There’s a gray area where insurance goes from protecting against unpredictable losses to becoming a subsidy from those experiencing fewer losses to those experiencing more losses. In a true insurance market, people’s entire health is not insurable, since it’s guaranteed to have losses therefore it’s simply a subsidy from those who are not currently experiencing losses to those who are.
What would be more akin to actual insurance is insuring specific events within a specific timeframe, such as broken bones from year x to year y, and then the insurance can charge more to people who play sports versus people who don’t, since obviously they would experience more losses, just like people who drive more pay more for auto insurance.
However, this all gets murky with our requirement to force everyone to be provided with healthcare and people being in control of some things about their health (via diet and lifestyle) and not others (genetics, environment) and the inability to tease out causal factors.
The primary purpose of health “insurance” in today’s world is to serve as an agent for the buyer since the buyer typically has no idea about what they’re buying from healthcare providers and at what cost, so theoretically, the doctors, pharmacists, and statisticians employed by insurance companies can do proper vetting of treatments for the patient.
Huge proponent of socialized medicine here. Lived under it for 18 years. It works. You are utterly correct when you say the "buyer" has no idea.
American "healthcare" is a sham in many ways. It's the only "transaction" a person enters into whereby you have zero idea of the final costs. I buy a car, I can negotiate and know before I sign. Ditto a house. Medical care in the US is designed to make money. Full stop. Not long ago, maybe even here on HN, an article was posted about American hospitals trawling the Internet for every bit of info they could glean about patients to both see if they would be monetary donors, as well as to ascertain if they were hiding their "wealth". This is what results from a for-profit system.
I have always believed that healthcare is a basic human right. I will never change my beliefs on this point. Profit and healthcare are mutually exclusive. When a cancer patient is literally refused treatment because a) their "health insurance" runs out or b) they cannot afford to pay, the system is morally bankrupt.
A friend of mine has a family member who needed a helicopter ambulance to save his life, as his accident was rural and he would have died. The 15-minute flight was almost $60k and they were billed for the full amount almost overnight. Insurance did not cover this. Another friend had a seizure and an ambulance was called, and the ensuing ride took about 10 minutes. Cost for the ambulance ride? $1200. This was in addition to the medical care, which in this case only paid 80%, even after deductions, etc.
Anyone who defends for-profit healthcare for reasons of "I'm not paying for others' mistakes, etc." is being short sighted. There is no way a cancer doctor should be making millions off the back of dying patients, many of whom have cancer through no fault of their own. Even smokers deserve compassion, because addiction is a beast that many play hell getting out from under. So many factors at play here. It's easy to sit back and play moral general, but unless and until it's you or yours, it's an entirely different animal.
We could easily afford single-payer in the US. The numbers being tossed out by various mouthpieces are intentionally misquoting to support the lobbyists and their ilk.
Many of you may know that almost all hospitals lease their equipment. The leases are not that expensive for most stuff, even MRI and like equipment. For the prices charged, they have paid their leases in full after less than a week, yet they charge for all manner of false bullshit, and I quote from personal experience:
"Mucous recovery system: $120" WTF is that, you may ask? After deciphering the code by obtaining a medical billing handbook, it turns out this is a box of Kleenex.
I'm 50 and I refuse to go to the doctor unless I have either an infection or I have to go because life demands it. Eat right, brush your teeth, exercise, and call it good. I cannot afford the insurance, deductibles, co-pays, additional money always being asked for, plus RX costs. Not everyone has the money for the sham that is American healthcare. When I do go, I go the low-income clinic, pay cash and get as good or better care than the expensive places. Remember, massive debt in America is largely brought on by medical crises.
> I'm 50 and I refuse to go to the doctor unless I have either an infection or I have to go because life demands it. Eat right, brush your teeth, exercise, and call it good.
Pushing back against this part but in support of your larger point: many of us don't really have that option due to chronic conditions. Society incentivizes us in various ways to hide them when we can, so people mostly don't realize how prevalent these conditions really are. By some criteria, American adults with no chronic conditions are in the minority. Much of that is due to hypertension and hyperlipidemia being their own diagnoses, but to pick one example, overall asthma prevalence may be as high as 8.3%. [1] [2]
The biggest issue with the US health insurance is very simple: it is underwritten for one year. Want to fix it? Pass a law where the minimum coverage period is 10 years and force the companies price it out in advance. Hell, make it 20-30 years. Suddenly the insurance companies will start buying hospitals and optimizing for health care costs rather than information and funnel arbitrage.
I agree with your overarching point, but why not just kill insurance?
My family in England go into hospital, checkups, RXs, never a cost to them directly. Everything is paid for by dint of taxation, and the taxes are not as high as Americans are lead to believe. My UK family are not wealthy by any standard, yet the do far better than me in America. They get 6 weeks paid holiday, too, something almost unheard of here. Time off leads to less health issues. Everyone needs a good holiday release a few times a year to get away. No email, no calls, nothing work related. This is actually good for people, but Americans in general don't even use up their allotted time off. Sad.
For the same reason that the insurance exists in the UK - when my family lived there, my sister had an issue. The choices were crappy slow "meh, but it will get better" NHS service in 6 months or deal with it within a week in a private hospital covered ( mostly ) by the insurance. We picked the private hospital and everything was resolved within 3 weeks.
Did you live in Switzerland? Doctors make a nice salary, many hospitals are private, yet the system seems to work well (from what my friends who live there are telling me).
> When a cancer patient is literally refused treatment because a) their "health insurance" runs out or b) they cannot afford to pay, the system is morally bankrupt.
Then every system is morally bankrupt.
We have to face the facts: resources aren't infinite, tradeoffs are necessary, and we can't help everyone. That's why even most "socialized medicine" has limitations and restrictions about what kinds of treatments they offer and to whom (e.g. you can't get a free breast scan every year).
I grew up in England. My father is British and my mother American.
We owe it to people to give them human dignity up to, and including, their last breath. Anything short of this is crass, careless, and evil. The West has always tended to value human life more so than other cultures, but in the last couple of decades, we have devolved horribly on this point.
When my first wife died of cancer, I did ridiculous amounts of research into costs. Pharmaceutical companies are utterly shams. They may make life-saving drugs, but at what cost? I learned that they intentionally manufacture as cheaply as possible and charge as much as possible. Look at the recent shamelessness with the Epi pens. Those cost very little to make. They would still see a profit at $20.
When my wife died, the chemo she was getting was $12k for a 500ml bag. Cost to manufacture? Less than $100. That is not a profit, that is outright effing theft.
What would be more akin to actual insurance is insuring specific events within a specific timeframe, such as broken bones from year x to year y, and then the insurance can charge more to people who play sports versus people who don’t, since obviously they would experience more losses, just like people who drive more pay more for auto insurance.
However, this all gets murky with our requirement to force everyone to be provided with healthcare and people being in control of some things about their health (via diet and lifestyle) and not others (genetics, environment) and the inability to tease out causal factors.
The primary purpose of health “insurance” in today’s world is to serve as an agent for the buyer since the buyer typically has no idea about what they’re buying from healthcare providers and at what cost, so theoretically, the doctors, pharmacists, and statisticians employed by insurance companies can do proper vetting of treatments for the patient.