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One of the downsides of "free market" insurance is its refusal to cover pre-existing conditions. Why should capitalists sell their product at a guaranteed loss?

This potentially effects tens of millions of people. Do they declare bankruptcy to pay for care? Do you just let them die? What free market principles solve that?

Otherwise, much in this post is true and the points are well taken. And if we look around the average Wal-Mart, the obesity is incredible. America now vs. 1950s or 1960s America. You can see it in photographs. There's about a 40-pound-per-person difference.

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The whole thing is a complicated issue. I personally think other areas like education and transportation are simple to fix (de-regulate and get gov't out of the picture entirely). Healthcare is a multi-layered clusterf*** with blame available for all involved. But, I'm glad you brought up the obesity issue. It points to the reality that so much of our healthcare "nightmare" is at least partly self-inflicted.

1) Personal health. My great grandparents were not buff, they smoked cigarettes and drank, and they lived to be over 100. Like...all of them and their siblings lived independent lives into their 90s+. One to two generations later and the family is living 10-20 years shorter lives. IMO, the great grandparents gen lived that long b/c they ate real food that they grew and cooked it themselves (there was no other option). No fad diets. No big Ag and big Rx basically offered aspirin and morphine. And they worked hard. Physical, manual labor. These things are what the human body was designed by nature to do. It's not fun or easy to force yourself to eat better food and work your body, but it needs to be done. Despite what our pop culture says, it's not "progress" to live a more convenient, easier, sedentary life. We can't blame health insurers for that. Though we can blame big Ag and government for their role. Mainly, the blame needs to fall to the individuals who think McDonalds every day is okay. Or that a "frappuccino" is a cup of coffee.

2) Rx as our lifestyle. Additionally, we need people to stop diagnosing themselves with issues they do not have and then finding compliant doctors who will prescribe them expensive pills to fix the non-existent issue. This is a direct result of DTC Rx ads and Rx financial incentives for doctors. These ads and those incentives should probably be re-outlawed. Something like 30% of healthcare costs are Rx. And we know the majority of Rx prescribed is not actually helpful...though it does allow doctors to take some nice vacations! So, we could lop off 20% of the costs tomorrow (sorry, docs, no more all expenses paid trips). We can blame patients, doctors, Rx, and the gov't for this one. Perhaps health insurers for not denying Rx claims often enough.

3) Role of insurance. Finally, when I hear comments from the liberals/left about health insurance, I realize they simply don't understand what it is and what it is supposed to do. It's not Big Daddy Warbucks with his giant checkbook, there to pay for all their stuff, just because some doctor said so. It's not a social safety net program either. It's not pay-for-full-access to the club. It's basically lower risk gambling, similar to other catastrophe insurance products, but providing more benefits as a baseline than those products do.

But, just like those products, not everything is always covered, nor can it be, nor should it be. Part of this misconception is the fault of insurers (who fancy themselves "healthcare" professionals when they are not), part is doctors, part is government, and part is the patients themselves. Additionally, if you have a mandated, partially monopolized fee-for-service model, it shouldn't surprise anyone that both services and fees (and thus, costs to the consumer) rise to unsustainable levels over time. Yet, somehow, everyone seems to be surprised by this. Also, ever notice the doctor's fee if you pay cash is lower than what they bill the insurer for? They're gaming and defrauding the system, which also increases costs. Blame for all involved on this one, especially insurers for not properly defining and maintaining the scope of their business and doctors for playing games with it.

Would it be good for all health insurers to go under? IDK. Who would help distribute the costs of the majority of care then? Can the gov't do it? Obviously, no. Nothing the government touches works out well. If Medicare was so great, there wouldn't be Medicare gap plans and supplemental plans. If the government had been doing this well, there'd have been no health insurance co's in the first place. That said, yeah, the insurers are a long way from the roots of their industry as a religiously affiliated non-profit and something needs to change drastically.

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"Also, ever notice the doctor's fee if you pay cash is lower than what they bill the insurer for? They're gaming and defrauding the system, which also increases costs. Blame for all involved on this one, especially insurers for not properly defining and maintaining the scope of their business ..."

This. ^^^

And equipment suppliers are in on the problem as well, not just health care providers. Wheelchair provider price if a rehab hospital loses a wheelchair it was supposed to return: USD $2000+. Price for a more updated model of the same brand wheelchair via Amazon? Under USD $200.00.

(Hana's Helpful Hint: if one is in the US, look for community medical equipment donation groups/charities. They accept lightly used and cleanable equipment, for loan or to re-donate.)

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Thanks for the add'l info. The more you look at it, the more the "issues" with the healthcare system (which are really only cost, esp. considering the poor outcomes) are driven by providers. They're trying to blame insurers, but it's the providers steering the ship. And they've found a cash cow and are milking it for all it's worth. Probably not a coincidence that in my relatively short lifetime "doctor" has gone from being a middle class job to being an elite, high status job.

