> The private part is optional and not widely used in many countries. And in some places it’s even illegal.

Going in descending order of population for EU countries:

* Germany: Mixture of private and public. Taxpayer funds cover about 75% of expenses. Private insurance can be used to cover the remainder.

* France: Mixture of private and public. Taxpayer funds only cover about 70% of expenses. Private insurance can be used to the remainder.

* UK: Arguably the most nationalized system, but still a heterogenous pool. NHS England ostensibly covers a little more than 90% of expenses, though it's complicated because the NHS sometimes subcontracts out to private management. NHS also has some of the worst ratings for specialized care (not routine care) among OECD countries, which is what other countries typically lean on private payments for.

* Italy: Mixture of private and public. The SSN doesn't cover 100% of expenses, and private insurance can be used to cover the remainder (or to pay for treatment in private practices). Similar to Medicare in the US, the SSN drives up reimbursements for private practices by setting minimum prices for private practices.

* Spain: Mixture of private and public. SNS doesn't cover all expenses, such as ambulances, dentists, pharmaceuticals, etc.

I could go on, but you get the idea. It's not really accurate to say that "the system in most developed countries has nothing to do with insurance", because most OECD countries require private payments for a non-trivial portion of care, and insurance is typically used to manage that portion of the costs.

Ok, let me be more precise. The universal healthcare system which pays for the large majority of healthcare costs in most developed countries does not work as an insurance (it’s paid by taxes or compulsory affiliation unrelated to actuarial risk). In some cases, one has the option to contract private insurance to pay for the parts not covered by the public system. It’s debatable to what extent this is comparable to actual healthcare insurance, because it’s not insuring the catastrophic events (that are already covered) but the relatively small and frequent out-of-pocket payments and some particular things like dental and vision care.

> Ok, let me be more precise. The universal healthcare system which pays for the large majority of healthcare costs in most developed countries does not work as an insurance (it’s paid by taxes or compulsory affiliation unrelated to actuarial risk)

As pointed out at the beginning of this thread, even in the US, health insurance is "insurance" in name only. Premiums are not set by actuarial risk (with the binary exception of smoking status).

That was the whole point of this subthread: there is no such thing as "actual healthcare insurance", because actual insurance is not a model that's applied to healthcare in any OECD country.

I don’t disagree. Healthcare insurance in the US is a fiction (especially now that catastrophic-only coverage is not an option). But other countries don’t even have this fiction of lives being saved by healthcare “insurance” because the one saving your life is the NHS, etc.

When mschuster91 said that insurance is the only ethical model it was not clear to me if he meant “insurance as in the US which is insurance in name only” or insurance as in “the model used in other countries which is not even called insurance”, hence me question.