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Small-Scale Question Sunday for December 8, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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However I think the issue with insurance is when it becomes mandatory or defacto mandatory, because then you lose proper economic controls on the price via supply and demand.

Failure to consume food is much more quickly and reliably fatal than failure to buy health insurance, and that market works fine. It just isn't true that supply and demand don't apply to necessities. I may have to buy food, but as long as I don't have to buy from you, you're not going to have much luck selling me potatoes for $10/pound.

The bigger problem is just that health care is really expensive. Supply constraints may play an important role here: The US just doesn't have enough doctors. Coverage mandates may be another issue. The government mandates coverage for treatment x, which adds $y to the premium. How many consumers, when fully informed, would a priori actually be willing to pay an extra $y per year for x to be covered?

Lack of price transparency is another issue. Lack of competition among insurers may be an issue, but insurer profit margins are pretty small, so it's likely a minor issue.

Coverage mandates may be another issue. The government mandates coverage for treatment x, which adds $y to the premium. How many consumers, when fully informed, would a priori actually be willing to pay an extra $y per year for x to be covered?

I think this is part of what I mean about it being mandatory. It's not just that the government forces you and/or employers to buy some sort of insurance, but also that insurance has to have certain properties, which if applied universally across all of them prevents competition by undercutting.

So perhaps the analogy would be if all foods sold must contain at least 2% caviar by weight. The store is going to sell potatoes for $10 per pound because they have to in order to cover the costs of the caviar that comes with it, and they can't be undercut because all the other stores have similar prices for the same reason. Maybe I decide to forgo potatoes and buy carrots instead, but those come with caviar too. It's only 2% of your diet, but it ends up being a much larger percent of your budget.

I do agree with your other points about things contributing to the cause. Lack of price transparency is also an issue (although the latter is tied to the role insurance companies paid, since they're the ones paying rather than customers, leading to principal agent problems). But if it was normal for the majority of people to not have health insurance then there would be strong pressures for more transparent prices and I think that issue would resolve itself.

Regulations requiring overly limited medical degrees is also an issue that this would not resolve. Although is similarly the government's fault.