcare health insurance companies still exist. In Germany, for example, you can freely pick which insurance company you want to go with, just like you do in the states. My wife's brother works at a gigantic insurance company and I assure you he and the rest of his company make bukus upon bukus of money. Everyone really can win in this, Americans can get healthcare and the insurance companies can make money, it isn't like we're going to throw the insurance people into the sun or something.
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?


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I think I read that like 2/3rds of Canadians buy supplemental private health insurance, so I doubt that the industry would just disappear.
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?


Sent from my iPhone using Tapatalk
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As any "universal" health care would by necessity ration treatment in some way or another, most persons with halfway good income would get extra coverage.
 
RabidAlpaca said:
Everyone really can win in this, Americans can get healthcare and the insurance companies can make money, it isn't like we're going to throw the insurance people into the sun or something.
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It's disingenuous to claim there will be administrative savings while also denying that the admin sector of health care will shrink (which, yes, means job losses).

That's not a bug, it's a feature, as the underlying premise behind the argument that we need administrative savings is that health care admin is unjustifiably bloated and many or most of those people should instead be working in some other sector of the economy.

If single-payer is just shuffling the deck chairs, then there won't be any savings relative to the status quo.
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?


Sent from my iPhone using Tapatalk
Click to expand...
Some will remain to provide supplemental insurance, some will provide administration, some will be removed from health care.

Except in the supplemental markets, profits will be eliminated or curtailed.
 
Greenbeard said:
It's disingenuous to claim there will be administrative savings while also denying that the admin sector of health care will shrink (which, yes, means job losses).

That's not a bug, it's a feature, as the underlying premise behind the argument that we need administrative savings is that health care admin is unjustifiably bloated and many or most of those people should instead be working in some other sector of the economy.

If single-payer is just shuffling the deck chairs, then there won't be any savings relative to the status quo.
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Agreed.

But where those remain to provide administration, a substantial amount of the "pure profit" component will likely be eliminated.
 
Chomsky said:
Agreed.

But where those remain to provide administration, a substantial amount of the "pure profit" component will likely be eliminated.
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What concerns me is that so many single-payer advocates don't want to acknowledge what they're really talking about. There needs to be an honest discussion of the trade-offs and realities of transitioning to that system.

I remember watching Bernie himself do the same thing at a townhall last year. A supporter who works in health insurance asked him this very question and he told her that under his proposal people wouldn't lose their jobs, they would just get shuffled to other areas of health care. That's either not true or there won't be any savings to boast about.
 
Greenbeard said:
What concerns me is that so many single-payer advocates don't want to acknowledge what they're really talking about. There needs to be an honest discussion of the trade-offs and realities of transitioning to that system.

I remember watching Bernie himself do the same thing at a townhall last year. A supporter who works in health insurance asked him this very question and he told her that under his proposal people wouldn't lose their jobs, they would just get shuffled to other areas of health care. That's either not true or there won't be any savings to boast about.
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I respect your opinion in this matter, and believe you are better versed in it than I.

But it seems to me the best way to go about this might be a stepped-graduation transition to Medicaid or Medicare over a period of time, keeping our private-provider infrastructure intact.

For example, bring the Medicare age level down 3-5 years every year, raise the Medicaid cut-off 'x' amount of dollars every year, etc.
 
Chomsky said:
I respect your opinion in this matter, and believe you are better versed in it than I.

But it seems to me the best way to go about this might be a stepped-graduation transition to Medicaid or Medicare over a period of time, keeping our private-provider infrastructure intact.

For example, bring the Medicare age level down 3-5 years every year, raise the Medicaid cut-off 'x' amount of dollars every year, etc.
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Certainly a transition of some sort would be necessary.

The issue I have is that, as I understand it, the selling point of single-payer over more incremental (some would say realistic) options is that it's disruptive--it has a bigger impact faster. We have big savings from slashing administrative costs and streamlining things, we immediately start to push health care prices downward through price-setting, whatever.

Those are huge things! Lots of people would find themselves out of a job, some providers wouldn't be able to keep their doors open. Health care is a major employer everywhere. In some places it's the employer (see The Largest Employer in Every State from this month: "In 14 states, a health care network is the largest employer, including Partners HealthCare in Massachusetts, which employs 68,000 people. Several of these health care networks are also part of a university system, such as the University of Pennsylvania Medical Center, which employs 61,000 people in the state.") You suck money out of that industry overnight, as some single-payer advocates promise to do, and there will be major repercussions.

That's why this is hard. And when you press people on this, they dial down the disruption. They begin to downplay the layoffs and the pay cuts and the savings. But the disruption is one of the points of the whole thing! If you take the edge off the disruption, you're reducing the impact of the change and undermining the rationale for doing something so drastic in the first place. And the unwillingness of even the zealots to own the intended impacts, much less embrace them, should be a major red flag for the feasibility of the whole thing.
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?


