> Edit: Anyone wanna do me the courtesy of explaining why I'm so wrong?

just a guess, but it might be because of...

  Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US.

... one of the reasons most visits in the us is the er is precisely because preventative care is so expensive/hard-to-get in the u.s and people put off visiting the doctor regularly since its so expensive... the market isn't very amenable to these extra costs in the short run, whereas a state-run system might not have the same short-term cost concerns and encourage/subsidize regular visitation/preventative-care...

Preventative care in the US isn't expensive or hard to get for most patients. Under the Affordable Care Act (Obamacare) there are a wide range of preventive services that must be covered at no cost to the patient. While some coverage gaps remain, those plans cover the majority of US residents.

https://www.healthcare.gov/coverage/preventive-care-benefits...

What about treatment for severe conditions such as cancer or chronic conditions such as life-long disabilities where the expense is significant to the point that it may well be crippling for an individual but is rare enough that it's only a moderate cost spread across a society?

These are the cases where insurance is a perfect fit. The issue with letting it be market-based insurance is that (as you say) it allows insurance providers to take a fat cut. The obvious solution is to regulate insurance costs. At which point you might as well state fund it. Which leads us to the system we have in most of Europe.

As these system seem to work quite well, why do you think a market-based approach would be better?

I misunderstood your comment on first read, and looking at other replies others did as well.

> Market is a fine fit for every healthcare need that doesn't start with a trip to the ER which is the overwhelming majority of healthcare dispensed in the US.

I think most people are interpreting this as “market is a fine fit for every healthcare need [except for those that start in the ER] which is the overwhelming majority...”

I.e. that you’re advocating the market for the majority of healthcare rather than the majority.

I think your actual recommendation is the opposite. Maybe this would be clearer if you just laid it out like, “Most healthcare is non emergency, cost is a primary concern which insurance makes worse, markets are good at solving cost issues.”

Responding to your actual argument, however, I see many people claim that insurance companies are taking a “fat cut”, but I see very little evidence of higher than expected ROI/ROE in Aetna / United / etc. (ref: United’s net margin is ~5%, ~15B in net income on 300B of revenue). ROE is ~20% which doesn’t seem ridiculous for an insurance business.

The bigger problem seems to be personnel spending in healthcare (admin, support staff, billing), and generally a systemic culture that’s not even knowledgeable about what prices they charge, let alone price conscious in the services they deliver.

> ~20% which doesn’t seem ridiculous for an insurance business.

I think the issue with healthcare insurance companies in the US is that they collude with the hospitals to artificially inflate the cost of things so that their 20% is 20% of 10x the actual value of the treatment.

> routine activity

But as you observe yourself, that's not the majority of healthcare, which is emergencies and unforseeable needs. Hence there has to be an insurer of some kind.

> There's no reason someone shouldn't be able to get a physical or a colonoscopy the same way cosmetic surgery and dental care are done. These are cookie cutter outpatient services. The deviation from instance to instance is small and predictable so insurance should not be needed on the consumer side.

Sure, whatever, the small part of the healthcare market that actually functions like a market - consumer choice, legible prices - can be left to get on with it. Let's not let that get in the way of a functioning provision of necessary care to the majority of people.

The healthcare industry already pisses away huge amounts of money. Its evident in all those stories we hear about people getting a huge $5000+ medical bill, then calling the hospital and suddenly its $100 or less. That $4900 is literally all wasted