The widespread need for medical insurance only exists because regulation has introduced many artificial inefficiencies within the health care sector that in turn severely distort the pricing of medical services and medical products.
We'd see far more reasonable pricing, and much less need for something like medical insurance, without the regulations that artificially limit the supply of practitioners and clinics, that prevent competition, and that introduce unnecessary costs, among other distortions.
Healthcare is cheaper in every country everywhere regardless of whether they have public or private coverage. This implies that the difference isn't public vs. private, it's some other regulatory differences which are driving up costs in the US.
"Regulatory capture" is the regulations the people complaining about regulations are complaining about.
"Lack of government oversight" almost never leads to high consumer prices. It can lead to externalities, but if there are no regulations preventing anyone else from competing with the incumbents, it's very hard to sustain monopoly rents.
> Most people in the U.S. think regulations are bad in and of themselves. Regulations as a concept are the wrong target.
Regulations as a concept are the category of thing which is causing the problem. You then have to look into which specific regulations are contributing to the problem, but there are 10,000 of them. You can name some of them, like Certificate of Need laws, but that's just a representative example rather than an exhaustive list of every problematic regulation. So people say "regulations" or "inefficient regulations" because what else are they supposed to call them?
Hardly anybody thinks the ban on leaded gasoline is a bad regulation.
> Lack of government oversight and regulations almost always leads, eventually, to cartel pricing and/or monopolistic type pricing.
Only if you're specifically talking about lack of antitrust regulations, which is the exception rather than the rule in the overall category of regulations.
Most regulations simply increase costs. This is true whether they're good or bad. The ban on leaded gasoline increases the price of gasoline; lead is a cheaper stabilizer than what they use now. The ban on circumventing DRM increases the price of playback devices (or reduces quality at the same price); device makers have to pay to license the stupid DRM and it impairs competition by preventing anyone from making a device with features Hollywood doesn't like. But the ban on leaded gasoline is a good regulation because it's preventing a major externality, whereas the ban on circumventing DRM is a bad regulation because it doesn't do what it was sold as doing and instead is used by the studios to capture the market for playback devices.
Getting rid of bad regulations improves efficiency and lowers prices.
We tried the no regulation method after the Civil War. It lead to robber barons and an overall shitty country. Regulations as in the concept is not the problem. Bad oversight and governance is.
I honestly don't understand why someone can't say "we should get rid of these bad regulations which are causing problems" without someone hearing "we should get rid of all laws of any kind whatsoever".
Because for 40 years now the Republican party has demonized regulations as a concept. So now we are in a situation where people like you write:
Regulations as a concept are the category of thing which is causing the problem.
No sensible person thinks regulations as a concept is bad but, well, roughly 1/3 of the U.S. population is not sensible on this topic. No sensible person thinks all regulations are good. Regulation is not the thing to talk about since the issue isn't regulation but bad governance and oversight. The issue is politicians in the pockets of insurance companies. The issue is that we live in a country where profit is the holy of holies that must not be messed with.
The actual problem is that "regulations are bad" has become a decent heuristic, because such a high proportion of the existing and proposed regulations are a result of regulatory capture. Your objection seems to be that you want to call this "bad governance" instead of "bad regulations" but it's not clear how that's even supposed to be different.
The number of people who think that all regulations are bad is limited to a handful of actual anarchists with no real power and a presumably larger number of rules pedants who want to play different definitional games where they use "regulations" to refer to the things they don't like and call the things that they do like "laws" or "rights" or some other allegedly distinct thing where the distinguishing criteria is doing all the work.
Of course, getting people to spend all day arguing about terms is to the advantage of the people who like the status quo, because then they can get the people who claim regulation is generally good to pass their regulatory capture rules and get the people who claim regulation is generally bad to repeal or fail to enforce the e.g. antitrust rules intended to protect people from their predatory behavior. But then you're just playing into their game -- the Certificate of Need laws etc. are of the first category.
But not sure americans would be okay with the limits on healthcare you got in europe. I'm from sweden and here you often have to wait several months to see a doctor if it isnt "im dying right now"-urgent. And if you got something complicated that isnt easy to diagnos but isnt killing you they will just not do anything about it.
The healthcare is good if you got something well defined and urgent like a hearth attack or cancer (but less good than cancer treatment in the US). But if you got something less urgent then you are kind of screwed.
The healthcare outcomes in most European countries are better than in the U.S. The wait time of someone without access to the healthcare system is infinity. In all healthcare systems there is rationing of care. In the U.S. we ration in an immoral way.
I think the causality runs the other direction. Europe has an efficient system so they can easily afford to give everyone health care. We have a very expensive system so we don't.
Medicare costs do not look like the rest of the world. Medicare has slightly lower costs than private insurance but that's mostly bargaining power not any increases in efficiency. They free ride a little off money made off private insurance.
High costs are certainly present in socialist medical systems, they're just somewhat obscured.
I'm more familiar with Canada's taxpayer-funded, "universal" provincial health care systems than the European ones, so I'll describe the costs we typically see with them.
Government health care spending makes up a huge portion of the provincial budgets each year. This results in costs like high tax rates, and significant government debt. (Those, in turn, introduce other costs, such as the stifling of business development and employment, among others.)
Another significant cost is the poor quality of service. Long delays are the norm. This can mean single-digit hours-long waits for emergency service, double-digit hours-long waits for semi-emergency situations, and weeks to months for routine diagnostics and specialist appointments.
A lot of Canadians don't have a family doctor, and walk-in clinics are typically quite busy and have relatively short hours, so people end up going to emergency rooms even for relatively minor health issues. That only exacerbates the problems there.
Even once you're finally seen by a practitioner, there is little incentive for them to do a good job because there's pretty much no competition, and no punishment for providing poor service. Don't expect a favourable outcome, especially for anything requiring in-depth investigation or long-term treatment.
Common dental, vision, and pharmaceutical costs often aren't covered by the provincial systems, which results in many Canadians paying even more money for costly private medical coverage on top of the "universal" coverage they've already paid for via taxation and public debt.
It's very revealing that despite paying a lot for the local health care systems, Canadians with the means to do so will often seek treatment in the US anyways. Even if they have to travel and pay a lot more money to do that, at least it tends to result in much faster, and much higher quality, service than they would ever have received in Canada.
To be clear, the "artificial inefficiencies" here include treating poor people, treating elderly people, and treating people regardless of their conditions.
The alternative, which we have lived, is those people just dying. We, as a collective society, decided these features are "non-negotiable". Hence, the US has a semi-socialized system in the form of insurance.
The reason your premiums are so high is because some homeless man somewhere is getting Narcan as we speak. Your woes of a communist future have come to fruition, but it has been packaged in such a way that the average American does not realize it. We have the worst of both worlds - the sheer greed of the private sector, with the burdens of a public policy.
If we seek efficiency, as you say, the answer is obvious. Abolish insurance, and provide single-payer healthcare. Delete the middle men on top of middle men.
We'd see far more reasonable pricing, and much less need for something like medical insurance, without the regulations that artificially limit the supply of practitioners and clinics, that prevent competition, and that introduce unnecessary costs, among other distortions.