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Click to expand...

The health insurance industry makes a crapload more money.

A nice fat fee for managing the universal government system... with no risk. Just as they manage Medicare and Medicaid now and get paid for it.

AND then they offer supplemental.. and expensive supplemental health insurance to the wealthy and upper middle class.
 
Greenbeard said:
Certainly a transition of some sort would be necessary.

The issue I have is that, as I understand it, the selling point of single-payer over more incremental (some would say realistic) options is that it's disruptive--it has a bigger impact faster. We have big savings from slashing administrative costs and streamlining things, we immediately start to push health care prices downward through price-setting, whatever.

Those are huge things! Lots of people would find themselves out of a job, some providers wouldn't be able to keep their doors open. Health care is a major employer everywhere. In some places it's the employer (see The Largest Employer in Every State from this month: "In 14 states, a health care network is the largest employer, including Partners HealthCare in Massachusetts, which employs 68,000 people. Several of these health care networks are also part of a university system, such as the University of Pennsylvania Medical Center, which employs 61,000 people in the state.") You suck money out of that industry overnight, as some single-payer advocates promise to do, and there will be major repercussions.

That's why this is hard. And when you press people on this, they dial down the disruption. They begin to downplay the layoffs and the pay cuts and the savings. But the disruption is one of the points of the whole thing! If you take the edge off the disruption, you're reducing the impact of the change and undermining the rationale for doing something so drastic in the first place. And the unwillingness of even the zealots to own the intended impacts, much less embrace them, should be a major red flag for the feasibility of the whole thing.
Click to expand...


And bingo was his name-o
 
CriticalThought said:
If you are talking about what happens in the event health care is nationalized then I imagine they would move to the new public and private sector jobs that would be made for implementing care. That seems to be the trend in nations that transitioned to such systems.
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Single payer wouldn't nationalize healthcare but would, to a significant degree, result in basically a nationalization of the health insurance industry.
 
blackjack50 said:
I am just curious what happens to those employed in the health insurance industry? Do their jobs just disappear? I'm not exactly sure how many people are employed in the industry, but it is not a small number. Is this something people think about?
Click to expand...

I think they'd change their models to either provide extra coverage for certain things or Cadillac healthcare for more well off people. Some would probably transfer over to fill positions in the government single payer system, which should just be an expansion of Medicare.
 
Greenbeard said:
Certainly a transition of some sort would be necessary.

The issue I have is that, as I understand it, the selling point of single-payer over more incremental (some would say realistic) options is that it's disruptive--it has a bigger impact faster. We have big savings from slashing administrative costs and streamlining things, we immediately start to push health care prices downward through price-setting, whatever.

Those are huge things! Lots of people would find themselves out of a job, some providers wouldn't be able to keep their doors open. Health care is a major employer everywhere. In some places it's the employer (see The Largest Employer in Every State from this month: "In 14 states, a health care network is the largest employer, including Partners HealthCare in Massachusetts, which employs 68,000 people. Several of these health care networks are also part of a university system, such as the University of Pennsylvania Medical Center, which employs 61,000 people in the state.") You suck money out of that industry overnight, as some single-payer advocates promise to do, and there will be major repercussions.

That's why this is hard. And when you press people on this, they dial down the disruption. They begin to downplay the layoffs and the pay cuts and the savings. But the disruption is one of the points of the whole thing! If you take the edge off the disruption, you're reducing the impact of the change and undermining the rationale for doing something so drastic in the first place. And the unwillingness of even the zealots to own the intended impacts, much less embrace them, should be a major red flag for the feasibility of the whole thing.
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Whoa, there.

I'm speaking of single-payer/private-provider, not single-payer/public-provider.

The provider network will remain intact, but the insurance industry would be partly revamped. Yes there will be huge changes, but the providers would be left reasonably intact. And private insurance and fee-for-service providers would remain intact for those that desire, but yes the fee-for-service providers would have to accept receiving single-payer reimbursement if their free-market clientèle recedes.
 
Chomsky said:
And private insurance and fee-for-service providers would remain intact for those that desire, but yes the fee-for-service providers would have to accept receiving single-payer reimbursement if their free-market clientèle recedes.
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And that's the issue I'm talking about. That reimbursement either:

1) Remains largely at the level it's at right now, which is good for stability but means there isn't much in the way of savings to speak of. And also means roughly the full $1.1 trillion/year that's current being paid out to providers by private insurers needs to be collected via new taxes and paid out by the single-payer entity. Or,

2) Prices are artificially pushed downward by the single-payer entity and reimbursement does in fact drop materially below where it sits today. Which means real savings (from the payer's point of view, anyway), but also real disruption and, if we're being honest, pain. That's where we start talking about layoffs, pay cuts, and perhaps even facility closures.

