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PaperclipPerfector  2d ago (text post)   8111 thread views

Culture War Roundup for the week of April 13, 2026

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Try telling them we need to stop requiring employers to bundle health insurance -- and that is the way to break the real principal-agent problem you mention -- and see how they respond.

"Medicare for All" is one of the main slogans among the populist left. I don't think you'd get the response you're claiming.

That's, uh, not exactly removing principal-agent problems from healthcare. I mean, it could work out better than the current system, which is a terrible chimera of the worst parts of several systems, but the mechanism of that improvement certainly isn't how it doubles down on separating beneficiaries from decision-makers. At least in the current system you can get a new job if your insurance is awful; if Medicare for All turns out to be awful, too bad.

If it's not clear, that was not at all what I was proposing. My solution to the principal-agent problem is just to make other arrangements legal (as it is currently not legal for an employer not to provide health insurance to fulltime employees). I imagine some still would, and some employees might prefer it, but it opens new options for those who don't. And I promise you, this is not a popular position with the populist left; I've argued with a few friends about it.

Not to bulverise, but I struggle to phrase the argument in a way that doesn't sound obviously stupid, which, uh, I kind of think is because it is obviously stupid. But my understanding is that they:

  1. Believe employees have no leverage when negotiating with employers and that they will only ever offer the bare minimum required by law. (All of them have jobs that pay above minimum wage; never got a clear answer on how they think that works.)
  2. Believe that if the employer pays for something (health insurance, but also payroll taxes), it 'comes out of' profit, not compensation. Meanwhile, if an employee pays for it, that's a direct reduction in compensation. (The truth is the employer only cares about total cost of employment, and has no issue rearranging how that cost is divided up if it lets them give the employee a better deal for the same amount of money. If they could get away with taking away benefits without giving out raises, they'd have already reduced your salary by the cost of your benefits.)
  3. Believe that employer-offered insurance is a better deal due to pooling, but that employers will immediately stop offering the option if they're allowed to. (But if employees value employer-offered insurance more than the cash value of it, companies that don't do this will have lower total compensation costs and outcompete those who do. Also, pooling is clearly net-negative for them, childless healthy-ish late-twenties/early-thirties professionals.)
  4. Believe that it's worse for the most unfortunate, e.g. people who get cancer young. (This is probably true -- though less so than they think, in my opinion -- and does represent a genuine values difference; it's not just that they're willing to donate to help these people, they strongly believe that everyone should be forced to do so)

That's hardly the same policy.

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