Another issue is that insurance does not have to compete across state lines. They've divvied up the country and are sticking to their corners (much like ISPs).

Insurance should be required to accept customers from anywhere in the country. Hospitals should be required to publish prices. These seem like no-brainers to me. But hospitals and insurance make too much money, and give too much of it to congress for any real change.

Apparently there are unincorporated areas that do not have fire service from the county but you can buy fire service from the nearest city's fire department. If you do not have fire service the firemen come and watch that the fire does not spread from your property to the neighbours who have service.

This ends up just as you would expect. The poorest and most indigent go without, and then there's death threats, newspaper coverage, the works. You wonder why people are permitted to make themselves wards of the state because if your house burns down your biggest savings vehicle is gone and you are homeless and a burden on the public pocket.

Similarities with medical coverage are incidental.

When my wife was in the hospital for days after a C-section, we were entirely at their mercy. They could add anything they wanted to our bill and we had no idea if it was justified or not.

At the base of this pile of bullshit are simple, incontrovertible facts:

Health providers make money when their customers are unwell.

Insurance providers make money when they don't deal with the most vulnerable people.

Employers only care as far as keeping their employees able to return value.

I don't understand why the USA is so adamant to see that forcing market solutions to every societal demand or problem might not be good a thing. To see that this ideology has had time enough to prove itself in the real world and has been found lacking. We need something different. Accepting that there are no absolutes and that perhaps some things shouldn't be market-based doesn't sound too revolutionary for a start...

A private health insurance marketplace seems like the type of industry ripe to take advantage of consumers. And what if the health insurers in the market conspire to fix prices? The government or a class action suit could fight against it but that's the type of corrupt business practice at large that could take over a decade to correct.

I don't know what to even call it. A bizarrely paid for fragmented national health system with a goofy market component?

I wonder what that means. I really hope something like this passes at some point.

https://www.congress.gov/bill/116th-congress/senate-bill/112...

How will they treat me who never served them?

I mean, those same folks give us Medicare, which is both quite popular with the public and gets better marks on results, cost, and efficiency than private healthcare.

I see no evidence my insurance company cares about me any more than the VA cares about its patients. Does the VA have problems? Absolutely. Is "give up and give it to for-profit corporations" likely to fix that? Nope.

And Medicare Part C is a private insurer option, where again, Medicare just funds premiums.

It’s how the system is set up that’s the issue, not whether it’s managed by the government or a private insurer.

Do you know if Medicare Part D insurers are able to get drugs at a lower cost than the Canadian system does?

So one reason why Medicare Part D works pretty well is because the private insurers do the negotiating on drug prices. I've read reports that they actually get better prices than for their private plans (there is a ton of competition for Medicare prescriptions).

Are the prices lower than Canada? No, not generally. But they are some of the lowest prices in the US (excluding Medicaid which has a mandatory discount).

The VA's problems are in no small part because of the way it is structured (i.e. duplicate facilities, staff, low salaries, etc) and funded (combined with other military appropriations). If VA benefits were provided via Medicare it would have a structurally better system.

Comparison to the VA is not apt. It's not the same people, it's not even the same concept as M4A.

I'd compare M4A to Medicare/Medicaid, if you look at patient surveys they are much happier in general than people who have to deal with insurance companies.

[1]: https://www.congress.gov/bill/115th-congress/senate-bill/237...

https://www.cnn.com/2020/08/08/politics/trump-veterans-choic...

I'd be happy with that level of care compared to what's currently available for everyone, which is none.