Allowing insurers to step in the middle of smaller, everyday health transactions by empowering them to negotiate price fundamentally screwed up the system.

There's no reason insurance should be involved in non-catastrophic or routine pharmaceutical purchasing.

The root problem is most Americans are too poor to afford healthcare at the current prices of doctors/medicines/medical equipment/liability protection/etc, period.

Just tell me how much money I owe you and let me pay.

Also, the ideal way to use an HSA is to not use it. Every year, transfer the HSA funds to Fidelity, invest in VOO or whatever, and let it ride as long as you can. PDF all the receipts, and then pay yourself with tax free income when you finally need to.

My understanding's that direct withdraws are possible after 65, taxed as income. Does your "when you finally need to" mean only withdrawing for healthcare reasons or is there a way to transfer or withdraw without a tax hit, besides for health costs?

But pretty much everyone will incur healthcare costs as they get older, so you should be able to withdraw tax free for those. And all healthcare costs incurred by your family during your lifetime while you had an HSA are eligible for reimbursement.

Quite frankly, I do not know how auditable a 40 year old medical receipt is. Is the IRS' plan to just take everyone's word for it?

https://www.irs.gov/taxtopics/tc502

Never needed it, so don't know all the rules are, but I'd imagine the IRS gets a lot of fraud through it (since hospitals wouldn't report from their side).

> Fidelity offers HSAs for employers and, as of November 2018, individuals.[36] Individual HSAs have no account opening or transaction fees.[37] In a favorable review of the Fidelity HSA's features, the The Finance Buff wrote: "No other HSA provider comes close to what Fidelity offers."[38]

I would go to Fidelity.com/toa and start a transfer of assets from your current HSA. If it is an employer sponsored HSA where your employer contributes to it, then leave $25 to avoid it getting closed. But every year, move the remainder to Fidelity and invest the remainder like any other IRA.

I think you're not supposed to use it actually for healthcare, at least not in your young age.

Every HSA I've had[0], I just reimbursed myself for eligible expenses[1] by transferring from the HSA to my regular bank account. That amount then gets reported on line 15 of form 8889[2] the following April. If it's not an eligible expense, that's between me and the IRS—not the bank at which my HSA is held.

[0]: I highly recommend Fidelity, for anyone reading this and thinking they need a better option.

[1]: https://www.irs.gov/instructions/i8889#en_US_2022_publink379...

[2]: https://www.irs.gov/pub/irs-pdf/f8889.pdf (PDF)

Belgium spends 11% of GDP on healthcare (https://ec.europa.eu/eurostat/statistics-explained/index.php...)

The US spends 18% of its GDP on healthcare: https://www.cms.gov/data-research/statistics-trends-and-repo....

> Also how bad are the wait times to get socialized medical care?

How bad are the wait times for not getting healthcare at all because your insurance doesn't cover it? Or because the associated costs will bankrupt you?

Middlemen can't raise the price that much; you could just go around them if so, either by not using it or by going to another country.

Anyone who thinks the universal model standard in Canada and the UK is actually working has a hole in their head. The solution is a combo.

https://www.kff.org/report-section/ehbs-2022-section-1-cost-....

It is quite feasible that redirecting all of that to a tax-free savings account could pay for itself in no time.

That is not something any policy change can fix until far in the future. In the short term, all that is possible is deciding who gets allocated the available healthcare.

> It is not as easy as that because supply is heavily constrained

I don't think this argument works when the data shows 90%+ of the population has health insurance.

What's a "competitive healthcare market" for diabetes? Or cancer? Or childbirth?

> Anyone who thinks the universal model standard in Canada and the UK is actually working has a hole in their head.

The UK has a population of 67 million. There are half a billion patient contacts in any given year. I've yet to hear stories like "I can't afford my insulin" or "we had a child, the bill was 200k and we were also charged for holding the baby"

Some of them did manage to release statements about how much they support the NHS before dying. I'd be more impressed if they lived though.

    The United Nations World Population Prospects suggests current life expectancy in Australia in 2022 to be 83.79.

    In fact, Australia enjoys one of the highest life expectancies in the world, ranking 8th out of 60 developed countries. That’s higher than the UK (81.65) and the US (79.05).

[ raw data source ] https://population.un.org/wpp/

So it appears that both Australia and the UK with National Health services (named differently in AU) have greater life expectancies than the US.

Perhaps it's the authors you read?

Bertrand Russell was 97 when he died.

US's lifespan is not caused by lack of access to healthcare though, that is fentanyl.

True, however Australia has a tiered health care system with a very low gap to ensure that practically the entire population has access to healthcare that they can afford in addition to national bulk pharmacy deals to cap generics for the bulk of ailments that require prescription.

For all it's warts the Australian system delivers a kind of healthcare that the US system does not .. widely available affordable treatment for the bulk of medical issues.

US (general mean both sexes) life expectancy sharply dropped as COVID spread, the most that fentanyl can be accused of is the flattening of the general slow increase between 2012 and 2018 .. even that ended and was on the increase until the USofA foot gunned its handling of COVID.

[ Historic USofA ] https://population.un.org/wpp/Graphs/Probabilistic/EX/BothSe...

[ Historic Australia ] https://population.un.org/wpp/Graphs/Probabilistic/EX/BothSe...

How do people with substance use disorders stop using substances? They use healthcare, unless they're in the US where they'll using some quasi-religious abstinence-only residential programme.

If you're talking about Douglas Adams, he died of a massive heart attack...in California, where he'd lived for years.

So, in summary, uh wot mate?

Though everyone in my family in Glasgow seems to live well into their 90s.

Same for "medication wasn't available": "my insurance doesn't cover the medication required".

The US literally has a video genre of "rationing of insulin to survive".

on average, system is good for bottom half but system is pathetic in terms of services after paying such high taxes.

The difficulty is for sudden situations like heart attacks. For these you need savings accounts and a baseline catastrophic plan.

You don't have unlimited fully equipped hospitals and operating rooms. You don't have unlimited heart surgeons. You don't have unlimited MRT scanners or labs doing blood tests.

In healthcare both the supply and the demand are inelastic. Market forces here work only for the most common and the most simple cases like nasal sprays and eye drops.

Furthermore a lot of innovation goes to increasing bandwidth of the existing doctors. See tele health.

I think you have a very limited view of what is possible.

The US is composed of very fractured tribes, that people move in and out of throughout their lives. And US politicians are tasked with keeping taxes extremely low, and services very high, and the various tribes do all they can to give disproportionately little relative to how much they benefit.