What We Learned from a Year of Americans ‘Risking It’ Without Insurance

How does anything about the way medical care is administered in the US work in the context of the mythical "free market"?

But people also firmly believe they don't want price discrimination once they're on fixed incomes, and want government to take whatever steps are necessary to pay for that.

Healthcare costs for old people is most of the game, and those are regulated. No one is willing to challenge that.

Thus, we have a market that remains too regulated for presently-allowable-competition to make a difference.

In terms of competition, the real problem is the artificially low numbers of health care workers and facilities. The Drs are limited by the low number of medical schools, etc and the number of facilities are limited by requiring Certificates of Need, etc.

First remove these barriers to entry and require transparent pricing. Then... maybe competition would result in lower prices.

The money for these inefficiencies has to come from somewhere and that area will suffer.

Pure private like the US is just insane. It technically works but when you go in you have no idea what you're paying. Random service providers can bill you months later and there's not much you can do to stop it. Plus you have to be sure your provider is in-network and a bunch of other pointless nonsense. Finally, insurers can charge you whatever they want.

Switzerland's eliminates most of these problems. Everyone is required to have a "basic" level of cover, where "basic" is defined by the government to include basically everything medically necessary (in much more precise terms than mine). The maximum premium is fixed to be just a little over what's profitable for a well-run company but customers get to choose their deductible, up to a mandated maximum. All procedures and medications have fixed prices.

Thanks to the regulated premiums and procedure prices, you end up with everyone paying roughly the same amount for the same thing but to different people. Service providers have to send and process bills for 30 or 40 different insurers or hundreds of individual customers. Customers have to pay bills to their insurer and/or each service provider they visit.

This makes no sense to me. When everyone's paying the same amount for the same thing, it doesn't matter that there are different choices. By centralizing everything with one insurer, you can drastically reduce the paperwork for everyone. Providers send bills to one insurer. Customers pay bills to one insurer.

Yeah that might be because “The goal of socialism is communism.”

An orange is not necessarily orange.

A government with social programs is not the definition of Socialism.

Socialism is two things:

- No profit

- No private property

The consequence in 100% of historic attempts has been immense suffering. More than even the Nazis could deal out.

It’s not propaganda. Open a history book.

Regards,

A left-wing liberal who’s ancestors suffered first under Nazi occupation, and then under Communism — which is the goal of Socialism.

I hope that perspective helps you in your future discussions. :-)

At an individual level that is correct. But at the macro level it is wrong because when a person gets sick those costs are realized in the economy (eg. instead of cheap preventive care up front avoidance of early treatment means some percent will end up in much more expensive ER services that will cost more than if all those individuals saw a family physician).

Yes, medicine is a business, an industry, and obeys the same rules as other businesses.

But the goods it produces, "healthcare", are not like other goods. Demand is infinite, supply is scarce, and on a national level it makes sense to make sure it is distributed on a needs basis instead of a can-afford basis, because that leads to a healthier and more productive population, which is good for everyone.

I'm happy that my non IT-friends are also able to afford healthcare when it goes wrong. Not everyone does IT and only cares about their own situation.

You mention that the wages are a lot more, but here we don't need a scholarship to send your children to a good school. I'm wondering where your children will go to school if you travel around everywhere.

Ps. You need to be a Belgian to get the government to repay you. So you can't get it at the same price of us. So, that's another place where your "logic" fails.

What if your mother, brother and dad get sick within the year and they "don't do IT". Here the OCMW will help you. They won't help other nationalities.

Ps 2. I hate to categorize my "non IT friends", for me everyone is the same. I'm not handy and someone else can't work with a computer. Tomayto, tomahto

The point of the article was that salary is no longer an indicator of healthcare availability.

> Medecine (sic) is a business just like any other.

This is the ideology that functions as the crux of the matter. In the US, medicine is a business from which people involved should earn profit. Healthcare (and health, by extension) is not a right. In other places, I suspect it's the opposite. In a herd you can either strengthen your weak, or let them die off. Either way, the theory is that your herd will get stronger. The US has implicitly chosen the latter of the choices.

> If your local shop tries to screw you, take your business elsewhere.

It's not that simple. Everyone gets sick. Not everyone needs an iPhone XR or a brand new pair of Nikes. You can get by with a flip phone and a pair of brand x sneakers. Freedom of choice is great for goods and certain services. Healthcare isn't one of those services where "taking your business elsewhere" is any good, mostly because of the pricing collusion between the providers.

I was hit by a driver 6 weeks ago. He and insurance company accepted 100% liability. My 2015 Audi was totalled due to multiple airbag deployments (though the vehicle is largely intact other than frame, so will be healthily recouped by the insurer on the parts market).

Despite this...

I got a settlement offer from my insurer (who, bear in mind, are going to subrogate this to the opposing side) of $5K less than KBB for the vehicle (which was bought a year old, and is now 3 years into a 5 year loan), and $3K short of my outstanding loan (don't even start me on gap insurance - I've never seen that pay out, there's always a loophole).

So the insurer's idea of indemnifying me, mitigating my risk is for a 0% fault accident, I:

1) lose my car, which was in excellent condition, and barely 4 years old;

2) lose 3 years of equity in a five year loan;

3) do not have a car;

4) still owe my bank ~$3,000;

5) need to come up with a down-payment and a new loan for a vehicle within 7 calendar days of their (pitiful) settlement offer.

All the while getting condescending remarks like:

"Gap insurance would have protected you" (not in my experience, and my credit union 'neither recommended nor required it based on the FMV at purchase', and the only reason there's a deficit is your woefully inadequate settlement offer)

"We're looking after you - remember we've been paying your medical bills so far" (how ominous, "so far") - and I've been paying for a policy which included PIP for nearly a decade, so you'll forgive me for not lauding you fulfilling your contractual obligations _for which you have been compensated_.

To add insult to injury? They direct debited my premiums, including for the vehicle they totaled, and I had to explain this to a CSR. Who then said they'd take the amount they'd erroneously debited, and "apply it as a credit across the remaining 7 months of your policy on your other vehicle". No, thank you, I just want you to refund it.

Considering the medican income in Spain in around $1100, I understand why they like clients who can pay $900 no question asked.

We are now investigating getting coverage in some European or Asian country, where they sell insurance for non residents + world coverage + air repatriation (in case of a serious condition, like getting hit by a car in Chicago) at a decent price.

Best we've found so far is around $120 month, with something around a $1000 all-inclusive medevac fee (that gets you in a plane, with a doctor and everything needed)

I can't let it go that someone is ... Well, like that. He's lucky that he hasn't got any life experience in this situations.

Not travelling because I'm unconscious or in a critical condition? Foreign insurance + air repatriation.

Some countries do sell that, even to non residents. Just get world coverage - it's a bit more than $70, but if something bad happen, you get med evac'ed to that country and treated there.

I'm exploring that option as I discover the wonder of medical tourism.

Even repatriation is only when you are travelling, not going abroad for visiting a hospital.