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0 pointsjtc33111y ago0 comments

There's a question though here as to how to define insurance: in your example, everything still works if everyone has catastrophic insurance.

Insurance, classically understood, is risk sharing, not cost sharing. In other words taking it from a "not everyone will use this service" risk sharing model to "everyone will use this at some point" cost sharing model is what causes the problem of hidden pricing.

You can have it both ways (risk sharing and visible prices) because most healthcare costs aren't unforeseen. In other words, the number of accidents where the hospital needs to be relatively sure insurance is involved pales in comparison to the cost of routine visits/care which could be paid for out of pocket and prices would then be visible allowing for competition.

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tomp11y ago

That's a good point, which is why there were some suggestions in some European countries about having a "paid first visit" that is refunded if there is actually something wrong with you. I in general support things like this. I also support some parallel "private" medical system, where you can pay to "skip the line" (but e.g. in Slovenia, only certain procedures can be performed in the private system).

However, there are also many medical costs that can be foreseen (even planned for) but are either "beneficial" for the society (e.g. childbirth) or still risky and essentially no-one's fault (e.g. cancer - most people will get it, but some will get it at 50, others at 95). Incidentally, it's cancer and the catastrophic treatments (e.g. heart surgery) that are most expensive. Possibly also because it's in the big-pharma's interest to keep it this way (at least for cancer).

cookiecaper11y ago

This is exactly the root of the issue with medical "insurance". We know that everyone will need medical care at some point. Insurance models work only in circumstances where the policy is rarely used; the concept is that everyone wants to be protected in case this rare, almost anomalous event happens, so they're all willing to put up a small payment to pay for that coverage in the extremely unlikely event that it will be utilized. However, in today's society, medical care will be needed by everyone at one point or another, and many people will need it consistently or in large amounts.

Insurance is absolutely the wrong model for something with this kind of usage pattern. The insurance industry is notorious for its antics precisely because they're one of the only industries that can only make money when they don't provide the service you're paying them for. The fact that medicine is so widely used makes this especially egregious with regard to medical insurances. They'll do anything they can to deny your claim because aside from basically accidentally having a healthy group of people in the insurance pool (due to the way corporate policies work, and the new health legislation), denying claims is how they make money.