The other place I've personally seen doctors defraud the system is with end-of-life care, where they keep people "alive" - at a huge cost - who should be allowed to pass with dignity. Even some cases (like an aunt of mine) where providers talk patients into useless surgeries that worsen their quality of life...but net the doctors involved hundreds of thousands of dollars. This is something else that didn't happen in my great grandparent's gen.

Of course, these are the same doctors who mandated C19 shots to enter their facilities, continue to wear purely political, virtue-signaling "masks" in their offices, and actively killed people with remdesivir and forced intubation for "covid." They locked up and killed elderly people, who had to die alone. They're also the ones prescribing drugs they know have to be harmful for things like mental illness and obesity, to say nothing of the "trans" grifters. They make substantial money (our money) from all of these things.

So, another important lesson from the covid debacle is that - for the most part - doctors are not acting in the best interests of their patients and are not blameless re: the issues everyone wants to blame only the insurers for.

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If I remember correctly, Kentucky had traditional, workable health insurance. Everyone could get whatever insurance they wanted on the open market. The state directly paid any additional costs for insurance for preexisting conditions.

In my experience, anywhere that governments are major players in an economic sector, such as healthcare, education, retirement, and legal services, the prices shoot up and quality goes down.

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Another article at the Mises Institute does cover some of your questions.

https://mises.org/mises-wire/why-health-insurance

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That link makes good points, especially distinguishing between 1) routine care (not classically insurable risks) and 2) rare accidents/illnes (classically insurable risks).

Today's cost inflation is certainly in part due to systemic grifting by pretending #1 is #2.

That's not "insurance" so much as a form of racketeering. The racketeer intrudes into the patient-doctor transaction, adds costly "insurance" that gives the patient a "lower price" at the expense of the doctor's revenue. Total cost goes up for patient (including insurance fees), and revenue goes down for the doctor.

I'm a bit skeptical regarding the faith that individuals honestly in need will get care however. They might, depending on how healthcare in their community is organized. Or they might not. It seems to me it depends on hard-to-define, hard-to-measure attributes of the society people live in and the organizations that serve that society.

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Totally agree with your excellent comments. Healthcare is a mess for patients and the doctors. I fall into the category with pre-existing conditions but had low cost family insurance coverage (~$350/month) in place since I was younger, so I was covered. That all ended when Obamacare blew insurance premiums over the top. I’m now automatically covered for pre-existing conditions but with sky high monthly insurance premiums and high deductible out of pocket payments, it’s simply the “illusion” of coverage. My solution has been to individually adopt a low carb carnivore diet 7 or 8 years ago and try to stay out of the medical system, as possible.

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I hear you. So true. "Self care" is the best healthcare, to the extent it's possible.

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Sure let’s get rid of all the government controls and then the magic of the free market will fix the problem. We all know that businesses really care about doing the best they can for their clients if only that pesky government didn’t get in their way we would be living in a capitalist utopia!

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Adding to your excellent article, the vast majority of the US population has taken a gene therapy injection, termed a " vaccine" that seems to be making many ill. The gift that keeps giving to the Medical Industrial Complex.

Be patriotic, get sick.

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And all the chemicals in our food, water, soil, air, clothing, and lotions. Like RFK Jr says, how many autistic kids did you know during your childhood? Exactly NONE.

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Ben Hunt has written extensively on the F@ckery of the AMA. If people weren't so obese, the need for "sickness care" would drop precipitously. We have an epidemic of obesity. Watch commercial TV for an hour, and all you see are happy fat people singing about their medication and commercials for Taco Bell and all that piss and s#it the food-like industry peddles. Go into a grocery store. The food is on the outside walls. Food-like substances are in the aisles. H/T Michael Pollan

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Can you imagine in the financial industry, selling option calls(health insurance) and making it tax deductible (employer based health insurance ) whereby the sold calls are transferred to a third party(the patient) . Then when the calls ate in the money (patient sick) the market maker (health insurance company ) refuses to pay the optional value? No one would be willing to play this game and the financial sector would be in ruin. Who allows this rigged game to occur? Uncle Sam.. Why you say this can happen? Because health insurance make so much money in this scam they can grift the politicians and bureaucrats. Spent 40 years of my adult life in medicine. Didn't really understand how the' insurance sausage was made' until I walked away from the "profession ".

And now I understand why most doctors are progressive. They like Taylor Lorenz need that big microphone in front of her face shoves up their ass.

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"After WWII, as healthcare grew more expensive, the government used the tax code to warp how Americans paid for healthcare." I have always heard the problem started during WWII, with price controls; employers got around not being able to raise wages by instead giving a value increase by including insurance as part of the total package. But that could be folk remembrance that is simply incorrect.

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Why do we never hear about a shortage of dentists, optometrists, or chiropractors?

