It could make sense for some categories of routine care to be included in insurance because they reduce risk or are cheap enough to be affordable perks of the insurance product. I just wouldn't call those features insurance.
If you're unconcerned about health insurance compared to health care as such, that's also OK. But the US healthcare system is mostly not a single payer healthcare system, at least not right now.
Insurance works best when risk is spread out over a large pool. In private markets, insurers profit by excluding 'bad risks' which leads inevitably to coverage limitations, exclusions, and high costs for those with the greatest need.
Universal healthcare systems remove this profit motive and market failure.
Everyone contributes, and everyone is covered, regardless of pre-existing conditions. This eliminates adverse selection and allows for better preventative care, ultimately reducing costs and improving overall health outcomes.
Markets are great for some use cases, but disastrous for healthcare.
How does universal healthcare system remove profit motive? Are doctors going to stop seeking profit? Maybe if the government knows exactly how much to pay for a service such that there is no profit, but of course information is decentralized and central planning and price controls fails basically every time it has been tried. Plus profit serves a purpose. If I'm a doctor providing a service and there is more demand than I can handle, naturally I raise my prices, signaling to others that there is profit to be made by providing that service.
> Everyone contributes, and everyone is covered, regardless of pre-existing conditions
Is covered for what and at what price? Presumably you want to reduce overall costs, so total reimbursements will be less. So naturally with a lower price you'll have fewer providers willing to provide that service, which means there will necessarily be a shortage. And now you have to worry about rationing
Because in a system with universal care, we would still have doctors who are compensated for their labor and expertise, but we wouldn't need the rent-seeking insurance corporation, or its officers, or its shareholders, all to prevent people from receiving care.
How much more care could be provided, for the same cost, without all that waste, fraud, abuse and economic rent?
I mean, I pay plenty for health care but I never use it. I'd be much more interested in buying lots of physicians. Pampered empathic physicians.
But I do want annual speeches from them. A website full of them.
I truly don't understand how we have many successful and thriving examples of publicly funded services, yet somehow healthcare - which we all equally need, and which is equally a backbone of a healthy society - is somehow unique in needing profit incentives to function.
The free-market theory only applies to products which you have a choice to engage with, and which are not essential to life and the basic productivity of all society.
Private police patrolling is often far more controversial than all the healthcare debate combined.
https://nl-m-wikipedia-org.translate.goog/wiki/Ziekenfonds_(...
We had a lot of.. shall we say.. doctoring with the system in the Netherlands.
Towards the end of the page:
> Negotiations between health insurance funds and doctors about health insurance fund rates for medical care were generally quite difficult and led to intense conflicts on a number of occasions.
Followed by a good example of "debatable":
> The lower income from the health insurance practice was compensated by most physicians by higher rates for private patients.
Could possibly be true but the opposite is definitely not true. If I get more money for bananas I wont sell apples for less.
If you really want to make health care affordable, increase the supply of everything and cut the red tape. The cost issue is mostly due to a lack of supply rather than an issue with who pays. Of course well-financed entities like governments and insurance companies are capable of distorting prices. But if there were enough clinics, doctors, and supplies, we would all be able to afford basic health care even on a meager income.
See this for example https://www.statista.com/statistics/1109036/satisfaction-hea...
Singapore has low costs and high satisfaction. Maybe copy that one?
But anyway Belgium is also on the list and other places. I did mention Singapore to a friend in the UK who works with the NHS and he said it wouldn't work here because Singaporeans are responsible and look after their health while Brits don't. Not sure about that one.
It seems to me that "It makes sense to include them with insurance but I wouldn't call them insurance" is needlessly pedantic
Maybe insurance isn't the right word for what our medical plans are, but this feels like some serious mental gymnastics to avoid seeing what obviously is.
This isn't really the whole picture though, is it? I pay £25.80 for a dental check-up thanks to the NHS. If I wanted to do that on a private basis I'd probably be paying double.
https://www.nhs.uk/nhs-services/dentists/how-much-will-i-pay...
