Whatever ideological team jersey we want it to wear, the root cause is that medical insurance has gone from being insurance used in case of emergency, and gone to being a middleman skimming as much as humanly possible.

The only way out of this is to remove the profit motive sparking this avarice: either nationalize the healthcare, or ban healthcare insurance and regulate hospitals so tightly that they aren't allowed to profit as a business, the executives have capped pay, and the business can't be publicly or privately traded.

The laissez-faire approach to healthcare has completely failed in the US. Given it is the wealthiest country in the world, I cannot think of a more damning result.

> The laissez-faire approach to healthcare has completely failed in the US.

Why do you think we have a free market approach to healthcare? Why can I only sign-up once per year unless I have a QLE? Why can I contribute a certain amount to an HSA which is triple tax advantaged with an HDHP but I can't with a PPO? If I have an HDHP+HSA why can I also contribute pre-tax dollars to an FSA that is use-it-or-lose-it for dental or vision only but if I have a PPO I can have a limited purpose FSA that can be used for medical, dental, and vision? Why are there contribution limits? Or even more basic, why is healthcare tied to employment?

The reality is we don't have a free market when it comes to healthcare at all, we have a hampered market where over the years we have politically regulated it into the abomination it is today with some of the worst incentives possible. We can certainly have the debate of whether a free market or nationalized healthcare is best, they both have trade-offs, but it's fallacious to assume we have the former and discount it entirely thus leaving either more regulation or nationalization as the only alternatives. More regulation is almost certainly the worst possible option, we've been on that path since WW2.

The answer to all of your questions is that if you are obscenely well off, all of these restrictions go away with enough money. Private insurance exists, or hell - just paying out of pocket. It is a free market, but only for those with enough money to pay.

The average person cannot pay. Health insurance is designed to maximize extraction of wealth from the non-wealthy, while doing just barely enough that they don't immediately get register away. The reason for this is greed: sure, greed drives efficiency in capitalism, but if it isn't reined in via regulation we wind up with the abomination we have today.

> sure, greed drives efficiency in capitalism, but if it isn't reined in via regulation we wind up with the abomination we have today.

This is exactly where we part ways though. You specifically said "laissez-faire", i.e. "leave it alone" in French; economically this is anti-interventionist, let the markets sort themselves out without interference from government. You are saying regulation is required for the market to function or it leads to what we have today and I'm pointing out that we already have enormous quantities of regulation in healthcare. I pointed out several very easy examples to identify with but by no means is that an exhaustive list of healthcare interventions. The very thing you are advocating for, regulations, has been increasingly attempting to "fix" this market for the past 80 years and our current system exists because of it, not in spite of it. It is not a free market in any sense of the word, and doubling down on more regulation will not improve it. I am more than happy to debate an actual free market or nationalized healthcare model, but further regulating this "free" market is misdiagnosing the system we currently have and assumes the same good intentions that have failed to improve it for four generations will somehow produce better results this time.

>employers can't discriminate by race

Seems to be flaunted in tech.

What is the market value of your mother's morbidity and mortality? Your spouse's? Your children's? Trying to apply a market to healthcare can become macabre rather quickly.

When governments make these decisions, it's just as macabre.

https://globalnews.ca/news/11812425/alberta-family-fights-fo...

https://globalnews.ca/news/11801531/bc-denies-funding-drug-c...

Assuming a nationalized healthcare model, should the entire productivity of the nation be dedicated towards keeping a single person alive and healthy at the expense of every other conceivable economic activity such as building houses, growing food, manufacturing water treatment facilities, etc? Would it be macabre to deny them any amount of healthcare?

All economic systems allocate scarce resources which have alternative uses and thus rationing must always exists regardless of whether it is a free market, mercantilist, socialist, or as yet unknown economic system. Prices are a rationing mechanism within markets[1] but every other system will have its own set of one or more rationing mechanisms such as by-status, by-lot, by-need, by-survivability, etc. That necessarily means that there aren't enough resources to treat everyone for everything under all circumstances. Do you believe that all economic systems are thus macabre? If so I agree if only because life itself gives us hard choices, never utopic solutions.

[1] In terms of emergency healthcare by-need tends to be used even in market systems.

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Every medical system in the world "ghoulishly den[ies] health care" to patients. If it's not an insurance company, it's the charity providing the care or a government bureaucrat.

And the least accurate label to apply to the US health care system is "laissez-faire approach", since the government is involved in literally every decision.

Most of hospitals are non profit. If you choose HMO insurance, its will probably be non profit as well like Kaisser. Some of big PPOs are also non profit like blue cross blue shield. Problem seems like over complicated billing and accounts receivables which leads to large administrative staff hospitals have to employee. Lack of medical professionals nurses and doctors which lead to increased salaries.

The largest expense in the medical system is caregiver wages; administrative wages are the 'foreign aid' of the medical system (very unpopular, but not a major cost-driver). Reducing doctors' and nurses' salaries is very unpopular even though the USA pays those two groups much more than any other country in the world (by almost any measure).

[delayed]

The top line bill in US medicine is almost entirely fictitious. Hospitals and insurers built a system to defraud people on percentage plans. If you're on an 80/20 plan, for example, and the bill is $100, in theory you pay $20 and your insurer pays $80.

But what actually happens is you pay $20, the insurer pays $80, and then the hospital has to remit a large block discount back to the insurer at some point (it's either the end of the quarter or year. I can't remember). I haven't looked into this in awhile, but when I did local area hospitals were discounting payments by almost 80%, meaning the insurance company actually pays $16 on that bill and the plan that's supposed to have you paying 20% of the bill actually has you paying 55.6% of what the hospital receives. Like I said, it's fraud. It may not meed the legal definition of fraud, but it's still fraud.

Are you saying the insurance company is not paying the 80% of the negotiated rate? Why would a hospital defraud people when they are non profit entities?

AMA is a literal cartel restricting supply. Most of a doctor's job can be done better by ChatGPT (or a regular individual with a 4 year degree with specialized training for that matter), so it is obvious the licensing and supply is a major issue.