I also actually liked the proposal in Congress that got rejected: allow people to make their own groups. So if you are a person who likes to work out and get your fat levels tested once a year, you could join a group of like minded individuals and insurance companies would bid to insure your group.
Health insurance is cheaper when more people are in it, not fewer. If you start offering discounts to the healthiest people, it gets more expensive for unhealthy people. So let's say the sickest people no longer have insurance. Now there's a new group of unhealthy people in the insurance pool. So you raise prices for them, and they get kicked out, too. Eventually you get to the point where insurance is not useful, because nobody needs it at all, as the insured people don't get sick. Until they do get sick, at which point they get kicked off the insurance plan. Health insurance that doesn't insure is basically fraud.
If you want to drive down the health related costs of healthcare, reduce the things that make people sick.
They only get kicked out if no one will offer them prices that they can afford and that they want to pay for. Why do you expect that would happen?
>Until they do get sick, at which point they get kicked off the insurance plan.
It seems like that would be solved by treating health insurance like term life insurance as the person you're replying to suggested.
That's an understandable attitude for a healthy person.
What is the person born with a disability or a gene making cancer, Alzheimers, heart disease, etc. likely supposed to do?
"Your insurance premium is $25k/month. We take checks!"
They are only required to (attempt) to (temporarily) stabilize you.
"Just go to the ER" also is pretty much the most inefficiently stupid way of handling healthcare for the needy you can come up with.
You need charity, not a market.
Everyone is at potential risk for needing something like a transplant eventually. Making the pool large enough allows reasonable premiums, just as I can pay a couple hundred bucks a year to replace my entire house if it burns down.
The rest of the developed world defines the risk pool as "everyone", and the end result is healthcare costs half of ours (including the tax component) and similar outcomes.
> You need charity, not a market.
You need government, not a charity.
Not everyone is at equal risk, and many choices people make can have an impact on that risk. That's the point of this thread.
>Making the pool large enough allows reasonable premiums, just as I can pay a couple hundred bucks a year to replace my entire house if it burns down.
What is 'large enough'? The populations of many entire European countries are dwarfed by the number of subscribers to several health insurance companies in the US. Of course we don't know how large health insurance companies would get in a market without heavy government interference, but do you have some reason to believe the size of pools in a market with less interference would result in unreasonable premiums?
>The rest of the developed world defines the risk pool as "everyone", and the end result is healthcare costs half of ours (including the tax component) and similar outcomes.
And our health care system requires subscribers to insurance companies to pay those insurance companies to A) provide charity to people who wouldn't be able to afford to buy insurance in real market and B) pay for routine care (i.e. care where there is no risk to insure against - you know you're going to need it). And of course the health insurance company is going to collect its cut of the money that the government has forced subscribers to funnel through those companies. Is it really any surprise that system gets expensive?
>You need government, not a charity.
You need charity, whether it's administered by a public organization or a private organization or funded by private individuals or taxpayers.
Demonstrably so. Just look at pre-Obamacare "high risk pools" for concrete examples. https://www.kff.org/health-reform/issue-brief/high-risk-pool...
You'll also see it in other insurance markets, like life, house, car, malpractice, etc. - many people are largely uninsurable in these markets.
> What is 'large enough'? The populations of many entire European countries are dwarfed by the number of subscribers to several health insurance companies in the US.
It's not so much raw population as how much you're allowed to slice it up. A decent sized city is big enough - many corporations of a few thousand people self-insure as it's cheaper.
The problem is when you allow insurance to pick their customers. They just pick the healthy ones, if allowed.
> And our health care system requires subscribers to insurance companies to pay those insurance companies to A) provide charity to people who wouldn't be able to afford to buy insurance in real market...
You are using some very weird definitions of "charity".
Obamacare's subsidized premiums aren't shouldered by the insurance companies, they're provided by the government. Those insurance companies are making bank, not providing charity.
Single-payer or income-based subsidized healthcare isn't "charity". Insurance paying out more than premiums taken in for a particular subscriber isn't "charity", it's how insurance works.
> Is it really any surprise that system gets expensive?
Oh, not at all, but that's because we've picked the least cost-effective bits of both private and public healthcare systems to combine into a monstrosity.
I'm obviously not talking about individuals who are so expensive to profitably insure that they can't afford the premiums. I've already stated that the market isn't going to work for them. It's not the size of the pool that's causing problems here; the contents of the pool are the problem.
>They just pick the healthy ones, if allowed.
They also pick the less healthy ones that are able to afford to pay the higher premiums it takes to make it worth it for the insurance company to cover them, assuming the insurance company is allowed to charge such premiums. There is plenty of money to be made there. Where there isn't any money to be made is in people who know they have high expenses and can't afford to pay them.
>You are using some very weird definitions of "charity".
Are you taking issue with my characterization of government welfare as charity? Why should it be excluded from such a broad category?
>Obamacare's subsidized premiums aren't shouldered by the insurance companies, they're provided by the government.
