how did the US screw up health insurance so bad?
More or less a private health insurance industry was built up out of the efforts of individual hospitals and private hospital associations like the American Hospital Association and other groups to develop payment structures for care in the first half of the 20th century.
The US government never engaged in rate setting or any other policy aimed at managing the amounts hospitals could charge*. Public payers with the heft and and incentive to bring down costs while maintaining low prices for members were only developed for the old, disabled, and very poor. Private insurance and provider markets became extremely concentrated and there was basically no anti-trust reaction.
In short, the government didn’t do any of the several key things other governments do to contain healthcare costs. Every attempt to do so is, generally, met with violent screeching by the Republican party and determined opposition by providers and payers.
*I just want to note that, as a health policy researcher, it’s kind of BS just how little providers get blamed for astronomical prices.
Insurance is a pooled risk against unlikely events.
It should not be used for routine care.
To base a heathcare system on Insurance operating assumptions will always result in unreasonable costs.
All negotiations are carried out at the confluence of interests of organizations that do not have your interests at the center of their positions:
Once they all agree on a position that they find acceptable, you are then sold on the “benefits” being offered.
At no time is there a feedback system that provides downward pressure on costs and improved quality of service.
Unregulated greed on the part of insurance companies. little we can do to go back on it now. as an american without health insurance, any major life event is not only a debt sentance, it’s likely a death sentance as well.
We are also pretty unhealthy…. Not exactly surprising healthcare costs have gone up as we have gotten more obese and older as a nation.
Unrestricted free market and a government prepared to pay insurance companies rather than provide healthcare directly themselves.