Seems to me some Americans on here love to complain about the Canadian medical system but frankly it's great you pay very small yearly premiums ( $0 to $900 depending on income per adult taxpayer ), no deductibles, and are completely covered for catastrophic events in the unlikely event you need it. If you travel, you can get affordable travel medical ( pretty much a must have if you own anything at all ). Only extra expenses are a small fee for ambulances and prescription drug costs ( people in financial need may get the drugs free ). If Americans are going to continue to fear alternative systems like the one we have in Canada ( and it is an irrational fear ), then you are stuck paying the fees you pay and/or have significant numbers of people either underinsured/uninsured or unable to afford care they need. That's not even taking into account the lack of free choice many Americans have concerning employment because they need the medical benefits.
I’ve had medi share for about 3-4 years. With the extra healthy discount I pay $180 per month. I’ve been to the doctor 10 times in 10 years and it’s been for my yearly check up. With the medi share discount I now pay about $170 for lab and doctor visit as opposed to free. It’s free if you are allowed one preventive visit a year with your normal insurance which medi share does not offer. The way I see it, this is more a plan for a catastrophic event. I’ve saved $1000’s in premiums. If there is a big event I’d be out $10k deductible which I can then work out with the hospital to pay in installments. You can get the deductible to as low as $5000 I believe. They offer and app called MDLIVE which you can see a doctor from your iPad for free from the comfort of your home within 15 minutes for little stuff like ear ache where you are really just looking for a prescription more than you are a Dr visit. Keep in mind they are not regulated and are not recognized as an insurance plan so they are not governed by an agency. In other words they don’t have to pay out. It’s a religious organization and have claimed to never ever not have paid out. I love it
Bernie says we are all going to have "medicare-for-all" under his plan. Except his plan eliminates co-pays and deductibles but original medicare has co-pays and deductibles. And his plan is going to cover dental, vision, and hearing but original medicare does not cover of any of those. And medicare requires American citizens to pay in for years before receiving benefits unless you are disabled. But under Bernies plan- and all the others trying to out-Bernie, Bernie- you don't have to be a citizen or have any legal status and you don't have to have paid a dime in. If you came across the border illegally last night, you are good to go. Pretty much stretches the definition of medicare in "medicare-for-all." Not your father's medicare. Not saying that expanded national healthcare should not be pursued. Just sayin that the marketing of medicare-for-all is bogus. It is another animal altogether. More like medicaid-for-all. Which you can think is good or not good. Just know what you are getting and pursuing and where the revenue IS NOT coming from. No one is deducting payroll taxes in El Salvador to pay for the illegals immediate receipt of benefits here. Be nice to take care of Americans first but I have learned that that is racist and because my ancestors owned slaves, even though they didn't but whatever. SPENDING OUR WAY TO PROSPERITY!!!!!! The whole thing is and has always been a two-step kabucki dance right from the beginning. Many Americans had good health insurance even though many did not- and the poor on medicaid were covered. But American health insurance was basically affordable for many, and that is why so many Americans opposed going to a Canadian or British NHS system. It was clearly a step down. But as was always said by the astute ones, "by the time Obama and the others finished "improving" the health care system, Americans would be begging for a Canadian system. Well, here we are right on schedule. Get in line early if you need any medical treatment and get used to it.
How Employees & Employers Get Bled by Health Insurance https://wolfstreet.com/2019/09/25/to-what-extent-health-insurance-bleeds-employees-employers/
I think it's interesting how we use the word "insurance" in the U.S. when it comes to health care. In the abstract and in most other fields, we use the word insurance to convey the idea that a bunch of people will pool the risk of a few catastrophic events that will inevitably happen to a few people in the pool, and thus no-one in the pool will suffer that catastrophic impact of that event, i.e. your house burning down, your car getting wrecked... Using car insurance as a specific example, we generally don't expect insurance to cover oil changes, tire replacement, brake changes or other routine things that every car owner can reasonably expect to pay. We could design a system that covered these things, but it would be difficult to price and apportion fairly between participants. When it comes to what we call "health insurance" in the U.S., on the other hand, we are actually expecting "health care". We're expecting those annual OB-GYN exams and normal childbirth and all the other routine care that can normally be expected as part of life to be covered, and we conflate that "care" part with the "insurance" part. Although not a perfect analogy, it would be like expecting Geico to cover your oil changes and brake jobs as part of your car insurance, and insisting that that insurance not go up in price. I think it's important to break those into separate areas when discussing them, as conflating them causes a lot of the confusion that we see any time health care comes up, as amply evidenced by this thread. From my inexpert view there actually aren't unsurmountable issues in the actual "health insurance" part of the market. Absolutely we need to do a better job ensuring that everyone is part of the catastrophic pool, as opposed to the system we still have which covers everyone through a shadow cost of requiring emergency rooms provide care regardless of payment. But aside from that, and the ridiculous bureaucracy of claims, the fundamental concept isn't completely broken. What is pretty much broken in the "health care" part of the equation. It is absurd that the same OB-GYN visit costs $170 or $850, depending. That's just horribly market distorting economics. There's also the issue of all of us in the pool (which is everyone in the country given the fact that hospitals take anyone) paying catastrophic costs that could have been prevented by affordable "health care" that everyone had access to. Way back in 2007 I had the opportunity to have lunch with Andy Grove who was as visionary in this as he was in semiconductors. His view was that much of the problem with this sector was that we insisted on using doctors with a minimum of 11 years of education/residency to do strep throat swabs and stitches, instead of physician assistants and nurse practitioners who could handle a huge part of the routine care load. We're just finally starting to see the Patient First style urgent care centers show in stip malls everywhere, which from my experience have been spectacular for treating mild issues that need a medical professional but not an MD at market rate costs. I'd love to see more of our discussion on "health care" revolve around this piece of actually structurally reducing the cost to provide care.
