Actuarial science is cool, not for everyone to be sure and you guys impress the hell out of me with the accuracy, especially morbidity predicitions. Here is the kicker, yes the risk exists no matter what and that is undeniable fact, the difference is that when all risk is included in the same economic table it skews towards the risk averse end. The idea that many companies have is to split off the risk into different coverage models and adjust prices accordingly. However you cannot do that in a tax subsidized system as the models simply provide a universal coverage, this means the most critical care falls under arbitrary numbers tabulations which can be less beneficial to those in the most need.
It's hard to use a private entity as an example, because if the risk is too high, they'll just opt out (ie they make the government insure against flood planes, hurricanes in some states, terrorist attacks). And as an insurance employee, I am sure you are aware of this. These people are a pit. No one buys wind insurance unless they live in a hurricane zone - which makes it virtually insurable. Same with flood planes. And how do you budget for a terrorist attack? So they opt out. Meanwhile, for all of the other tough insurable risks, as I am sure you know, they switch over to pooling. Wind pools being a classic example. If they have to take on this risk, they know that it is at least best to share the risk with everyone! And that's how I feel about UHC. UHC spreads the risk around to the entire tax paying country helps remove uncertainty.
The other problem is that rationing is has no appeals process, in other words if surgery quota is filled and you are in need at that point you are screwed, with insurance company models or even a first party payor system the monetary decisions are on an individual basis, i.e., not every company has to fulfill every surgery so it is easier to make the payments in smaller bites, thus the system allows for more costs to be absorbed rather than a collective pool having to absorb the sum total of all surgeries or procedures. The reason we spend more as a collective figure is because more services and better technologies are provided faster. I will also tell you that in my years I have seen some competitive high risk policies for individuals that looked pretty good, the biggest "problem" with high risk is that people tend to give up on being accepted for coverage, in a competitive market there are options.
See, I don't know that I agree there. Is there any evidence of that? As I recall, these places work less on a first-come first-serve basis, and more of a triage basis. If you need the surgery right then, you'll get it. And of course, there is still choice for private insurance, so for anyone well off enough to afford it, you still have that freedom. I do honestly understand what you are saying, and that would be a concern for sure, but I am not convinced that the waiting times, say, in London, are any worse than the waiting times in NYC.
Well, it does more than that. If anything UHC consolidates sum total cost to the taxpayers which causes grievous expense rather than individual companies or payers taking smaller bites of the total cost. What happens is that UHC doesn't "hide" the risk any more or less than a decentralized system but rather it prolonges problems until they matasticize into something worse and treats symptoms rather than problems which is the path of least expense, so yes, both systems show the risk but UHC actually hides the problems of cost and provides less advanced treatment. Let's not forget that end of life discussions are mandated in this latest D.C. turkey rather than treatment options.
I think I see what you are saying here, but I am not sure. But I will respond by clarifying how I feel a bit better. Since I deal with math a lot, I'll just look at some numbers:
------------------------
Let's just say the average single-payer health plan is like $400 a month. However, there is a $100 surcharge to everyone's insurance because of all of the abusers of the system who don't pay for their health care. So the average person pays $500 a month - $100 of which is due to non-payment of treatment.
It's my assertion that UHC would help this problem in two ways:
1) Under UHC, you are combining the clients of all of the current companies. That can only lower prices because, again, as law of large numbers states, uncertainty is lowered and reserves can be smaller. The bigger the sample pool, the better. But we still have those bastards who don't pay ****. Which leads to #2.
2) Those non-payers now have health coverage and can have a regular practitioner who will examine them on a yearly or bi-yearly basis. This would drastically reduce uncertainty in this crowd, and lower health insurance costs because of prevention rather than treatment.
Of course, this means our government needs to know how to manage money effectively because, unlike with Medicaid, they will actually need to pay the doctors. But I just generally try to have a positive outlook on this issue and I cannot see any negative side to
universal coverage.