The American health care system is easily the most expensive in the world, and one of the least efficient. It all goes back to the end of World War II, when progressive ideas were in vogue in most of the world, though not here. Countries around the world adopted various kinds of health care systems:
- Great Britain chose a government-owned and run system where all costs are subsidized and doctors and nurses are employed by the national health care system. Coverage is effectively 100%. All injuries and illnesses are covered.
- Switzerland chose a private insurance model, but heavily regulated the insurance companies, insisting that they turn no one away. Coverage is effectively 100%. All injuries and illnesses are covered.
- France chose single payer insurance, that is, there is only one insurance “company,” the government. Coverage is effectively 100%, all injuries and illnesses are covered. At one time France was reputed to be the least costly and most efficient system in the world. I have not looked lately, as my “research” for this piece is limited to what I did around the time of the Affordable Care Act, aka “Obamacare”.
- Canada chose single-payer as well. Its system is not as effective as that of France, and there are many complaints about long waits, mostly in Ontario.
- Taiwan was a late comer to public health care. Its US-like private system was strained and inefficient, and many people went without coverage. The government decided to go public, and wanted to learn from a system called “Medicare.” That is not the US health care system for senior citizens, but rather the official name of the Canadian health care system. That became the Taiwanese model.
- The U.S. chose private care given by private doctors and funded by private insurance companies. It was a mess, and senior citizens were losing their life savings due to medical bills. The problem was that private insurance would not cover seniors citizens, or made the coverage so expensive that few could afford it. In 1965 the U.S. Medicare sytem was formed, and all seniors in the country automatically gained coverage.
Side note: People on the right complain that our Medicare is too expensive and will go broke. That is impossible, as MMM, Modern Monetary Theory says that any country that makes its own currency controls its own future, and cannot go broke. The only imperative is to control the money supply to prevent inflation. (Medicare’s cousin, Social Security, is also perpetually solvent for this same reason.)
In the insurance business there is a concept called “moral hazard,” defined as “… a situation where an economic actor has an incentive to increase its exposure to risk because it does not bear the full costs of that risk.” The usual example given is a person seeking unnecessary medical attention only to gain sympathy. The term used for this behavior is Munchausen syndrome. It is rare, but real. But for the most part, people only seek necessary medical attention.
But the concept of moral hazard also exists in the insurance industry, not in people seeking unneeded care, but rather in insurance companies seeking avoidance of claims, legitimate or not. They took the concept of “preexisting conditions” to new extremes in the mid-twentieth century.
Moral Hazard: Suppose, for example, that I am a smoker, and because insurance is not mandatory, avoid coverage even as I smoke for decades. Then I learn that I have emphysema. I seek out an agent and attempt to purchase insurance for what are going to be horrendous costs. The insurer rightly refuses coverage, as the person seeking the insurance is merely gaming the system.
That is a legitimate preexisting condition. However, insurers over time expanded the definition of preexisting conditions to include any condition known in advance, from trivial to terrible. Millions of people in the US were refused insurance coverage. It was a scandal of immense proportions, but the industry refused to budge. In fact, they hit it hard and harder, making people suffer in droves, and caring not a whit. Tens, if not hundreds of thousands of premature deaths resulted.
There were stopgap measures to help people who could not get insurance. Some states set up funds to insure the refugees of the private insurance system, but those efforts were doomed to fail. For one thing, the programs were a magnet for people with expensive ailments, and for another, policy premiums quickly became unaffordable.
There was only one answer: Single payer, or maybe two, the British system. The insurance industry was having none of it. I am basically conservative, but see no real benefit in our private health care system, as it is expensive and terribly inefficient. Unless, like the Swiss, government steps in to regulate insurers, they will do their best to avoid paying claims.
The concept of single payer removes the incentive for insurers to hide from people with illnesses. Everybody is in the same boat. Everyone is insured. People on the right scream that single payer would quickly bankrupt the country, impossible anyway (MMM), but also ignoring the fact that those countries that have adopted single payer run systems that insure everyone and cost far less than the American system.o
But something had to be done, as a crisis was in full force, people dying of curable diseases due to lack of health coverage. A health care executive, Liz Fowler, headed a private industry committee that wanted to fix the problem. She left her job and went to work for Senator Max Baucus (D-MT). She brought with her a roadmap.
