Seriously? Spending a night in a hospital results in a $10,000 bill (though the real out of pocket is significantly cheaper. God help you if you have no insurance though). Healthcare in the US is the thing that needs the biggest disruption.
Her bill before "insurance negotiated prices" was $59,000. Effectively $1,000/hr, 24/7.
> large insurance pools that must span age groups and risk groups.
What you describe (community rating) has been tried and it works. But it requires that a lot of young, healthy people enroll, and seniors receive most of the care. In an inverted demographic pyramid like most Western economies have, this is a ticking time bomb, so costs will continue to rise.
> Mandate at least decent minimal coverage standards
I think a better solution is to allow the government to threaten in negotiating prices with companies as Canada does; it greatly reduces rent-seeking behavior by pharmaceutical companies while allowing them to continue earning profits and innovating. (I understand a lot of the complaints against big pharma but they are actually one of the few sectors of the economy that doesn't park their wealth and actually uses it for substantive R&D, despite what the media will tell you, and countless lives have been saved because of pharma company profits)
Essentially the gist of what I'm saying, as someone who has been involved with and studied this industry for the better part of five years, is that it's much more complex than what meets the eye.
Profit isn't even a big part of the overall revenue.
> Mandate at least decent minimal coverage standards
I assume you want higher coverage standards than what currently exists? Independently of whether that would be the morally right thing to do (or not), it would definitely increase prices.
> and large insurance pools that must span age groups and risk groups.
Why does your insurance need a pool? An actuary can tell you the risk, and you can price according to that. No need for any pooling. Pooling is just something you do, when you don't have good models (or when regulations forces you).
Wuh? The more diverse the pool, the lower the risk. Your way of thinking will very quickly lead to "LiveCheap: the health insurance for fit, healthy under 30s only" for dollars a month, and "SucksToBeYou: the health insurance for the geriatric and chronically disabled" for the low low cost of "everything you have to give".
There's insurance which allows you to convert an uncertain danger into a known payment. And then there's welfare and redistribution.
By all means, please run some means testing and give the poor and sick or disabled extra money. Or even just outright pay their insurance premiums.
But please finance that from general taxation, which is already progressive. Instead of effectively slapping an arbitrary tax on healthy people, whether they be rich or poor. And please don't give rich people extra stealth welfare, just because they are in less than ideal health, either.
Just charge people insurance premiums in line with their expected health outcomes, and help poor people with the premiums using funds from general taxation. (Where poor here means: take their income and make an adjustment for disability etc.)
We _want_ the guy who loses 5kg and gives up smoking to get lower insurance premiums. That's how you set incentives right.
> The more diverse the pool, the lower the risk.
No. The diversification comes from the insurance company running lots of uncorrelated contracts at the same time and having a big balance sheets. For that, it doesn't matter whether it's a pool of similar insurance contracts, or whether they have bets on your insurance contract, and on the price of rice in China, and playing the bookie on some sports outcomes etc. In fact, the more diversified they are, the better (in principle).
But that diversification is completely independent of the pricing of your individual insurance contract.
Have a look at Warren Buffett's 'March Madness' challenge, where he famously challenges people to predict all 67 outcomes of some basketball games to win a billion dollar. Warren Buffet ain't no fool: he doesn't need a pool, he can price the risk of someone winning this one off challenge.
More generally, have a look at Prize indemnity insurance https://en.wikipedia.org/wiki/Prize_indemnity_insurance which helps insure many one-off events.
Well, there I entirely agree with you - health insurance as it exists in the US now is "insurance in name only".
In any case, what you are saying is only true, if you buy your health insurance second to second on the spot market.
Insurance companies are more than happy to enter long running contracts, where you both agree today on (the algorithm for) the premiums for the next twenty years or even until the rest of your life. That's pretty common with life insurance and disability insurance already.
The above already exists, but if you allow some speculation: you could even envision people buying insurance for their kids before conceiving them. That way you don't have to worry about pre-existing conditions.
(Well, if the parents already have heritable conditions that would make the kids more likely to have expensive medical problems, those would push up their premiums. But then: perhaps these people should think twice about burdening a potential kid with these issues.
Compare how in Cyprus where sickle cell anemia is prevalent, even the Catholic church demand you get screened, before they'll marry you.)
If you really want specialised in-kind welfare, you can get people a voucher for the catastrophic version of 'unconceived baby insurance'.
Basically, you can buy insurance against insurance premiums being expensive.
Even SpaceX's vaunted "disruption" is just clever resource allocation; despite their iterative approach to building rockets being truly novel they're not market disruptors in the same way SV usually talks about them. And their approach has some very obvious flaws relative to more traditional companies like BO, which as of now has a lower failure-to-success ratio.
I don't think you'll find many providers clamoring for an AI-assisted app that hallucinates nonexistent diseases, there are plenty of those already out there that draw the ire of many physicians. Where the industry needs to innovate is in the insurance space, which is responsible for the majority of costs, and the captive market and cartel behavior thereof means that this is a policy and government issue, not something that can be solved with rote Silicon Valley style startup-initiated disruption; that I would predict would quickly turn into dysfunction and eventual failure.
Enshittification has done a lot of damage to the concept of "disrupting" markets. It's DOA in risk-averse fields.