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Illustration: Sarah Grillo/Axios
Democrats' Medicare for All debate has turned into a referendum on the existence of private health insurance. But simply having private health insurance isn't the weird thing about the U.S. system — the weird thing is how we go about it.
Employer-based insurance is the biggest source of coverage in the U.S. And that arrangement persists not necessarily because it's a great way to finance a health care system, but because it's a great tax break for businesses.
"In other countries [employers will] contribute, but not be responsible for providing the insurance," said Irene Papanicolas, a health economist at the London School of Economics.
The best comparison for the U.S. might be the Netherlands, which has universal coverage through heavily subsidized private insurance.
Yes, but: Polls consistently show that people like their employer-based insurance and don't want to lose it. I asked Ashish Jha, the director of Harvard's Global Health Institute, whether that's a real endorsement or a form of status-quo bias. He chose the latter.
The Wall Street Journal reports that HHS is thinking about forcing doctors and hospitals to publicly disclose how much they get paid from insurance companies — not just the list prices they start out with.
Why it matters: WSJ sums it up nicely — this move "would expose for the first time the actual cost of care."
Between the lines: The rates negotiated between insurers and hospitals are highly prized secrets for both parties.
Hospitals were already miffed at the administration for making them post their list prices, or "chargemasters." Expect to see even stronger industry pushback against this latest idea.
The intrigue: HHS actually released this proposal a month ago, but no one noticed until now because it was tucked into a 724-page rule on health information technology.
My colleague Caitlin Owens flagged this data, from the Peterson-Kaiser Health System Tracker, which shows that while the U.S. pays more than other industrialized countries for drugs, the discrepancy in out-of-pocket spending is a lot smaller.
Yes, but: As insurance deductibles rise, Americans are paying more out of pocket than we used to — for everything, including drugs.
Here’s a subtle reminder of why hospitals wield such power in their communities: They provide stable, well-paying jobs.
By the numbers: Sutter Health, a giant not-for-profit hospital system in California that has been accused of anticompetitive practices, just filed audited financials for 2018. Axios' Bob Herman breaks it down:
Go deeper: Health care is still a reliable job creator
Photo: Drew Angerer/Getty Images
Martin Shrkeli is still trying to build a pharma empire, even though he's locked away in prison for the next five-plus years. WSJ has all the glorious details:
Despite the public uproar that surrounded Shrkeli's price hikes, he was able to keep control of his company and install a friendly board before his conviction, enabling him to keep calling the shots from behind bars.
When he's not firing his CEO or looking for new deals, Shrkeli apparently "reads about research into fatty acids and the prevention of cardiovascular disease in the inmate computer lab or on his phone."
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