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Almost no one covers them. Dental coverage includes a cleaning and trays and up to 1000 per year. So, people avoid going until they must and then pay out of pocket.

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Let's see what Trump does, we need reform for sure.

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Raven, in my lifetime the real changes that took place were when Hillary was driving around the country in her Healthcare Bus trying to push for National Healthcare....this ushered in a new level of HMO's which required primary Physicians to become "gatekeepers"...you had to get a referral if you wanted to see a "Specialist"...with this came a delay in care and allowed for the Primary to become more decisive...This lasted until the Primary Physicians were being held to a quota for the amount of referrals they produced...Over time this has evolved in to a "buddy system" (prior to Insurance companies buying up physician practices) where Specialists were providing favors in an effort to boost their referrals...Obamacare had good intention but that is where it ended...Obama brought the 8 largest Health Insurers to the White House and said "you are going to provide health insurance to these 47 million who can't get Health Insurance and the Govt will make up the difference in the premiums. Here is a classic example of why Obama was a sellout (actually every Democrat since no Republicans voted for it) because rather than call the Insurance Companies out for their "selective" healthcare and not offering insurance to those more risky (pre-existing condition)...he provided them with the "cover" that they needed to increase premiums and deny care all the while increasing the premiums for those who could pay to offset the "uninsured"...When people bring up their disdain for Trump I ask them "how was your life impacted by his first presidency?" and they cannot provide any answers...But since the advent of Obamacare my premiums for a family of 4 have tripled while he has increased his wealth to $160 million...Health Insurance is a racket...and when you have a company like United Healthcare reporting Billion dollar NET Earnings FOR A QUARTER (https://acrobat.adobe.com/id/urn:aaid:sc:US:4d0eb09a-7626-4c5a-9d3e-4866bb85f222) and multiple people are struggling as Healthcare premiums now represent at least 10% of their income there is a problem. The book Deny, Delay, Deflect does provide ways to legally fight your insurance companies and they take time...I do not support the murder of Brian Thompson nor any violence...Interesting fact: Obama had control of the House, Senate, and White House in 2010...why did he choose Healthcare over eliminating the 2nd amendment? FOLLOW THE MONEY...

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Great article. Just like the Pentagon paying $100 for a hammer due to the firehose of money available to it, hospitals and drug companies are also recipients of too much money. Hence, the daily cost of a hospital bed is $3,000. Should a stay in the average hospital cost as much as a suite at a 5-star hotel in Rome?

Turn off the government-engineered money spigot. Unnecessary procedures will stop, over-prescribed drugs like statins will stop, price gouging, such as $32 for two Tylenols from the hospital pharmacy, will stop.

Reduce the flow of money and people will be made to care about what things cost. They will read the entire bill, instead of just the part about how much isn't covered. They'll ask tough questions about the value they're receiving instead of not caring because the cost is someone else's problem. Make the consumer drive these hyper-inflated costs down and then pre-existing conditions or financially catastrophic illnesses become less onerous.

In other words, remove the government's fat finger from the scale and let the power of 350 million consumers bring discipline to healthcare.

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Replying to "...online progressives did not try hard to hide their delight that a millionaire health insurance executive like Thompson was killed." OMG you live in a dysfunctional society. You hate the left the left hate the right but do the left carry guns and incite violence.

https://www.nytimes.com/2024/02/18/opinion/magas-violent-threats-are-warping-life-in-america.html your comment has nothing to do with health insurance just another excuse to fuel the hatred.

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"If we’re ever going to see the end of this century-long nightmare, we need to start listening to the people who have gotten it right, not those who pretend they are blameless as they fantasize online about others starting a violent revolution."

An excellent quote to end the article. And true for a number of fields, almost all of them liberal darlings where government has had the strongest hand: finance, education, healthcare, transportation. We've spent the last century applying the left/liberal preferred "solutions" to these "problems" and have seen each become demonstrably, consistently worse over time. Just more government, and an extra 1000 pages of regulation by unelected bureaucrats per year.

It's become very obvious to all but the most ideologically blinded that left/liberal policy prescriptions do not work. They make things worse and it's time to try something different. I don't believe we can't find better ways of doing things. We just need to give up the addiction to government as a solution.

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Thank you, Chris. I've stayed away from all the media on this topic, happily making cookies for Christmas and, as always, you delivered a sound article and excellent clips bringing me up to speed.

I am not taking a position but I did caution a friend the other day 'Innocent until proven guilty'....sensational stuff like this grabs our attention and the media exploits it. I remember clearly Richard Jewell.

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The excellent book Ensuring America's Health by Christie Ford Chapin details the history of why the AMA created the insurance model and why health care is so expensive today. She also summarized many of the major points in a 2020 Reason article. Highly Recommended. https://reason.com/2020/04/05/how-doctors-broke-health-care/

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