Barack Obama had been elected president in 2008, and would lend his name to the private industry scheme, calling it “Obamacare.” He had nothing to do with its formation but had a vital role to play. The forces that wanted single payer were powerful and getting organized, and had to be stopped. Baucus headed a congressional committee that was to address the health care crisis, and announced at the outset that “Single Payer is off the table.”
The most powerful force that could have forced real reform, liberal Democrats, such as they are, were taken out of the game. All that was left to do was to pass the Liz Fowler solution. Because Obama was seen as a force for good, opposition to “Obama/Fowlercare” fizzled, and Obamacare became law.
I regard Fowlercare as the largest tax increase in human history, or at least in American history. Americans were given no choice but to submit, as fines for failure to buy insurance were very large. Even after the insurance was purchased, more expenses were in store, as policy deductibles were massive (in 2023 MOOP, or maximum out of pocket costs for a family is $18,200).
Imagine that a family adopts the cheapest care possible, called a “bronze” policy. For a normal family, $18,200 in annual costs is staggering. But this is what the people behind Obamacare wanted – protection from small claims. It virtually assures them that most people will not be filing a claim in any given year. And this, in my view, was why the insurance industry was so ruthless in enforcing preexisting conditions on millions of Americans – in order to impose their Fowlercare solution, they had to create the crisis to justify it.
Here’s an example: I looked up health insurance costs for a family here in Colorado on the assumption that we would have moderate exposure, a few doctor visits, maybe one hospital stay of one day. The annual premium for basic insurance would be $8,979, coupled with a maximum out-of-pocket expense of $18,200, meaning that a family would have to spend $27,179 in premiums and medical expenses before an insurance company would spend $1.00.
This is the essence of Obama/Fowlercare, to shield insurance companies from expenses, to protect them from all but the most expensive claims. And why would they not do so? After all, they, and not Obama, wrote ACA.
They needed the right guy to symbolically carry the load, a guy who had been chosen and whose public image had been built up to the point where he was virtually insulated from criticism. Obama being black was an important factor, as any criticism of him could be labeled racism. He was the right guy at the right time to give the health insurance industry a massive subsidy. He was indeed “the one.” He was spotted long before his election, and the manufactured health care “crisis” had to be seen as extreme for this planned solution to take hold.
It has been many years since I first wrote about the “Affordable Care Act” and all of its ramifications. As of January 1 of 2019, the mandatory insurance factor was removed from ACA, and I guessed at that time that we would be back where we started, millions of uninsured Americans, but people richer for having saved the outrageous premiums being charged for the scant coverage given under the so-called bronze, silver, gold and platinum policies offered by insurers. At the time of passage, I made up a set of illnesses and injuries my family might have in one year, only for sake of comparison (I was safely on Medicare). I then ran these costs through the various plans. My conclusion, buy the cheapest coverage available. It is overall the cheapest way to fly. There is nothing to trade up to in going from bronze to silver to gold to platinum.
Going bare is also a viable option. I can only look backward, as I am now covered by Medicare and loving it, but had I not carried any insurance prior to turning 65, I would be much better off, suffering only minor out-of-pocket costs. I realize that others are not in my boat.
In 2015 I joined (American) Medicare, and have never looked back. Insurance companies offer policies called “Advantage” that add deductibles and co-pays to basic Medicare, and limit choices of providers. I spend my first 65 years subject to private insurers, and was so happy to get away from them. Why would I go back? But millions indeed choose Advantage, and suffer accordingly from co-pays, coinsurance, and limited choices of doctors and hospitals. Makes no sense.
ACA was easily to most punitive legislation ever passed, used to solve a problem created by the health insurance industry. Had George W. Bush been president at time of the scripted debate that went on around it, liberal Democrats would have opposed it. Because it was Obama, because he was worshiped, they were voluntarily lined up to face financial slaughter.
