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 ?
The very concept of “healthcare insurance” is capitalist. Medical care is reduced to a commodity that can be valued monetarily and “bought” from hospitals or clinics. There’s nothing inherently commodifiable about individual healthcare services to the point that they get a price tag that later has to be covered by insurance, public or private. Contrast that with medicine which has a very specific and calculable labour value required to create it, though it’s actually quite low as patents and trademarks inflate prices.
Rather it’s much more in line with the development of an efficient healthcare system to have it be national and funded through tax or other state revenue-collection methods, and available to all citizens (and possibly non-citizens) without any sort of attached price tag. That also solves this problem of old people, chronically ill, disabled people or whichever sorts of people statistically require more medical help without negative impact.
And this is not some idealistic notion off the top of my head. In Brazil we have a national healthcare system that functions on an availablity and queue basis, without any “insurance” or price tag, funded through federal and state budget allocations from taxes. Sadly it’s underfunded due to the private insurance lobby and our horrible political situation, but it’s still leagues more accessible and egalitarian than whatever insurance system. I think Cuba works that way too.
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 ?
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 : if you’re saying that capitalists could make public care trash(, e.g. by increasing the out-of-pocket amount), then that’s what they’ve already done in a lot of countries.
I mean, 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, by force of habit, but wouldn’t be able to complain anymore of being forced by the state to contribute agaisnt their will. 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 ?can you cite a country which doesn’t offer the possibility to subscribe to a private insurance
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.
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 any healthcare systems without some private involvement (well 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 :) !
Insurance functions as ideally as possible in the “free world”, regardless if its private or public, your money goes directly to the stock market, directly to maximize shareholder value!
