Obamacare/ACA has this too. The "Medical Loss Ratio" or "80/20" rule says that 80% of premiums have to be paid as claims. There's no downward pressure on claims payments because they raise rates and take 20% of a bigger number.

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lotsofpulp 4 days ago | parent [-]

Customers switching between managed care organizations (MCOs) is the downward pressure. Theoretically, there are enough customers for multiple MCOs to choose from, although, the large amounts of people locked up in employer and government subsidized plans prevents this in smaller states.

UNH can’t charge too much more than Elevance/CVS/Cigna/Humama/Centene/Molina/etc.

That cannot happen with a utility like electricity.

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throwaway173738 4 days ago | parent | next [-]

You can’t change insurers without changing jobs. The “private market” doesn’t exist because there’s no way to access the premium your employer pays for you to take it somewhere else, and even if you could you have to wait for open enrollment. No such window exists for cost increases in health plans.

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lotsofpulp 4 days ago | parent [-]

You can go to healthcare.gov and pick the same plans, many millions of people do it and price shop every year.

You can tell your employer you don’t want to pay for the employer subsidized plan, but then you lose access to the employer subsidy and ability to pay premiums with pre tax income.

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dml2135 3 days ago | parent | next [-]

They are not the same plans. Most employer plans are not available to the individual market. The marketplace plans often have vastly reduced networks, higher premiums, higher deductibles, etc.

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lotsofpulp 3 days ago | parent [-]

Most are, as ACA compliant plans have metal levels that are based on the expected annual costs that the plan covers.

A silver plan an employer subsidizes is similar to a silver plan from healthcare.gov (expect plan to pay 70% and insured to pay 30%).

https://www.healthcare.gov/choose-a-plan/plans-categories/

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dml2135 3 days ago | parent [-]

But that means nothing if you can't find a doctor -- these plans have paltry networks.

They are better than nothing if you qualify for a subsidy, but if you don't and you live in a HCOL area (which the subsidies are not adjusted for) you are pretty much screwed.

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lotsofpulp 3 days ago | parent [-]

They sell the same networks in my experience (west and northeast coast).

The MCOs are not carving out different networks for specific employers. You buy a bronze PPO from United Health directly, or your employer does, it’s going to be all the same providers. If you get gold, then the deductibles/copay will be less.

The networks used to be different when HMOs were in vogue, but if your employer is only giving you an HMO option, you need to find a different employer. PPOs are the only sensible option (except maybe Kaiser on the west coast, but even they sell PPOs, just costs more to see a non Kaiser provider).

	▲	dml2135 2 days ago \| parent [-]
		This was not my experience on the NY exchange but that was several years ago at this point. So I guess it's possible that things improved.

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supertrope 4 days ago | parent | prev | next [-]

Paying 25K a year in health insurance premiums instead of 2.5K is not a realistic choice for most people. That employer subsidy is a massive difference.

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throwaway173738 2 days ago | parent | prev [-]

My employer subsidizes my plan to the tune of 2/3 of the list price. Are you seriously suggesting I should pay 3x as much so I can shop around? This is by law too that they have to offer insurance.

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massysett 4 days ago | parent | prev | next [-]

I think that's the idea with deregulated electricity. Where I live (Maryland USA) I can pick who generates my electricity. I have no choice in who delivers it and that is still regulated.

I found that in practice the non-default options do not wind up being any cheaper so after trying it for a few years I switched back to the default option, where the price is not regulated but is set through a prescribed auction process.

I suppose the deregulation might still put downward pressure on prices in theory.

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jpalawaga 4 days ago | parent [-]

I don’t know why people delete rules on fairness (laws) and then expect things to become more fair.

Electricity transmission at the minimum should be owned wholly by the public to remove profit incentive.

There’s your downward pressure—no incentive to jack up costs.

Until then, providing electricity to people will be a profit generating activity.

	▲	WarOnPrivacy 4 days ago \| parent [-]
		> Electricity transmission at the minimum should be owned wholly by the public to remove profit incentive. My provider is a coop and my rates are lower than the publicly held providers in this region. So you seem to be correct.

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zdragnar 4 days ago | parent | prev [-]

The market for customers who freely move is very small, as most get their insurance through their employer. Many large companies self fund their own health insurance offerings and just have third party companies administer it.

Everyone else gets stuck with the awful mess of their employer choosing their insurer, switching not more than once a year.

	▲	lotsofpulp 4 days ago \| parent \| next [-]
		The point is the managed care market is not structurally similar to a utility company. It is only tax rules that disincentivize people from shopping for managed care. Whereas multiple utilities are disincentivized due to the cost of moving earth and labor to get you the utility. Also, I like how the trope is managed care organizations wield unlimited power and make enormous sums of money and have laws that help them benefit over everyone else, but their profit margins and stock returns are abysmal.
	▲	1123581321 4 days ago \| parent \| prev [-]
		The employers switch between providers and administrators and negotiate on behalf of the employees on renewals (tweaking plans, threatening to move.) The employers are incentivized because they pay for some of the premiums and to keep employees happy.