...discussing hypothetical free market solutions in the context of the Rube Goldberg world we live in is an impossible task because it would require a complete reboot of the existing shitty system, which ain't happening. (Social Security is another such example.)

The appropriate use for health insurance (or any kind of insurance) is to take low probability, high-dollar risk off the table. People should be paying for most healthcare services out-of-pocket just like they pay for groceries, which by itself would cut costs and red tape (which is related to cost). You shouldn't buy (or be forced to buy) health insurance that covers routine doctor visits and basic drugs any more than your auto insurance should cover routine inspections, oil changes and new tires.

People should be able to buy (and most people should buy) catastrophic health insurance that covers the usual stuff (e.g., cancer, stroke, surgery, etc.). Those policies would be vastly cheaper than today's current insurance boondoggles because 1) they'd be so much easier to administer and 2) they wouldn't have to cover a lot of what is covered now. Likewise, it would enable providers to price their services much more efficiently and effectively. (As an aside, I acknowledge that routine preventative care -- e.g., annual physicals -- can lower long-term healthcare costs, so insurance companies can OFFER to cover those if they like, but it shouldn't be mandatory.)

Plans should also be able to purchase a la carte, meaning, for example, that I can save money by buying a plan that doesn't cover shit I don't need. If other people want more stuff covered in their plan, then they can pay for it, but the whole pool shouldn't be forced to pay for everything for everybody, which is how it works today -- a massive and costly moral hazard.

Likewise, premiums should be based on health at the time of purchase and/or each year as it renews. If you smoke, use drugs, are fat, have a bunch of speeding tickets, etc., then you pay more. Every year, you can go get a physical with blood-testing and good results could be rewarded with premium rebates.

There should also be plans that guarantee premiums won't increase due to changes in health. You mentioned life insurance, which works just like that. Both term and permanent policies allow the insured to buy into a plan at guaranteed future premium rates regardless of future changes in health. Health insurance should work the same way (or at least companies should be able to offer such plans).

You mentioned two potential dilemmas: 1) people who choose not to buy insurance and 2) people who can't buy insurance due to preexisting conditions. Regarding the first category, fuck 'em. You don't buy health insurance, then you pay out of pocket. If you can't pay out of pocket, then you don't get care. Your choice.

Regarding the second category, very few people would be in a position where they would not have the opportunity to buy insurance prior to picking up a preexisting condition. Expectant parents can buy policies to cover their unborn kids. Those policies can be flipped at age 18 into policies that cover those people as adults. Someone who gets cancer at age 40, for example, shouldn't be trying to buy insurance then. They should already own it, so the preexisting condition is moot. Further, there is charity, which could cover a lot of the truly sad sack cases.

I could go on, but stopping here due to length of post.

[Post edited by Los Angeles Hoo at 04/01/2024 11:06PM]