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I think we may not mean the same thing here. What I mean by insurance is that it only pays out for people with a demonstrable need, rather than being a defined benefit that you get at a given age regardless of any need. You can be perfectly able-bodied to the point of being able to hike twenty miles and climb mountains— if you’ve reached retirement age, under the current system, you get SS. Likewise, you can be filthy rich have millions in assets— if you’re at the right age, you get the same check as everyone else. My ideal system is based on turning people away who don’t need it either because they can still work or because they have enough money to not need money to retire. I’ve little objection to paying for people who literally can’t work for various reasons but are too poor to afford to stop working. Fair enough. But we’re showering money on able bodied people who can provide for themselves which doesn’t make sense.
That's not "insurance", that's "welfare".
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I'm with @WhiningCoil. I agree with what you're getting at, but I think it's a tough sell because people literally don't understand what "insurance" means, in part due to how severely the concept has been undermined in health markets, where we have effectively banned actuarial tables as well as requiring people be insured for things they have effectively zero risk for or need of. I absolutely promise that I don't need PrEP to be covered by my insurance, nor do I need weight loss drugs, but I actually could use significantly more coverage for sports injuries than the median person. Can't do it, all bundled, because telling homosexuals or fat people that they're higher risk and have to pay more would be discrimination.
Why wouldn't this pan out the same in social security? Someone is going to get their ox gored if it isn't just everyone gets it after whatever age.
As Scott once said, dealing with the biology side of things is relatively easy; changing human behavior is what we don't have a solution for.
Besides, pharmaceutical costs aren't really high because other people's problems are uniquely expensive, they're high because we pay for patents - about 75% of pharma costs are from on-patent drugs. From my table napkin math Truvada was about $2 billion a year when on-patent, which is about 0.34% of pharaceutical spending, or not enough to notice any difference in your premiums if you opted out.
Prep, Ozempic, and other such stuff were never even costly in the first place because lifestyle-choice preventative medicine is more expensive than any other kind of medicine; on-patent drug prices can just be raised as high as the market can bear. Truvada fell over 20x in price after generics were released and will now be a fraction of a fraction of a percent and save us significantly more in down-the-road hospital costs. Ozempic will plummet in price soon as well because Medicare has made it target #1 for the next round of price setting.
But even if you it opt them and all the other "lifestyle" stuff out of the bundle now it would still all be a drop in bucket. Make it illegal for companies to even produce that stuff and they'll just invest in different drugs you don't need and raise the prices just as high.
Well, through those patents we’re actually paying for the drugs to be developed in the first place. The reason those drugs exist despite the huge costs of development is that the patent lasts long enough and Medicare doesn’t bargain down the costs of the drugs. Yes the cost falls after generics come out, but without the patent and guaranteed profit, no one would spend billions of dollars and ten years developing the drug in the first place.
I agree 100% - that's part of why I'm against some theoretical unbundled system.
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These were two examples of things I don't want and would never need, not a full cataloguing of things that I have zero interest in insuring myself for. I am very confident that if my insurance options were similarly varied to what I can select for other situations that I would have substantially lower premiums than current pricing.
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