I was very surprised in 2019 to see the mandatory element of ACA removed, an unanticipated release from servitude. Although I regard Donald Trump as controlled opposition, he and his people did this one good thing, and for that we should be grateful.
Piece of Mindful 
Leaving Obama out of this tangent;
Firstly, I have a friend from Canada, the French part; she is now a US citizen. Her aging parents live there, in a town of 20,000 and there is not one primary care doctor for that area. Consequently, they do not go to the doctor and her father has an untreated degenerative disease.
Secondly, since the scamdemic, doctors are leaving traditional practices and setting up private practices where the patient pays a modest monthly fee for routine medical treatment, etc. I don’t know how chronic conditions or emergency care is handled, I believe each practice sets their own “rules” The website is https://jointhewedge.com.
As an example, located in a suburb of Louisville, Kentucky, there’s a practice called OneFamilyMD and they charge an individual, aged 65+, $120 a month. That’s $1440 per year. There are more practices like this cropping up all over.
I read about this in a book called “Big Brother in the Exam Room, The Dangerous Truth about Electronic Health Records” by Twila Brase, RN, PHN. It’s very interesting and thorough.
We need this parallel society, where likeminded people can live their lives without government interference and exorbitant healthcare costs that make “them” richer and us poorer.
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The Canada system is flawed, but so is every system. There are always problems. Our daughter-in-law, Canadian, has a mother who needs some personal care, and waits on a list.
I am on Medicare, and want nothing to do with Advantage. I am healthy, and avoid doctors and annual physicals. I have had problems requiring surgery, mostly minor, and the system works well, I pay my 20 percent. But I work around the edges. At my age, prostate is troublesome, enough said, but if I enter the system, i am likely to be subject to invasive surgery resulting incontinence and impotence. So I keep my distance, and if I die, better without them. With that horrible surgery, they can often buy 45 day of life. They consider that a good deal..
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“You can keep your doctor”
He emphasized that, instead of “You can pay a penalty for not pay for this scam”
btw sometimes the reply box sometimes doesn’t show up lately.
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Others have mentioned this problem. I have noticed it too. I will contact WordPress.
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WordPress.com testing the comment form.
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I think they changed the comment format.. in my case I just click the “envelope” icon and it works about like the old version.
I have some tidbits about insurance but rather jumbled and partial, so anyone feel free to clarify. One issue Jennifer Daniels pointed out is that hospitals can’t really collect much from insurers.. or they have to haggle anyway. Whereas if they can get an individual on the hook – the uninsured? The incompletely insured? – by signing a contract when they enter, it opens up their real profit center. Then they can collect the “full bill” via taking homes, cars, savings, etc.
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Tangentially.. a recent Mathis guest paper on the yogurt shop murders talked about the fakery being used in insurance fraud, and one of the players eventually faking his death to escape all his past frauds. This idea has come up in previous papers, but never addressed is the obvious question imo.. it’s one thing to fake out the public, but an insurance company will be run most likely by other “peers” and connected players.. so they’re claiming internecine war? Or warring families? Or, the insurance company takes part in the fraud?
But in the latter case, if it’s all among friends, why even the need eventually to totally disappear, as if real legal consequences were catching up to them.. these are the sort of questions I’m left with, as an outsider to insider machinations, ha.
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I like that idea, have had the same thoughts myself. The Titanic was insurance fraud, we are told but insurance companies are among the savviest of people around, alert to all fraud. It’s what they are good at. Therefore, they had to be in on it, and at that point, it makes no sense. Not as I see it anyway.
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Does is not make sense though?
Even the most corrupt government couldn’t blatantly appropriate public funds for their seaside estates and yachts, they always make up some reason.
Even if the insurance company is in on it, there’s still ‘normal customers’ who paid the company and would complain (sue legally; or at least cause the reputation to plummet which hurts future sales) – so there’s always a need for a superficial reason.
