If employers stopped providing it, I think it is presumed that the mentality towards individual plans would change
True meaning it averages out to a reasonably healthy person
It is unfortunately true in the US (probably everywhere) there is worse health/higher incidences of chronic conditions in the poor (mostly because all chronic conditions are diet related). However, in the US the biggest weight would be the elderly who have chronic conditions at a higher rate than any other demographic (generally due to a lifetime of poor diet combined with irregular care over their life to treat the conditions until they are Medicare), but thats the irony these are the people already covered by Government healthcare (and they seem fairly happy with it. Its time to extend it to everyone.
Imagine there were no private companies but a perfect decentralized blockchain shamwow insurance system that magically worked and distributed all profits back to its participants.
I would think the dying man is committing moral hazard here. But it’s up for debate.
If you do this against a big private insurance company and they lose a penny, it doesn’t sound so bad, but I’m not convinced
I see people say this constantly. Insurance by definition is literally always a "group plan"—everyone who buys insurance is in the same group. That's literally the point of insurance. It's why it exists. That's what it is. That is fundamentally how insurance works. All insurance, in every category, of every type. There are no exceptions.
Insurance always pools risk across all payers (everyone is in the "group"), and then you expect only a fraction (but we don't know which fraction, of course) to require a payout in any given payment period.
If you're selling something that doesn't work like that, then it's not insurance—by definition.
The difference is that if I know the mean and variance of expected health costs for the group, I can offer a lower premium to every individual member because the variance of total actual cost goes down by n^(-1/2) and I don’t need to cover my butt as much. Especially since almost all group plans are centered around relatively healthy working age people. The privilege of group plans is you’re in a healthier subset.
Individual plans are for people not on those plans and they suck dickballs. There is a high chance of moral hazard. There’s more retired old people. You offer little value to the insurance company so you don’t get to negotiate like a group plan does.
Medicare is mandatory in the US for retired old people. It's universal, it's mandatory, and it covers everything. They're literally not in the insurance pools, so I don't know what you're talking about.
As for the "group plans", those "groups" are too small for insurance purposes—they do not spread risk effectively. The entire "group plan" thing is a scam, and it would be trivial for gov't to just outlaw them entirely in the US, and force individual pricing on business-purchased health insurance like we do for every other kind of insurance we have. Costs would go down for everyone, and individual plans would no longer "suck dickballs".
That said, that is not how I would "fix" the health insurance issues we have. But it's at least better than what we do now...
How about everyone who retired before 65?
As for your other points, I mean yeah, we shouldn’t have employers provide it. But they do, and you need to recognize it. There are definitely group plans large enough to spread risk.
Personal anecdata:
2018, my employer didn't offer insurance. I signed up for a "silver" tier individual plan ($1250 deductible, good coverage) on the ACA marketplace and paid $170-something/mo. (after receiving ~$250/mo. in tax credit).
2019, my employer starts offering insurance, so I'm no longer eligible for the ACA tax credit. The only plan they offer costs me $125/mo., has a $4500 deductible, and extremely skimpy coverage. According to the literature they gave us, my employer's pitching-in another $400-something/mo.
So this group plan costs significantly more, has a much higher deductible, and covers significantly less (in my case, it's the difference between medication being covered and not).
[0] https://www.irs.gov/affordable-care-act/individuals-and-fami...
In scenario 1, I start working at a 1000 person company that offers insurance benefits. I sign up for their plan, and my employer pays for nearly all of it.
In scenario 2, I start working at a tiny company that doesn't offer insurance benefits. I find an individual plan (coincidentally from the same insurance company used in scenario 1) that suits me, and sign up for it, paying out of pocket.
The total amount paid to the insurance company in scenario 1 is, as is typical, lower than in scenario 2.
In both of these scenarios, the insurance company doesn't know anything about me. For scenario 1, sure, they might know the mean and variance of expected health costs of the 1000 people already at the company, but that does not extend to me. They cannot assume I will conform to the rest of the group. I am new, and an unknown, and they do not know how I will affect those statistics. For scenario 2, I'm just another independent signup. I might have health care costs in line with the average of all of their beneficiaries, or I might be an outlier (on either end), or something in between. But that's the same as scenario 1.
This feels like it has nothing to do with risk assessment; this is just a reflection of the company in scenario 1 having greater negotiation power because they're representing 1000 people, versus you just representing yourself.