> Japan has a clever way to handle the mandate. If you don't pay your premiums, nothing happens, but if you need healthcare you're not covered until you pay your back premiums.
So what happens when you go to the ER? Obviously if it's a true emergency they'll save your life and try to bill you later, but then what?
Would it ever make sense to deliberately stop paying your premiums? If you can pay "out-of-pocket" for medical expenses, you might be better off saving your premium money until you need medical care that's actually more expensive than the back premiums. That creates an adverse selection problem (assuming that enough of your prospective customers are devious enough to try this). Even if you can't pay out-of-pocket, you could just stop going to the doctor until something serious happened.
It's about to stop working out very well for Japan. The costs in their system are exploding higher rapidly and putting everything at risk. Their system won't remain intact for much longer at the rate healthcare costs are outpacing economic growth.
"Health-Care Paradox Threatens to Add to Japan’s Debt Problems"
"Japanese seniors, who enjoy the world’s longest life expectancy, pay as little as 110 yen ($1) out of pocket for specialist appointments. While these visits may help prevent expensive-to-treat diseases, they’re becoming unaffordable in a country where almost 1 in 7 people is 75 years or older, and annual health-care expenditure grew at a pace 40 times faster than the economy from 2000 to 2016."
Japan has a very unique healthcare crises based on it's aging population. The median age in Japan is over 9 years older than the United States and the population is continuing to get older. This crises would be very hard to deal with in any health care system, and it compounded by other pressures of taking care of an older population. Pensions programs are being stressed as the relative number of young workers are decreasing. Additionally the older population is likely to prefer economic policy that reduces inflation (to make pensions stretch further), making the working generations fight harder in international trade.
Japan's healthcare system doing so well given current stresses is a testimony to it's strength.
Not strictly true - we do pay a nominal fee for prescription drugs and NHS dentists (although some classes of people, eg students and retired people, are exempt).
Additionally, a lot of long-term care in the UK is provided by charities (Cancer Research, Macmillan, Heart Foundation, etc) which can be expensive but IIRC doesn't appear in the NHS budget.
True enough. I was thinking of specialist Doctors appointments, which are covered. It seems crazy, in a kind of roll your own adventure way, to pay for diagnosis, per specialist.
I sort of imagine conversations going like:
Doctor A: You might have this other nasty thing, but I'd have to send you to doctor B to check. Doctor B will cost you a hundred bugs.
Patient: I don't have a spare $100
Doctor A: we'll just hope it isn't that then.
Me: WTF?
So what happens when you go to the ER? Obviously if it's a true emergency they'll save your life and try to bill you later, but then what?
Would it ever make sense to deliberately stop paying your premiums? If you can pay "out-of-pocket" for medical expenses, you might be better off saving your premium money until you need medical care that's actually more expensive than the back premiums. That creates an adverse selection problem (assuming that enough of your prospective customers are devious enough to try this). Even if you can't pay out-of-pocket, you could just stop going to the doctor until something serious happened.