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I read MM as well. I have a question about something I saw a couple of days ago while watching either a Houston news station or Austin on ROKU. I’m in CA but my daughter moved to Texas last month. What I’m asking about is a segment caught on video about “jugglers.” Yep. Apparently these are young men who follow a driver who withdrew money from an ATM, to their home and is then confronted in their driveway by these young men who are armed with some serious guns. It is called jugging. The driver was backed into his driveway and the attackers started banging on the windows. The driver just drove off through a convenient opening between the curb and the Escalade or Suburban the attackers drove. The “victim” was interviewed at home in his easy chair totally non-plussed. His face not obscured. Seems a bit staged or maybe they just didn’t want to add unlawful detention to their resume’.
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The same could be said for how Obama managed the manufactured economic crisis of 2007-08: he continued Bush’s bailouts of corporate America at the expense of the lower classes while implementing superficial changes or “protections” against predatory capitalism during his first few years in office (e.g., the Dodd-Frank Act).
And speaking of insurance/healthcare, it’s no coincidence that some of them – such as AIG – were large recipients of federal bailout assistance at the time. So, essentially, the insurance and healthcare cartels did a double ripoff of the American sheeple with the bailouts and Obama’s fraudulent healthcare “reform.”
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Tangentially 2… I worked an event for an insurance company the other day. Had never heard of them, but they seemed big enough.. bunch of brokers at a casual bar/ restaurant / video arcade chain at a huge (but languishing) indoor mall. The CEO had flown in from out of town “on the red eye.” (Or somebody had. I was never sure who was who. Was the CEO the youngish Asian man, more casually dressed than most there, who did most of the talking in front of the group? – in a glass walled room though, so who knows maybe he was just a random motivational speaker. I think he was the man though because later a real “grinder”/ top seller was being introduced to him. “You’ve got to meet so and so, he sold 700” something or other this year.)
But don’t think it was all about the money. No no, there was this one gung ho guy out in my area, who was introducing himself to, I guess, newer people, and talking up the altruistic glories of the enterprise. The good they were doing. He gave examples – the miracles insurance could accomplish. Wtf is this, I started to wonder. These aren’t the typical cynical apathetic employees I’ve met! His peers agreed, maybe a little coerced, but indeed, it was a noble enterprise, and that was the main thing here, the good they were doing. That’s what it was all about. My mind started drifting to thoughts of cults, and the overlap between business “tribes” and such.. they suck you in with a good salary, then suddenly you’re a Moonie. Well nobody ever said this life would be easy kid.
There was one attractive fortyish woman who told me she’d been at it about five years. She seemed a little shell-shocked, had that look of a nervous rodent (I speak here of the more adorable, pet rodents, not the off-putting pestilent kind) not quite sure what kind of madness this was, but again, the good salary. I have to say I have more respect for that reaction than the ones who didn’t seem to think anything was a bit off. And then again, maybe the fault is mine that I can’t even fathom where the more zealous guy was coming from, in his missionary outlook.
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I have a family member who is a high end tech salesman. The gung-Ho guy you describe sounds just like him- they are alpha males. They need competition, friendly challenges from other top dogs with checkbooks open. Prep isn’t their top super power, but engagement is. When my family guy goes into sales pitch mode, it is a wonder. Just a different side of him. I suppose if he wasn’t raised right, he could sell snow to eskimos. As it is, he sells ‘property protection’ software, to remain deliberate vague. Not a bad thing of you believe in owning your own shit.
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Funnily enough, this corporate hack (Liz Fowler) is now the Director of the Center for Medicare and Medicaid Innovation, which was created under her misnamed “Affordable” Care Act. I wouldn’t be surprised if this organization handles the Medicare/Medicaid Advantage schemes being run by the healthcare cartels and their bought-off HHS. Before then, she went on to work for Johnson & Johnson, further cementing her already strong loyalty to corporate America. Johnson & Johnson itself, of course, is another infamous insurance-pharma cartel responsible for some of the hazardous pharmaceuticals on the market, such as their COVID-19 injections and cancer-causing baby powder, so it’s only fitting for her to have worked with such a despicable company. To quote CMS.gov:
https://www.cms.gov/about-cms/leadership/center-medicare-medicaid-innovation
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https://en.m.wikipedia.org/wiki/Center_for_Medicare_and_Medicaid_Innovation
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