My view as far as healthcare is that we should either go totally private, with no insurance companies involved, where people just pay out of pocket (but because of the way the free market works, the cost of healthcare services is very low), or we should go to a universal single-payer healthcare system (which, again, would result in lowering costs and creating more efficiency, like in Canada or Scandinavia). When we have a system that’s neither one nor the other, what we get is the one of the most expensive and inefficient healthcare systems in the world. This is because of the role of insurance companies as intermediaries between doctors and patients. Because they have insurance and don’t pay out of pocket, patients can remain blithely ignorant of the true cost of services and pharmaceuticals, while doctors and pharmaceutical companies have every incentive to provide unnecessary services and push unnecessary drugs to get reimbursed for them, and patients have no reason to educate themselves and just say “sure” to whatever the doctors push on them because the patients aren’t the ones paying the bill when it comes due. The result is that we have all these unnecessary services and drugs being performed/prescribed, and they’re being priced much higher than they need to be, and insurers then are forced to keep hiking premiums to make a profit. And then, on top of this, we have the problem of pre-existing conditions and adverse selection, in which it’s the sickest people who are most motivated to get insurance (or good insurance), which results in premiums also being driven upwards. Obamacare, of course, was intended in large part to deal with this second problem by forcing people to get insurance, but because it still allowed both consumers of insurance and insurance companies so much choice in what insurance to buy and whom to sell insurance to (to participate in exchanges or not to, etc.), the result is/was chaos.
Where you have a totally privatized, non-insurance driven market, you don’t have these issues because patients are forced to pay out of pocket, so they’re only going to authorize services and buy drugs that are truly essential (which will also force them to take responsibility and learn more about their own care), while doctors and drug companies can’t raise their prices beyond the point where most patients can afford to pay, so this will keep the cost of healthcare low. (Maybe in that system we’d still want publicly provided basic, bare-bones emergency care so we didn’t have people dying in the streets, etc.)
The other alternative is that we have a true universal single-payer system, so that risk is spread across the whole population, and then you don’t have the problem of adverse selection and pre-existing conditions that drives insurance premiums up, and there’d also be strict, universal, centrally dictated rules about what services are authorized in what situations, etc. (rather than a variety of opaque and divergent rules made up and constantly changed by profiteering insurers), and if you want to pay privately for other services that won’t be covered and have the means to do so, that’s your own business.
That’s my view, anyway, but I can’t claim to be any sort of expert in this area, so there could easily be facets of the issue I’m not accounting for.
