If the goal is providing subsidies (i.e. wealth transfers), then insurance is not the way to do it. That is the government’s role.
And it naturally means the people with highest premiums are the least likely to be able to afford it (the elderly, the disabled, those with chronic conditions that make them less likely to maintain high earning jobs steadily, etc)
"If I focused on my health, ate clean and exercised daily, why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"
This is why there is a hyperfixation on shifting blame away from (failing) individuals. The logic breaks when Billy has to admit he just hates exercising.
And yes, before you comment, I know "maybe Billy has (condition outside all control) so it's not on him". Please, see what I just said in the previous statement.
> why should I also be subsidizing Billy "video-games-are-my-exercise" fatass's chronic health conditions?"
Nobody is asking you to: enrolling in insurance is a choice in the USA.
Also, replace "chronic health conditions" with "unavoidable inherited genetic risk factors". We don't want Billy to be screwed for life just because he was born to a suboptimal combination of parents.
But such a system comes at other costs that most people intuitively feel infringes on core values they have.
Edit to add: this system would actually have some great advantages over an “existing conditions” tax in that now you pay low rates until you have diabetes, all during the time you are leading the unhealthy lifestyle. But once you have it you are not rewarded for starting to exercise and eat healthy and get it under control. In the hypothetical scenario above, you’d be punished economically during the period you were building bad habits and you would be able to restore sane costs after course correction
I don't think we should play arbiter for who has and hasn't lived a healthy enough life to still believe they should get healthcare?
Then why are you not asking your insurer why they cover a lot less preventative health or other options. For example, Kaiser flat out refuses to prescribe GLP-1s for weight loss, others insurers are the same with gym subsidies or not covering nutritionists.
But they'll happily pay for your gastric bypass.
That's true for predictable costs, but not true for unpredictable ones - which is the point of most insurance (housing, car, etc). The point and use of insurance is to move risk to entities that can bear it.
Utility is non-linear with money, and so you easily have situations where spending X times more on something "costs" you more than X times if measured in how useful the money is to you.
Typically, as you have more money, each further dollar doesn't provide as much benefit as the last (sometimes things are lumpy, the difference between "not quite enough to pay rent" and "just enough to pay rent" is huge, but broadly this is true). Going from $1000 to $10000 is more impactful than $1001000 to $1010000.
That means that moving the other way, each additional dollar spent has a greater personal cost to you.
Therefore, sharing unlikely but high expenses can mean that your expected cost is the same (if there's no profit/middleman) or a bit higher, but your expected personal cost is lower.
That has not been my impression as an outside observer.
Absolutely not. They inflate prices by 200% and then give you 20% "savings" back. The whole idea of a health insurance company as publicly traded corporation is totally insane. They are designed to extract maximum profit from wherever they can get. The is no incentive to save money for patients. Any savings go to shareholders.
If your claims were true, then the publicly traded businesses would have no customers.
When that didn't happen, the story changed to that number being how much more premiums would have risen.
Insurance premiums have only gone up as far as I can remember, though there's a ton of variables at play here. Inflation is an obvious one, plus continual introduction of more and more costly treatments- biologic injections, cancer therapies and so forth. The unfortunate increase in obesity rates in my lifetime (along with all the health complications) has been a significant contributor as well.
It all adds up.
An interesting thing about rising health costs is that it has happened at roughly similar rates in most first world countries for the last 50+ years.
For example in 1990 the UK, FR, and US were paying 2.0, 2.2, and 2.6 times their 1980 costs per capita. By 2000 that was 4.1, 4.1, and 4.2. By 2018 (the last year I had data for when I calculated this a few years ago) it was 10.6, 7.5, and 10.2.
Here's the 2000 to 2018 increase for those and some others: DE, FR, CA, IT, JP, UK, US were 2.1, 1.8, 2.0, 1.7, 2.6, 2.6, 2.3.
When politicians in the US talk about rising health care costs they usually put the blame on recent policies from opposing politicians. That so many first world countries with so many different health care systems all have seen similar increases for the last 50+ years suggests that it is due to something they all have in common and that government policy doesn't affect it much.
That was eliminated by a Republican bill, the Tax Cuts and Jobs Act of 2017.
Prices were always going to increase.
https://www.healthcare.gov/coverage/pre-existing-conditions/
https://www.healthcare.gov/how-plans-set-your-premiums/
Health insurance premiums in the US are more tax than insurance. They also have low single digit profit margins with less than desirable shareholder returns (many are non profit in the first place), so they don’t have much room to lower premiums without also reducing healthcare expenses.
The insurance business in general is very competitive and not very profitable, so an insurer that tries to collect outsized premiums will usually suffer a loss of business.
Knowing several Americans, and how much they pay for health insurance (and are still required to pay for some things "out of pocket"), this is incredible to me. And that's before you even get to the process of making a claim.
Such a broken system.
Even the age rating factor is capped at 3, so there are also massive wealth transfers from young to old.
Mathematically, health insurance premiums in the US are more tax than insurance premium.
