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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’ve known people who are on health sharing models as an alternative to insurance, in which healthcare over a certain amount is reimbursed. There are lots of things it just refuses to cover and there is a very large class of people excluded from coverage.
Ultimately, that’s what actual insurance is. Not health insurance as it currently exists.
How does this work exactly? I've heard of similar things offered via churches or other trust networks, but the practicalities seem difficult.
For example, let's say I get an MRI. Maybe the clinic charges me $5000, but then the insurance negotiates it down to $1000.
What price is the health sharing network paying?
Related, but I think one solution to the health care cost crisis is full cost transparency. If you charge Medicare $1000 for an MRI, you must charge all patients the same rate, and all costs must be disclosed up front. Imagine if the price for a hamburger at McDonald's was either free, 99 cents, or $37 dollars depending on who was paying. That's our medical system.
From my anecdotal experiences (which weirdly enough include specifically receiving an MRI as part of a health sharing system) you pay out-of-pocket and that price ends up being equal or lower to the negotiated insurance prices. You may have to do some negotiating yourself, but it’s usually as simple as calling the office and saying “this is unreasonable, give me the real price” and then they do. The $5000 price is there because they know insurance will haggle, and so they can charge the government systems exorbitant amounts, insurance pays the $1000 price, and if you pay out of pocket it’s more like $500, then health sharing reimburses you. The amounts aren’t accurate but the ratios are.
The $5000 price is part fraud, but realistically mostly just because they have to recoup the cost of all the non-payers who receive care and don’t pay for it. It’s basically just backdoor government-funded healthcare for the poor, scummy (has money just doesn’t pay or pays like $10/month), or undocumented. The only ways to bring the costs down are to not allow those people to receive maximum care, which the public doesn’t have the stomach for, or to address the elderly medical cost issue, which is politically untouchable, or address the supply cartel issues mentioned above.
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