I live in an EU country where this is not covered by the state health service, so everything is done privately. A filling is around the same price as the NHS, but a crown starts at €500 and dentures are even more.
By contrast trying to do something as simple as buying a new medical device for my wife has been a Kafkaesque nightmare with random charges, wrong billing codes, switching companies, fighting insurance, demonstrating need, etc, etc for something I am willing to purchase. The device is also marked up several thousand percent to boot.
Part of the problem with the healthcare discussion is that we need to clarify what we mean by healthcare. When I hear people complain about healthcare they either are complaining about medicine, or hospital stays with crazy and confusing billing processes, and these 2 problems are completely different than each other and require a whole different set of discussions apporaches and solutions, but everyone just talks about "healthcare" with no nuance and it obscures any possible forward progress.
As a final question for pondering how much healthcare does everyone deserve? I think we'd agree it probably isn't reasonable to say a 96 year old woman should get a multimillion dollar experimental cancer treatment that will extend her life by 6 months before dying, on the other hand simply having access to Ibeprofun and Antibiotics means you have access to better medical care than anyone else at any point in history longer than 40 or 50 years ago?
Or, it being too confusing. That's a problem with health insurance, and not with money.
That's why some think that a national health care system that is designed primarily around effectiveness of distribution of payment, rather than extracting maximum profit from the flow of money between patient and provider, is the moral and effective solution.
To your last point, rationing low availability health care is nothing new. Alcoholics can't get liver transplants for example. There's a whole field of bioethics that can surely answer some of those questions.
Why would we expect the incentives inherent in putting health care under the monopolistic control of those who seek political power to be any more favorable than those manifest in the current situation of apparent oligopolistic control by both profit-seekers and political-power-seekers?
Where would this solution leave those who just want to obtain services directly from service providers, without any political or financial middlemen either taking a cut, usurping their agency, or homogenizing the market?
This isn't true. Plenty complaints about long waits for appointments, rushed appointments, not getting proper medicine. My wife recently couldn't get a specific potentially more effective medicine covered (it was in the end) because the insurance company wanted the dr to give her something cheaper.
"Health insurance in my country is so obtuse and convoluted I would rather not put my basic medical needs in there, and rather just pay out of pocket for it separately."
Strange approach.
The common conception of health care has moved beyond just remedying severe illness or injury, but rules and incentives are still calcified around treating it that way.
Insurers like to take all the benefits of the insurance model, and as few of the downsides as possible.
I mean, look at the model of "first you have to meet your deductible, then you have a co-pay which is your 'contribution' to your health care, but also you have to pay coinsurance which is the your portion of your costs after the deductible".
It's a partial amortization scheme for healthcare with a little "benefit of group negotiation" thrown in (when it doesn't actually cost "you" more to go through insurance than out of pocket... "you" because some people, like Martin Shkreli, make money pushing the illusion that somehow insurance companies are magical money fairies who pay providers with something other than the premiums you and I pay, either directly or through an employer...).
Why wouldn't you just do what works very well elsewhere?
The insurance model is broken because of political intervention in the first place. I'm not about to give political institutions de facto monopoly power over the most personal and private aspects of my life just to mitigate a public problem that they created to begin with. I want to cut out the middlemen entirely, not just shift dependence to a different, often less trustworthy, set of middlemen.
Realistically, the price is at or around most people's insurance deductibles.
I am also not impressed with all of these just asking questions it's so complicated asides; there are dozens of existence proofs that demonstrate a diverse set of approaches that more or less solve this problem at the nation level. But that would require a bit of curiosity about how the rest of the world works, I suppose.
The problem with health care/insurance in the US is not because of unanswered economic theories (or lack of half baked econ 101 approaches), rather it's because of hard ideological commitments to maximize rent extraction based on historical contingencies.
Ever wonder why US corporations generally provide health insurance? World War II something something.