It's all really just twisting the dials to calibrate between those two things: more disruption to the status quo means more immediate savings but also a significant human toll. By the end of this decade, health care will be the largest employment sector in the economy. If we decide to shake things up and say that industry's too bloated and we'll abruptly cut off the spigot of money flowing into it, that means a lot of those jobs go away.

But on the other hand the more the disruption is tamped down and the status quo is preserved, the more new revenue the feds need to raise through taxes to cover the spending currently accounted for by the private sector. And the more one might ask what the point is (not that there aren't any! but there is a depth of introspection and goal-setting that I rarely see people go to when talking about single-payer).
 
Greenbeard said:
And that's the issue I'm talking about. That reimbursement either:

1) Remains largely at the level it's at right now, which is good for stability but means there isn't much in the way of savings to speak of. And also means roughly the full $1.1 trillion/year that's current being paid out to providers by private insurers needs to be collected via new taxes and paid out by the single-payer entity. Or,

2) Prices are artificially pushed downward by the single-payer entity and reimbursement does in fact drop materially below where it sits today. Which means real savings (from the payer's point of view, anyway), but also real disruption and, if we're being honest, pain. That's where we start talking about layoffs, pay cuts, and perhaps even facility closures.

It's all really just twisting the dials to calibrate between those two things: more disruption to the status quo means more immediate savings but also a significant human toll. By the end of this decade, health care will be the largest employment sector in the economy. If we decide to shake things up and say that industry's too bloated and we'll abruptly cut off the spigot of money flowing into it, that means a lot of those jobs go away.

But on the other hand the more the disruption is tamped down and the status quo is preserved, the more new revenue the feds need to raise through taxes to cover the spending currently accounted for by the private sector. And the more one might ask what the point is (not that there aren't any! but there is a depth of introspection and goal-setting that I rarely see people go to when talking about single-payer).
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Yours is a very good assessment of the macro forces involved in balancing cost-savings with industry hardship, and I agree 100%.

I believe we are eventually going to have to clamp down using your option #2, if we are to provide adequate and available care over the vast majority of the country. But in this country, capital, corporate, and profit interests weigh heavier than elsewhere, along with having direct and effective influence on our government.

I have no idea where the line may fall here, but cost containment is I believe the largest issue we face - above all else!
 
Chomsky said:
I have no idea where the line may fall here, but cost containment is I believe the largest issue we face - above all else!
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Agreed.

But let me make a provocative observation. H.R. 676, the perennial House single-payer bill that currently has 72 co-sponsors, calls for converting all for-profit health care providers to not-for-profit status.

But one could make the argument that for-profit hospitals (which only make up about one in five community hospitals) are actually better positioned for a world in which everyone rolls into Medicare. And that's because they tend to be more efficient and have lower cost structures--as a result they currently tend to make money on their Medicare business while not-for-profit hospitals tend to lose money on Medicare.

This is from MedPAC, the body that advises Congress on Medicare payment policy, a few years ago:

In aggregate, overall Medicare margins at for-profit hospitals were positive in 2012, well above aggregate margins for nonprofit hospitals. In 2012, the aggregate overall Medicare margin for for-profit hospitals was 1.5 percent compared with –7.1 percent for nonprofit hospitals, an 8.6 percentage point differential. In aggregate, for-profit hospitals have higher inpatient margins (6.4 points higher) and higher outpatient margins (11.2 points higher) than nonprofits. Our analysis of data in recent years shows that most of the differential in margins can be explained by lower cost structures for inpatient and outpatient care at for-profit hospitals. However, a detailed analysis of 2009 outpatient services indicates that for-profit hospitals’ outpatient margins also benefit somewhat from a more favorable service mix and from being less likely to incur outpatient teaching costs (see text box, p. 68)
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So if a major goal of single-payer is to go after the high cost structures of this industry that we're all paying for, should we be looking to the for-profit sector to lead the way, or are we at least prodding nonprofit providers to think and act more like for-profit providers?

I don't know that the average single-payer advocate would be comfortable putting it like that--but digging into the implications of an idea shouldn't always be comfortable!
 
Chomsky said:
Yours is a very good assessment of the macro forces involved in balancing cost-savings with industry hardship, and I agree 100%.

I believe we are eventually going to have to clamp down using your option #2, if we are to provide adequate and available care over the vast majority of the country. But in this country, capital, corporate, and profit interests weigh heavier than elsewhere, along with having direct and effective influence on our government.

I have no idea where the line may fall here, but cost containment is I believe the largest issue we face - above all else!
Click to expand...


Disagree. Cost containment when it comes to the medical industry has been going on for some time. I make less per patient today than I did in 2005. I made less in 2005.. than I made in 1995.

The only reason that overall costs have increase is because of demand.
 
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