[blackflame7000]

Many people see it as "Oh I was paying $500 a month on healthcare but now the government will pay for it by increasing taxes. However, I'm not a 1% so it won't affect me as much as it affects them so I'm getting a dollar's worth of government for 80 cents today." Those same people aren't paying attention to their tax withholdings all they know is that if they don't get a refund then they are upset.

[perl4ever]

I think you are misguided in your assumptions about motivations.

Insurance is worthwhile whether you get $0.80 or $1.25 back on the dollar. It's not necessary for people to have a positive expected value from it.

[blackflame7000]

There will always be a large number of Americans that don't want to pay for other's poor habits. With car insurance people with fewer accidents or tickets get discounts but you can't do that in healthcare because of pre-existing conditions.

I propose a 2 part system. One system is government funded and pays for ambulances, ER visits, annual checkups/physicals, and maybe a few other basic services like dental cleaning. When you dial 911, the police and fire department both come for free, so why does the ambulance bill you a grand? Any sort of life or death situation would be covered by this. Abuse of the system can be monitored and the government has plenty of recourse.

The 2nd part of the system would cover short and long-term illnesses and conditions as well as prescriptions. Things like orthodontics could also be a part of it. Basically, it pays for any doctor that doesn't work in an ER. This way people who don't use these services a lot aren't burdened by those that do while at the same time eliminating the fear (and litigation) that comes with being bankrupted by a catastrophic accident

[perl4ever]

The analogy to car insurance comes up over and over, but I think it's flawed.

Pre-existing conditions are not defined by the average paid out in claims to a person.

It's normal to have a deductible that's over $5K and is not met in a typical year, and one or more pre-existing conditions. So it bewilders me how people keep debating as though the contrary were typical.

The question is not whether a person should have their predictable costs paid for through "insurance", but whether a person should be able to get insurance for catastrophic costs, if they are considered to have a non-quantifiable risk.

There is a fundamental inefficiency in a market that discriminates against sick people, not just a lack of "social justice" or whatever. If insurance companies are allowed to discriminate against pre-existing conditions, then they have to charge not just enough to cover the true risk of the high risk customers, but enough to cover the risk of being wrong about the risk - insurance against "unknown unknowns", adverse selection.

"Fairness" often costs more money.