You'd make it illegal to pool costs by barring insurance - meaning that healthcare providers would either need to provide service gratis for the majority of the population (which is, really, just another form of insurance so that's out) or they'd need to secure a personal loan with their bank some time between getting hit by a truck and the operating table.

And for pre-existing conditions and long term health disabilities - the individual would need to somehow justify the profitability of their existence to a private underwriter who was willing to bear the cost - in most cases those people "aren't worth the cost of keeping them alive" (assuming you're looking strictly at numbers).

Hence - a lot of people would end up dead.

> meaning that healthcare providers would either need to provide service gratis for the majority of the population (which is, really, just another form of insurance so that's out) or they'd need to secure a personal loan with their bank some time between getting hit by a truck and the operating table

There's also the Chinese model, where you or your family are expected to have substantial cash savings on hand for any medical emergencies.

Even with good insurance, medical costs in the US can exceed the savings of even the most thrifty.

My uncle spent $1.7 million in 3 years to care for my aunt, and that is with excellent insurance.

That’s way above any legal out of pocket max so I’m curious where most of that money went. Definitely wouldn’t call it good insurance.

My mom is fighting cancer and her medication is better than 25K a month, but she pays 200. That’s closer to my definition of good insurance.

I’m guessing they were using a course of treatment insurance refused to cover. Or it was nursing/residential care.

You got it. Nursing care.

I'm not particular familiar with Chinese health insurance - if you lack those cash savings are you left out in the cold? Does the government step in?

I don't have any direct experience with the Chinese health care system, but there's a lot that is not covered by insurance, and bribing doctors or hospital administrators to receive better or quicker care is supposedly widespread (and therefore is or is perceived to be necessary). https://www.newyorker.com/magazine/2014/08/25/under-the-knif... is a good overview.

Can you really call it 'insurance' when it's a pre-existing condition? I realize we can call insurance whatever we want, but when I think of insurance I think of it a way to pool for mitigating risk of the unknown.

No one would sell insurance that would fix your already destroyed roof.

> No one would sell insurance that would fix your already destroyed roof.

But they will sell you homeowners insurance in areas prone to wildfires or hurricanes. The difference is that you are expected to know the amortized cost of disasters for your property and either insure against it or simply accept the risk. Either way, you as a homeowner are supposed to make an informed decision. If disaster is too likely to occur in a certain area, you can either move or not purchase a property in the first place.

Science still hasn't figured out how to let us move into healthier bodies or choose our bodies prior to birth, so, alas, we are forced to seek fairness through other means.

> But they will sell you homeowners insurance in areas prone to wildfires

And in areas with wild fires, tar roofs aren't legal for new construction! Roofs have to be built out of something non-flammable.

Lessons to be learned perhaps.

Most of the building code is written with the blood of victims who died in a horrific accident.

If you want to know why doors in public places have to open toward the outside in modern countries and why "panic bars" are often mandatory, the answer is large piles of dead children (literally). Depending on who you ask and the country they live in, they will refer to a different disaster, but the common element in all of them is 70 - 600 people stuck in hallways unable to escape due to bad exit designs (eg. people piling up against doors that open towards the inside).

The unseen deaths are those who are unhoused or unsheltered due to building codes causing elevated building prices. Secondary effects (for those who can afford up-to-code) include less money to spend on healthy foods, good health insurance, quality child education, and other victimized children at the hand of building codes and other regulation.

You can virtually ramp up building codes ad-infinitum, until the house is as safe as can humanly be built, if your expense is to hurt a lot of children by bankrupting families of expenses to take care of other necessities in life.

Well, whatever we call it we as a society need to choose whether we want to keep people with expensive preexisting conditions alive. I don't think it's really necessary to debate the point since almost every western country has decided that their ethics fall in the camp of "Yes, we support those people and give them the best life possible" whenever they're actually pressed on the matter. For a while the US skated by on budgetary excuses but all the while I think society still idealistically held on to that standard - I think this point is fairly debatable though.

I think it's more a question of whether we'd be willing to install and maintain a roof on a building that had been designed without a roof in mind or whether we'd tear down the building to make room for a new one. You'd probably rationally lean in the second direction for a house - but when we're talking about a human life the math changes for a lot of people.

Either way, a return to an insurance-less situation would leave people with preexisting situations out in the cold, unless your definition of insuranceless involves government subsidies for all preexisting conditions and at that point you're basically talking about medicare for all.

I think as a society if we can't discuss this in an honest manner without deceptive terminology, we're doomed to be stuck in a bad spot. Perhaps phrasing it as charity of the healthy towards the less healthy would lead towards a more productive and honest starting point. It's something many, including myself, would be much more supportive of than feeling like I'm deceived by misrepresentation of a product. I'd feel like I'm taking part of a noble charity rather than this sort of deceptive 'insurance' product.

