doing this on an annual basis is such an obviously inefficient system (on both sides) that you'd think somebody would've developed a basic mathematical approach by now to disrupt the market.

but of course in practice, most US healthcare consumers don't really have an actual choice about who they buy their healthcare from.

Annual basis for what is a lifetime time frame is one of those things that's bonkers the harder you think about it.

I knew a guy. In 2008 his wife's company went under. So lost the health insurance she'd had for 15 years. No COBRA and in 2008 no ACA either. Her gall bladder got infected and they had to put a second mortgage on their house. Both of them had been paying for insurance for 25 years at that point.

Me I didn't have health insurance between 18 and 40 when I started working for a big corp. Two years later racked up $50k in medical bills. Insurance paid almost all of it.

Crazy.

Weird America-only medical bullshit: it costs way more money to have a pregnancy that spans 2 calendar years, than if you keep it all in one year.