You also have Online Doc visits which are part of some insurancesand are offered at zero cost. Like MDlive. For smaller things like when you know what you have but just need the prescription. You can see a doc in less than 15 min from your iPad without having to leave your home.
Within the past few months I went to an urgent care twice. Once for a dog bite and once after getting stung over thirty times by Yellow Jackets. In both cases my primary care doctor's office was closed. Each visit was under $200 and the service was phenomenal. The Yellow Jacket incident was especially stressful as I thought I was having an allergic reaction and the medic on staff (a PA - Physicians Assistant) rushed me in without the need of completing the paperwork first. She even called a few days later to see how I was doing. I can only imagine how much I would of had to pay had I gone to an ER. That being said, my fiance is works for the county fire department and as an EMT before that and it is ridiculous the amount of abuse that goes on. I am not joking when I say people will call 911 a fake a health crisis just to get a ride across town!
I think I have a fairly nuanced opinion on this having family in the industry and also being a victim of absurd surprise medical costs: The current system is a racket. Insurance companies have virtual monopoly-by-proxy power in states, of course assisted by the "health insurance is an employer benefit" mentality that came from the post-ww2 job boom. There are some ways out in order of (what I think are) decreasing ideal: 0. Force congresscritters to use the worst-performing insurance in the country. This has the effect of driving votes towards fixing a broken system by dogfooding it to the people who are supposed to look out for us. Bonus because older people are typically more likely to be sick, so they will pay way higher prices because the "people that represent us" are almost twice the average age of the country (HAH!...represent "us") 1. Cross-state healthcare. Allow the free market to determine the price by allowing companies to merge risk pools, thereby reducing total risk. 2. State-sponsored health insurance. This idea is a great substitute for (1) because even though it shirks the free market, in reality health insurance companies driven by profit have a perverse motivation to not help the people who actually need it. A state government run system allows states rights to determine the way this is executed without infringing on rights of everyone. 3. Single payer healthcare. Again, we cannot single-payer to a company (this creates an even worse FEDERALLY SPONSORED monopoly) but if the government truly only exists to tend to the care of it's citizenry this falls perfectly into the realms of responsibility of any (even small) government. I think most people would pay into (2) or (3) if (1) was tried and failed. What bothers me is that the democrats are the only people proposing a solution (literally any solution) and the republicans seem to think our broken, awful, system is working. The TEA party was even willing to stop the government to prevent the ACA (now recognized as a general half-assed solution) despite it actually improving the lives of many people (including myself) who many have been forced to leave the country otherwise due to pre-existing conditions and insurance companies raking sick people over the coals for even simple medication that would vastly improve (and thereby reduce total costs) of their conditions! We need something, ANYTHING, that isn't our current system. I feel like once the boomers die off (literally...in an average of 15 years) we will see real change in this country in this realm. This backwards mentality held by the 70+ year olds in congress won't stay forever. We just have to hope none of us get cancer until then. The side effect is this is one issue that is driving the left to go even further left because the right is digging their heels in and refusing to move. It's a very sad situation.
All very good points. I would push back on option 1, although I'm not sure that means we disagree in any way because I think perhaps you're advocating to try in order to definitively show it won't work, and bonus if it does, we'll take it? First off it isn't apparent that premiums are being driven by too small of a risk pool. If this data is to be believed (https://www.businessinsider.com/healthcare-costs-in-all-50-states-ranked-2019-3) the average cost for health insurance is actually lower in small population states like ID than large population states like TX, although I didn't actually do a regression on it to see how strongly that holds. In general though, you would think you hit the diversification benefit at just a few thousand subscribers and it doesn't get much better after that given the incidence rate of expensive medical issues. Second, given that health insurers aren't morons, allowing "selling across state lines" really means "all health insurance companies effectively move to the state with the least regulation". Funny how the people who scream for state's rights are dead set against CA's right to limit car emissions; seems this would put that "least regulation" state in the same drivers seat when it came to dictating nationwide insurance regulation policy as they claim CA is in with emissions standards and car manufacturers. And from my experience in another regulated industry, electricity, I would think we're actually better off just not regulating health insurance at all compared to letting Mississippi or Delaware or wherever very laxly regulate it, since regulation actually provides a massive legal umbrella for the regulated companies to do anything without consequence to themselves as long as the state regulator approved it.
This is actually a good counter point and follows along the lines of what I was saying about insurers having a perverse motivation. However if we don’t regulate at all, we have another problem where insurers will stack their risk pool with only healthy people. This runs counter to the purpose of health insurance in general. This wouldn’t be such an issue if the only way to pay a medical bill wasnt through some backdoor negotiation between a doctor and an insurer, which you, the person on hook to pay, are not allowed to know about. If I could walk in to a doctor with a broken leg, or a heart attack, or whatever and pay a reasonable rate for medication and service you might eliminate the need for anything but catastrophic insurance. Government subsidy could help bring the cost down for at risk populations as well. A governments only purpose is to look out for the welfare of its people and that seems like a good place to do it.