That's not what I'm talking about. I'm talking about people who have pre-existing conditions, who are definitely going to cost the insurance company more than they're going to be paying in, regardless of subsidies, who the health insurance company can't charge more money to and can't deny coverage to.
>Insurance paying out more than premiums taken in for a particular subscriber isn't "charity", it's how insurance works.
Actually that hinges on whether it's known before the agreement is made that the particular subscriber is going to have more paid out on his behalf than he is going to pay in. If it is known, then that's not insurance. It's charity.
How much money you have isn't a determinant of the moral worth of your life, it's not even a proxy. So why do consider it as a relevant detail in the allocation of healthcare?
Why should the obese, smoking trust-fund kid get the heart bypass but the obese smoking poor guy not? Liberalism (classical or otherwise) requires some base level at which we treat people as equals, it seems the ability to continue living would be about as base as we can get.
I didn't take a position on whether or not I'm okay with a society where people die in the street if they don't have enough wealth.
All I said was that people who can't afford to buy health insurance need charity, whether that charity is public or private. The market is not going to help them. Attempting to fit that round peg into a square hole is going to cause a lot of issues that are very obvious to predict, in addition to all of the issues that are less easy to predict.
>How much money you have isn't a determinant of the moral worth of your life
Neither is anything else. The 'moral worth of your life' is fundamentally an opinion, not a fact.
>So why do consider it as a relevant detail in the allocation of healthcare?
Because that's how we allocate most goods and services, and it does a fairly good job at it.
>Why should the obese, smoking trust-fund kid get the heart bypass but the obese smoking poor guy not?
That's a pretty complicated question that comes down to an individual's own priorities and that individual's assessment of the potential effects of various alternative policies on the attainment of various goals.
So, a free market is ineffective at allocating resources in healthcare.
Unless we redefine healthcare to mean "care for people who are not sick," which does not really make it healthcare at all, does it?
It doesn't suspend reality, that's for sure. If you don't have the resources to pay for your own healthcare, and don't have the resources to pay someone else to pay for your healthcare, then you are going to have to get someone else to volunteer their resources for it, or you're going to go without.
>Unless we redefine healthcare to mean "care for people who are not sick," which does not really make it healthcare at all, does it?
Plenty of sick people, or people who become sick, are perfectly capable of having their healthcare needs met through the market. There are many, many people who have enough money to buy health insurance, even if they have some chronic conditions and therefore would need to pay someone a lot more than a healthy person would to cover their health care expenses.
If your standard for effectiveness in allocation of resources in healthcare is that no one's ability to get health insurance is affected by their current health status, then yes, the market is going to be ineffective by your measure.
If your standard includes, for example, having financial incentives for people to limit their own use of health care services, like how we have financial incentives for people to limit their use of basically every other resource out there (e.g. houses, cars, land, anything else that costs money), to ensure that resources are left available for other people to use, and you don't want to deal with heavy-handed government approaches to that problem, then by that standard, a health insurance market is very effective.
How much are you willing to forfeit for my cause, charitable neighbor?
That is reality. If you can't afford something yourself, then you're going to have to have other people pay for it for you, or else you won't get it.
I think you misunderstood something I said, however. A "risk pool"'s rates can only be decided by non-preventable risk factors of that pool. The examples you give don't reflect that well: some cancers are preventable, Alzheimer's cause and treatments are not well understood, and most heart disease is preventable.
For someone with a childhood disease, for instance, they could possibly fit into a certain risk pool, but they likely won't. Any "risk pool" based insurer will not have the funds to cover them anyway, and forcing them to cover the extreme cases has shown to leave more people without healthcare. [Take the case in Iowa, where a single person caused 30,000 individuals to lose their insurance. That is not an acceptable outcome!]. Right now, the best answer on how you handle these extreme cases will have to be a combination of Medicare and Charity, as they are the only organizations with a pool of money big enough to help them.
1) Letting peer pressure and self censorship to police our habits is the end of individuality and freedom. This is exactly what China is trying to achieve with that horrible social credit system. It also inverts the logic behind healthy practices: today you run because it makes you feel good; tomorrow you run because you can't afford to be left behind and lose insurance. This kind of thing really lowers the bar on the respect of privacy and dignity because it is basically large scale surveillance in exchange for cheaper insurance.
Take car insurance: are you willing to give insurance companies full access to your GPS and tachometer data just so you can prove you're a good driver (in their own terms) and pay a little less?
2) What is healthy today might not be healthy tomorrow. Imagine some food is considered healthy in 2020, and you happen to eat lots of it, but in 2050 it turns out it's the other way around.
And 3) this all boils down to the reason why, in general, associating people in groups and then judging individuals accordingly is unconstitutional in so many countries. That group may be gay people, black people, people that voted Left or some other group that you cannot leave or join because of some arbitrary definition. And is also worth considering that the group to which you belong can vote a change on its definition that leaves you out with no appeal, the worse case being some AI deciding that you're done.