[tptacek]

This is probably true for dental, for a lot of reasons, including the routinization of dental care, the degree to which dental expenses are preventable, the fact that fewer people have dental insurance than health insurance (and so the market for dental care is less distorted), and the extent to which dental care can be cosmetic.

The same isn't true of health care. The health care market is totally distorted by insurers, who collude with providers to set prices. Services fall into two buckets: routine "checkup" type stuff that costs so little it's not worth arguing about, and hospital/specialist services for which there is no pricing transparency and which, purchased by anyone other than an insurance company, is catastrophically expensive.

It is perfectly reasonable to advocate for single-payer health care even if one believes firmly in moral hazard. There are other interventions one could advocate for instead. But any way you slice it, the "market" we currently have is busted.

[_delirium]

Health also has significant variance in outcomes, much more than the variance in dental costs, so it makes sense to pool risk. However, the fact that events aren't uncorrelated like a lightning strike makes it hard to deal with as an "insurance", the usual risk-pooling strategy, because in many cases the event has already happened, so no sane insurer would insure against it (how is it insurance if it has an 100% chance of occurring?).

For example, an American friend of mine has a congenital heart defect which will over his lifetime cost probably $1m or so; I had better luck and was not born with one. It seems sort of problematic imo that this sort of thing isn't risk-pooled across the population. It's already bad enough that he has to have surgeries/etc. for it, but due to our health system it also impacts areas of his life that shouldn't be affected, like choice of career. For example, he can never start a startup or do freelance/consulting work, because he wouldn't be able to buy individual health insurance; so he has to work at a large company with a good group-health plan, and can never be unemployed for longer than the 18-month COBRA limit.

[stretchwithme]

There was single payer before the tax code subsidy for insurance came along. It was called "cash".

The subsidy is responsible for a lot of distortion. It has separated cost and benefit in the minds of employees.

And it hands more of a subsidy to people who make more money. Taking insurance from your employer is a bad deal if you don't make enough. Which is why many employers of lower paying jobs don't offer it.