It doesn't. It covers unexpected health bills, which is a very different thing.
Any type of situation that is expected to happen can not be covered by insurance, it needs to be covered by savings instead.
However many people want insurance premiums to be a type of forced savings plan, which is why there is such a huge argument in the US about health insurance.
Those opposed to government regulation want to handle the savings on their own. Those who like government regulation want it to force people to save for health care costs.
Part of the philosophical idea behind single payer is that people have minimal control over financially devastating illness and injury, and one thing society can do that individuals can't is allow everyone to share the risk, transforming a small probability of an untenable expense into a certain probability of a manageable expense.
You're right, and usefully so, to point out that private health insurance is treated like a utility instead of an insurance plan; knowing that also allows consumers to select high-deductible plans, and to take advantage of HSAs for tax-advantaged funding of the health care bills they do expect.
But single-payer insurance can handle both problems (routine billing and catastrophic coverage) coherently.
The transformation of insurance into a savings scheme puts considerable distortion on that model. It becomes impossible to see what payment is for expected treatment, and what is for risk assignment. The model then encourages people to use more ("I've already paid for it") and to pay no attention to cost. And it encourages the attitude that any problem should be paid for. It's hard to exaggerate the impact of these effects on health care's crazy cost structures.
The real problem isn't people who are riskier, it's people who are costlier. Someone with a prior condition isn't a risk, they're a cost. Insisting they should have "access to insurance" is simply insisting on cost redistribution. The circumstances under which that cost redistribution is a good idea socially should be an entirely different question than the efficient structure of health care payments.
These concepts are deliberately obscured by the political rhetoric around "health insurance", precisely to obscure the cost shifting nature of the project and to create a sensibility that the problems is somehow the greed of financiers. (Obscuring the cost drivers is also a goal, it's a very large industry that employs a lot of people, many of whom, at many levels, stand to lose a good deal if the system were ever seriously rationalized.) It's a very effective rhetorical strategy, especially given the abstractions around risk, but it shouldn't be confused with an actual discussion of the economic problem.
What "society" (government) can do is force everyone to share THE SAME risks
single-payer insurance == monopoly
It's not hard to make a list of "freedoms" we're mostly happy that people give up: the "freedom" to drive 100mph through school zones, the "freedom" to sell patent medicines with Pfizer branding on it, the "freedom" to set tire fires on our lawns. Those "freedoms" are respectively outweighed by the cost of collisions, of medical fraud, and of toxic and repulsive clouds of smoke.
When societies adopt single-payer health care systems, they're expressing a judgement that the "freedom" to take individual control over how to finance health care at the lowest possible price is outweighed by the cost to society of the uncertainty of health care costs.
And, setting aside principle for a moment, your health & well being is in fact one of the most important uncertainties in your life. You could be hit by a bus tomorrow, or stricken with a disease that outstrips your ability to pay for care. With the exception of a tiny, tiny fraction of people in society, nobody can truly provide an assurance of their ability to provide for their own care. So, to bring the principle back into the picture: if you're ideologically opposed to single-payer or socialized or mandated health insurance, it would seem that you must also support the idea that people who can't pay for their care must be denied care.
There's a wide variety of pragmatic objections to single-payer insurance, many of which are probably valid. But if we're going to bring "freedom" and "choice" into the picture --- ideology, in other words --- we should be clear about what the tradeoffs are.
I see conservatives (not trying to label you) make this argument a lot, and I think it is a mischaracterization of 1) what most people mean by health insurance, and 2) what health insurance and health plans are really about: pooling risk and creating groups that can negotiate for lower prices.
Re. 1: just skim the wikipedia article for health insurance (http://en.wikipedia.org/wiki/Health_insurance); the distinction between health plans vs. what you mean by "health insurance" all gets rather confused.
The fundamentals of the system we're moving towards in the US is actually a conservative plan from the '90s: an exchange-based market for private health insurance coupled with guaranteed issue and a mandate for coverage. That plan was itself a response to the original liberal vision of universal health insurance: nationwide government-run single payer insurance.
Yeah right. Until you run out of money. Then what?
In your world, you die. Good for everyone, until it's you or someone you care about. Then, like everyone else, you off running to the SS office to apply for (Medicare) disability.
The whole point of insurance is to protect against risk. Else why have it at all?
Not to be pedantic but I will stand on a soapbox for a moment: I'd also point out that we all have the ability to care for our health. Health care is a daily activity which requires no insurance, and often no cost.
Risk carries an element of unpredictability. If a scenario is predictable, there is no risk to be shared, ergo by definition a scenario with little risk (e.g. known diagnosis and treatment plan) is absolutely and unsurprisingly not fitting for insurance.
Did I miss something?
Quoting from the article: Hendren didn’t invent the idea of markets falling apart because customers know something that companies don’t. Nobel prizes were awarded to a trio of economists in 2001 for developing this idea of adverse selection in the 1970s. But his use of the concept may at least partly resolve the puzzle of why those with pre-existing conditions can’t get insurance.
Another quote: This individual mandate is a natural fix to the problem of adverse selection in health insurance: It keeps the lowest-cost participants from opting out, and as a result the market doesn’t unravel.
The "ignorance" is in "likelihood of utilization", not "cost of utilization".
(Personally, I would never use private health care in the UK. I know people who have.)
If you can't opt out, then choosing private basically means paying for both.
It's true that every health care system rations care. The difference is that a universal system rations based on medical need (triage) whereas a market system rations based on ability to pay.
It also clearly demonstrates one of the reasons why markets alone are simply not sufficient/appropriate for some problems. The rest of the developed countries outside of the US have long understood this with respect to health care.
Do 300M people really have to negotiate their own insurance, and research carefully all the terms and conditions and so on?
Why do you single out health insurance?
I know that health insurance is often used to teach asymmetric information models, but it wasn't always obvious that it's a good example. Someone selling a used car might know a lot more about the car's hidden costs than anyone else, but does the typical buyer of health insurance really know more about his or her probability of illness than a sophisticated insurer with good doctors and actuaries and a lot of data?
This led some economists to argue that the problem in health insurance markets is not asymmetric information, but rather too much information—the insurer already knows you will be a bad risk. This research makes it clear that there really is asymmetric information and spells out what it is.
