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Christopher B's avatar

I understand your interest in the moral dyad but there's also some practical and political drivers that are probably even more important. The preferential tax treatment of health benefits held over from WWII (another bad economic decision by FDR's brain trust) has long created an incentive for US companies to offer expanded health benefits in place of real wage increases. I like to say what companies offer is better understood as 'prepaid health care' than true insurance. In that light, the only way to unlock the value of the benefit is to utilize health services even when they are of low to no benefit. The advent of HSAs has pushed us away from that model a little bit but they really should be made universal, and adapted to Medicare/Medicaid. What we actually got wasn't a transition to a more stable and viable system but a reform designed to make providing employer-paid health insurance as painful as possible, the better to Cloward-Piven the system so companies would dump the entire mess back on the government.

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Roger Sweeny's avatar

One big reason for this result is that doctors are taught that people should not be able to do such cost-benefit calculations, that anything with possible benefits should be done, that it is in fact unethical to take costs into account.

In our system, insurance pretty much pays whatever the doctor orders. It would be shocking if costs did not constantly increase.

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