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I strongly question the insurance-based model for healthcare expenses.
One of the things that makes insurance work is that most people never need to use it. Life insurance stops being a thing (in almost all cases) when people retire - and most people make it to retirement. Car and home insurance are things most people pay for every year and yet use maybe once in a lifetime. Many people go on vacation every year for almost their entire lives and yet never file a single travel insurance claim. One third of physicians have been sued according to malpractice claim firms, but this is across a 40-year career - perhaps one in every sixty or seventy years as a doctor will they be (on average) required to use their malpractice insurance, if that. Most ships never sink. Most buildings never burn down. Most planes never crash.
Health insurance is different.
Many Americans, especially in old age, file health insurance claims most or all years. This is not what the classic insurance model is designed for, especially given the cost of some healthcare, which is why the US has created so many ‘workarounds’ that twist the provision of insurance to ameliorate the fundamental fact that health insurance makes no sense. These include Medicare (for a certain vast class of people no insurer could afford to insure) and Medicaid (for another vast class of people no insurer could afford to insure, just for a different reason). It’s why employers have to contribute to health insurance as a stealth tax, because otherwise many people would not be able to afford it. What is the difference between a system in which the government taxes companies by forcing them to pay for employees’ healthcare and then directly pays for the unemployed’s healthcare, and a classic single payer system? Multiple providers which are never really competitive because of an opaque pricing structure.
As with college tuition, the state has created a monster with no cost control, because the government backstops the most expensive treatment for a growing percentage of the population with unlimited “free” money. In a way, the US already has nationalized healthcare, just like it nationalized college education, it’s merely been nationalized in an extremely inefficient way.
I live in a country with a mediocre public healthcare system, in which almost every doctor and nurse is directly employed by the government in a full time capacity. But the NHS isn’t bad because it’s the NHS. It’s comparatively much cheaper than almost any other first-world healthcare system in a country populated primary by Europeans (can’t compare to eg. Singapore or Japan where people are much healthier and the culture is different). The NHS sucks because everything is done for the cheapest price possible, there’s been no economic growth in 20 years, and British GDP / capita is half of that in the USA, because Britain is poor. Its mediocrity is for the most part a consequence of the British economy, which is poor for largely unrelated reasons.
But I increasingly think the model, or maybe at least the Australian or Swiss semi-public models, could be successfully exported to the US. The usual criticisms of universal healthcare are already rendered bullshit by the American system. Homeless psycho scumbags already get millions of dollars in free healthcare in the US subsidized by the middle class taxpayer that they never pay back, it just gets taken from them in a slightly different way. The NHS isn’t really more “socialist” than the US system at all, because working people are still paying for everyone else in the same way. Old people (by far the most expensive demographic) already get free single payer in America. In fact, the US system is arguably even more unfair, since it costs much more as a percentage of GDP than the British system, which given usage statistics means middle class Americans are relatively redistributing more of their wealth to the old and poor in healthcare costs than many Europeans are.
I agree whole-heartedly. I'm not sure what insurance actually adds to the system given that the government is already subsidizing the kinds of people that really need insurance and the fact that insurance companies are incredibly reluctant to actually shell out the cash that they agreed to.
Health insurance companies are a tax collector (and insurance premiums a de facto payroll tax) that doesn't get voted out of office for raising middle/upper-middle class taxes, unlike politicians. Also, they (and the provider-level admins fighting them) are a massive white collar welfare program, with millions of marginally to highly educated workers drawing salaries to perform the office work equivalent of digging holes and filling them back up again for no reason.
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Cost control. It's keeping cost from going to infinity even faster than it is, given the limited supply and destruction of price signals by law and custom. The insurance company's reluctance to shell out cash is an essential service.
Untrue, especially in context of the 80:20 rule which means higher premiums directly equal higher profits because margins are effectively capped. Even beyond that, insurance cost control is highly limited to a few high profile cases. And again, much of the most expensive healthcare for chronic or long-standing conditions is funded directly by the state for the old and poor.
There’s no evidence that single payer nationalized systems are more generous. In fact, US private insurers are by far the most generous healthcare insurers when it comes to overspending on drugs and surgery in the entire world. Meanwhile, the most socialized systems like the NHS are often criticized for not paying for million-dollar treatments so that kids with incurable diseases can live in pain for an extra month and play hardball with big pharma even for very valuable drugs.
Yeah, I've seen it said that American lefties dream about Euro-style health care system because they think that such a system will dole out treatments at will and for asking, basically, when that is generally not the case at all.
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One quirk of the UK system is that drugs prescribed by an NHS doctor cost like $12 per prescription to pick up at a pharmacy. This fee is mostly the same regardless of medication.
But the old, the poor, and children are exempted from this fee. Because these people consume almost all drugs, this means that 95% of all prescriptions are free. So all the fee amounts to is an extra tax for 18-60 year old functioning, gainfully employed adults when they need medication. The US system reminds me of this.
One contributor to the UK's economic dysfunction is probably that we have a slim majority of the population with living standards that have been entirely insulated from the wider state of the economy, by pensions, welfare, or otherwise. Causes all kinds of political malincentives to place almost all the burden on a dwindling share of gainfully employed childbearing-age adults, while giving them nothing in return. The prescription exemptions are just a tiny fraction of the whole system.
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