Ideally, in the so-called “free world”, we should leave the choice of contributing to a collective or private insurance plan to the citizen :
- If an individualist prefers a private insurance, then so be it, s·he won’t have to contribute to the collective ;
- If a socialist wants to pay for the community instead, then s·he should be able to contribute to, a’d benefit from, a public insurance instead.
Apparently, we’re not given this choice mainly because of the adverse selection : private insurances are cheaper when you’re young, while public ones are cheaper when you’re old. This would make people subscribe to private insurances at first, and then switch to public ones later, which would cause the subscription costs of the latter to increase a lot.
That’s why Germany allows the wealthy who took a private insurance to stop contributing to the public one, however they can’t switch back to the public insurance past 55 years old.
If adverse selection is the only reason not to give citizens a choice between public//private insurances, then the solution seems obvious, we only have to ask those who switch back to public insurance to pay for the contributions they missed(, minus the estimated costs that the public system avoided).
In almost every country, citizens are either forced to contribute to the public system of insurances, or there’s no public protection and they’re forced to subscribed to private ones if they can afford to.
I doubt that what i proposed is the solution to offer a freedom to citizens of any country, because it’s so easy that governments would have already thought about it, but i don’t understand what ‘mistake i made’/‘i missed’, perhaps that some people of Lemmygrad could shed some light on this for me ?
Of course, it’d be forbidden not to have an insurance, you’d have to choose between private or public.
Otherwise, in a country without mandatory healthcare, the poor would struggle to get healthcare and, i.m.o., the wages would be reduced to the new minimum in order to maximize profits.
I suppose that the main problem would be that, in their old age, some people would be unable to continue paying for private insurances and also to pay for the missed public contributions. But that’d probably be an exception that wouldn’t weight too much on the budget of a last-resort public coverage ?
Just governmentally provide actually good health services and destroy the concept of insurance for the scam it is.
Or just let the citizen choose between both systems ?
In France, or China, …, you can have a private insurance plan, but you still need to contribute to the public system, and i don’t clearly see why it should be necessary.
In the u.s.a., with the exception of Medicare and Medicaid if you’re too old or poor, you can’t contribute to a public system of insurance even if you want to. I mean, even South Korea has a public healthcare system, universal since 1989, even if it’s far from free though, the u.s.a. is one of the few exceptions.
If i'm trying to look which country has the most expensive healthcare system for its inhabitants
(source)
(The “compulsory” part for the USA refers to the Obamacare, canceled in 2019. Perhaps that insurances linked to the employers are also included. And there’s Medicare and Medicaid)
(Healthcare looks expensive in China, although less than India, 🤷)
Beyond the relative costs, there’s also the absolute ones :
This is probably the most relevant link :
In both cases, the pro//anti capitalist sides could be satisfied if given the freedom of choice, but i’m probably missing something though.
Germany and Switzerland seem kinda close to such “proposal”, not sure that i’ll have an answer here though :)
By having public and private insurance the possibility exists for a two tiered system, where only expensive private care is any good and the public care is trash. The freedom of choice creates freedom for capitalists to destroy the public system.
Seems like Lemmygrad wasn’t such a bad place to get answers then, thanks :) !
However, your argument doesn’t seem to hold : can you cite a country which doesn’t offer the possibility to subscribe to a private insurance(, on top of the mandatory subscriptions to the public one) ?
The difference here would be that those subscribing to a private insurance plan wouldn’t be forced to subscribe to the public one, and wouldn’t complain.
They’d still perhaps try to destroy the public one(, or increase the out-of-pocket amount), by force of habit, and perhaps because it’s less private profits for them, but they wouldn’t be able to complain about being forced by the state to contribute against their will. They wouldn’t have a reason to feel concerned anymore.
Correct me if i’m wrong, but i don’t see why they wouldn’t try to destroy the public system now, and why offering them an alternative would increase their attacks ?
I agree that the best protection against such attacks would be to have a high subscription rate to the public insurance plan. Even better, to avoid having the state control that insurance, as well as capitalists obviously, there’s probably a way to make each subscriber take important decisions by vote, and really owning the insurance funds.
That’s what the ~french “mutuelles” were originally if i’m not mistaken.
Offering them a private alternative allows them to increase their attacks without actually undermining their own healthcare. They can destroy the NHS while not effecting their own health, and that’s exactly what they’ve done.
You raise a good point that there aren’t many healthcare systems without some private involvement ( there’s the DPRK, but due to the crippling sanctions it’s hard to tell how effective it is). I’m merely pointing out that having a public+private system creates a perverse incentive structure and in every capitalist country with private insurance we have seen endless attacks on the public system.
Ok, then i don’t have much to add to my previous comment, thanks for your answer :) !
Canada, mostly.
You can get private insurance, but only for things which the public insurance doesn’t cover (dental, optical, “alternative medicine”). But you can’t get private insurance to cut the line for surgery or an MRI or to get a private room in the hospital. The public insurance isn’t even really insurance in the traditional sense of paying a premium and getting something in return, healthcare is run out of provincial government ministries and funded with taxes.
Of course the far-right provincial governments are trying to gut the public system to get people interested in a private system, but where in the West isn’t that happening.