I don't see it as a charity so much as we, as a group, are pooling our money so that those that need health care get health care. That can be people with pre-existing conditions, people with a new condition, people that are in an accident, preventative maintenance, or even just normal life situations (pregnancy, etc).

In my mind, it's not charity because it's

- For everyone. Maybe not for you today, but maybe tomorrow

- For the benefit of society as a whole. If we let everyone who got sick just die, our society would be worse for it.

Characterizing insurance products in the US as a 'benefit of society as a whole' is a charity in and of itself. A large component of the insane costs billed for procedures has to do with an unhealthy symbiosis of the medical industry with 'insurance' companies. This massive black hole, much a result of poorly designed regulation, leads to reduced benefit to society as a whole and a system that is not for everyone not today nor tomorrow.

If you are thinking of something that is for literally anyone, you are most likely thinking of universal healthcare or some other like system.

I personally would avoid characterizing it as charity since charity tends to be an inherently voluntary action and charitable givers have some expectations on the usages of their charity. US charitable giving in a lot of areas of Africa continues to contribute to the illegality of abortions in many countries since the church groups offering aid condition their aid on moral stances they hold.

We've seen how the judgement of those receiving aid has affected US policy in the past - a handful of people are marked out as undeserving of the aid (maybe someone with a long term physical disability commits murder or something else) and then the full category of people are painted with suspicion (ala "welfare queens") and that suspicion is used as a justification to cut spending drastically under the guise of oversight. There are a fair number of people clamoring today for UBI for the reason, in my view at least, that it's the only way to undo all the complicated conditions on various forms of governmental aid.

I'd personally be quite in favor of keeping it dry, cold and governmental - healthcare is, IMO, an important enough topic that we can't let emotions override treatment. If we're going to put a bunch of money into a big pot we should have some very deliberate rules about how that money comes out and what it gets used for and posing it as a charity is going to get all sorts of rules applied to it (i.e. it can't be used for anything Planned Parenthood related, it can't be used for contraception, it can't be used by trans identifying individuals, you need to have a full time job to access it, it is unavailable to felons, etc...) - some of those rules might make sense, others might not. At the end of the day I think posing it as a charity will make it a lot harder to come up with a fair set of restrictions on it.

If you health insurance only covered “insurance events” in the normal definition of the phrase, much of medical care would not be insurable.

"those who went bankrupt under the old system would instead be dead."

The people who went bankrupt before were generally those without insurance. You've not said anything that explains to me why they wouldn't do the same under this supposed new system.

Well, in this current system everyone (excepting those who choose to opt out and pay a fine instead) receives a basic level of coverage - it's definitely not perfect and it has issues, I'm not going to argue against that. In the 90s and early 2000s it was much easier to bankrupt yourself due to extremely unlucky life events - but if insurance was prohibited you'd be unable to access care so instead of losing your house you'd lose your life.

I think I laid that out pretty clearly in the prior comment, is there some part of it that's unclear?

People without insurance used to get care and then go bankrupt. Today people without insurance still get care and then go bankrupt. What I’m not understanding is why people in this theoretical future without insurance wouldn’t do the same thing?

I feel like we’re talking past each other. Sorry if I’m being dense.

The blanket statement "people without insurance used to get care and then go bankrupt" does not apply to every single instance. Sometimes people were (and are) already so close to bankruptcy that they simply cannot afford the care that they need, so "I'll get health care and then go bankrupt" is not a live option for them.

Yes, emergency care has been essentially free in the US for those who can never pay for it, but that doesn't cover, say, chemotherapy. If you don't have insurance and don't have any way to generate significant cash (no house to sell and no wealthy generous friends) it's not that you're going to get chemo and it'll bankrupt you; you just won't get chemo at all (and you'll probably die). This is a little better now with the medicaid expansion, but not perfect, and not all states expanded medicaid.

Even today we have people dying of complications related to diabetes -- a serious but very treatable affliction -- because they can't afford supplies. In the US! The world's richest country!

Got it. Thanks for expanding so I understand better what you're saying.

I'd also clarify that emergency room services being treat first, bill later is itself a form of insurance. A decent chunk of emergency room costs are never paid by patients and end up being paid by... actually I'm not certain, but either private hospital corporations or the government. However, that is only for the initial triaging treatment. If, for instance, you are stabbed in the belly and some emergency patch work is done to stop the majority of internal bleeding and some antibiotics are issued with a scheduled regimen over the next few months to prevent sepsis then there is a limited supply you've gotten by the grace of emergency treatment but if your supply runs and you're unable to afford more at the pharmacy out you'll need to return to the emergency room to secure more meds. Emergency rooms regularly serve as extremely expensive pharmacies, but they're pretty busy places and the care you're seeking could be delayed and that delay can result in a perfectly treatable infection developing to the point of a mortal wound.

While everyone in America can receive emergency treatment no questions asked it isn't necessarily going to happen very quickly and can result in more health issues than being able to pursue medical care through more standard means.

Their life could be extended by some medical care they can't afford, so they would not get that care and die sooner instead.