According to who? It changes the calculus for me. I pay my health insurance because it covers the services I need. I could absolutely opt out if I wanted to, but I don't.
> I pay my health insurance because it covers the services I need
I think that, aside from the cost, this is probably the biggest issue most people have with health insurance in the US. UHC makes a lot of money specifically in part by not covering services you need, for example by having accountants override your doctors's orders.
If it were as simple as getting the services you need in exchange for money, I don't think as many people would hate the system as much.
How many Go Fund Me sites were brought up because of high medical costs for some accident or cancer? Is foregoing insurance an improvement over that if it isn't even possibly one of the big causes?
And that the US is the only country in the world where hospital "deathbed divorce" is a thing, to try to avoid family being saddled with ship-anchor levels of debt.
No, it isn't, which is why people want some form of insurance, whether public or private. To mitigate risk.
I was entertaining the comment about something being as "simple as getting the services you need in exchange for money". Which one certainly could do, but imposing that on everyone would also be a bad system for other reasons.
You missed the point of my comment. The "services" I was referring to was "health insurance," and the "for money" is the monthly premiums.
In too many instances, people pay the premiums and then do not get the benefits of the insurance.
An analogy in the travel industry might be if we had a system where at random, a double-digit percentage of air travelers were denied boarding and not refunded their money. No amount of legalese would make it acceptable, and in fact Congress regulates air travel such that practices like this hypothetical are not allowed.
Yes, people should get coverage under the terms of their agreement. I'd guess that the reason this is an issue with health coverage is because the sums involved are great, and usually the people on either side of the argument are either (1) unwilling or unable to effectively argue their case or (2) nonexperts who lack full understanding of the subject matter.
These aren't really an issue with airline tickets, not because we don't regulate insurance, but because the contract is exponentially more simple and understandable.
Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares. Similarly, they are not expected to plead their case in order to not be cheated by airlines.
I use the colloquial "cheat" intentionally, as it is a valid descriptor.
Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
> Air travelers are not expected to have a full understanding of how to operate a jet airplane, or an airline, in order to not be cheated out of their fares.
Correct. But it doesn't matter because the contract of carriage doesn't hinge on that. There's no confusion about what a ticket actually entails. If a ticket covers "one ride at the airport, from Cleveland to Omaha", it's pretty understandable what you are getting. If health insurance was just as simple, and covered "one ride at a hospital, from sickness to health", it would be likewise as accessible. But it isn't that way (although maybe it should be a lot closer)
> Notably, however: most insurance delays/denials will have in common that the patient is represented by an expert (a physician) on their case, while the insurer will be represented by a person who has typically never spoken with or examined the patient and may not have ever practiced medicine. The quality of the argument and expertise of the interlocutor are red herrings.
I understand but that's not what I'm talking about here. I'm talking about a broader information and accessibility disparity.
Having a physician isn't any help if your insurer is deadlocking you on coverage you legally have coverage for, you need a lawyer. That's a contract law problem, not a healthcare problem.
But if you don't actually have coverage for what you need, having a physician argue that you need it, isn't going to help you. Most people buy their health insurance policy all by themselves, without any legal or medical help.
The system wasn't designed. There were no design choices. The entire thing is a legacy result of expectations and costs that all started snowballing from the moment FDR decided wage caps were a good way to stop inflation.
We're not in the situation we're in because anyone thought it was a good idea. We got here incrementally over ~80 years.
of course the system was designed. of course there were design choices. it's a system implemented and executed by human beings at every step, constantly. every functional atom of this implementation was a conscious choice by someone. if nothing else, a choice is constantly being made to persist with the present system.
yes the design is a result of negotiation between countless people and groups of people, who all have varying power and responsibility and subjective consequence. yes all of these choices were made in context, but they were never the only choices that could have been made in that context.
this negotiation, and these innumerable choices, these designs have been a major if not primary concern of the past twenty years of american politics, economy, and millions of individual lives.
yes we have arrived at the implementation we see today, which seems ill-conceived, over-complicated, and pointlessly cruel. but at every moment that has passed and is passing now, different choices can be made, and a different system of different design can be implemented.
we are still in this system because there is infrastructure that prevents change to a more agreeable system. negotiation tactics may have just changed.
Sure, the healthcare system is "designed and perpetuated" by all of its participants, in the same way that poor labor practices in Asia are perpetuated by Walmart cashiers.
Technically all of the participants involved are a part of the system, yes, but my key point here is that none of them have the agency to change it.
The only people who can change it are voters and congress themselves.
> The only people who can change it are voters and congress themselves.
Most of the participants in the system are eligible voters, so asserting that voters can change the system is very much asserting that nearly everyone in the system has agency to change it.
(The fact is “voters can change it” is optimistic, because the US is not a direct democracy and, due to gerrymandering, campaign finance, and other factors, only loosely a representative one, being functionally more of a plutocracy. The people who benefit from its inefficiencies and inequities have disproportionate power over its structure.)
