> provide coverage for $5000/year with a $10,000 deductible, instead of $10,000/year with no deductible.
that's the wrong way to think about it. The above makes an implicit assumption that by doing this you "save" $5000/yr because the insurance company is "more efficient".
That's wrong - you actually cost $5000 (this being the "profit" the insurance company makes if you _didn't_ need the medical treatment that year). Under the gov't version, if you were healthy, you're "free". You only cost when you actually need the medical treatment.
Healthcare should not be done under a private insurance model. Any profit made by the private insurer is a cost to providing medical treatment, and does not contribute to the outcome. By making medical treatment a tax payer funded scheme, the cost of an unhealthy society is spread out amongst all. Not only does this give the gov't buying pressure to lower the margins of all medical treatments, it also makes a policy pressure for gov't to give preventative measures for good health outcomes (like legislating low sugar foods, or incentivize exercise and good diet etc).
> Under the gov't version, if you were healthy, you're "free". You only cost when you actually need the medical treatment.
Government insurance is still insurance. It isn't that each individual costs the government $10,000, it's that most cost them nothing and one in ten gets cancer and costs $100,000. Insurance is the same. The large majority of the money isn't going to the insurance company, it's going to healthcare providers.
> By making medical treatment a tax payer funded scheme, the cost of an unhealthy society is spread out amongst all.
This is literally the definition of how insurance works. It's also why insurance sucks, because it allows people to make risky/unhealthy choices and socialize the costs of those choices, and therefore why high deductible insurance is more efficient by introducing at least some price sensitivity.
> Not only does this give the gov't buying pressure to lower the margins of all medical treatments
This is equivalent to legislating prices. They can already do this regardless, but it's a bad idea for the same reason price controls in general are. How do you determine what the price should be? Too high and you're overpaying, too low and you force providers to lower the quality of care to meet the price target. If this was so easy then why wouldn't the insurance companies be doing it too?
> it also makes a policy pressure for gov't to give preventative measures for good health outcomes (like legislating low sugar foods, or incentivize exercise and good diet etc).
Couldn't they do this anyway? Also, wouldn't they have the opposite incentives, because then the companies making blood pressure medicine or whatever would lobby against any such programs, and be more proficient lobbyists because they're already dealing with the government to begin with?
And if the government really is so much more efficient then they should easily be able to out-compete the insurance companies and other healthcare providing systems on fair terms in a competitive marketplace, right?
I get the impression you're idealising the free market. The numbers[1][2] speak for themselves in proving that universal healthcare is the most affordable way to provide good healthcare.
In the UK the NHS (2016) per capita cost was $4,192 (PPP) and in the US the per capita cost was $9,892 (PPP). The OECD life expectancy average for the same year in the UK was 81.2 in the US it was 78.6. Comparable healthcare outcomes for vastly different costs.
I don't know how the politics of healthcare and lobbying differ between the UK and the US but whatever they are the numbers show that Universal healthcare is better for everyone in spite of your (or really anyone's) arguments against it.
Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised.
All that being said, if we were to use this metric, for the sake of argument...these charts are quite illuminating, but not for the reasons you think.
If you plot them on a graph, you'll find that the most efficient healthcare system is actually one closer to the "idealized market"...in Singapore[1].
Also the comment to which you are replying is strictly talking about "government insurance". "Government insurance" is not the only way to deliver universal healthcare. Germany, Switzerland, Netherlands, Singapore all have thriving multi-payer systems. In Switzerland and the Netherlands, ALL insurance is private. In Singapore, while the government covers catastrophic care, 70% of total health expenditures are private. Singapore's approach is actually the closest to what a system might look like if you replaced healthcare-specific targeted subsidies with a UBI — most health expenditure is through compulsory health savings accounts.
The common theme is that there is some degree of government intervention/regulation and subsidy. Having the government be the sole payer is definitely an approach, but it's by no means the only approach, nor even the best approach.
"Universal healthcare" just means that everyone has healthcare, it doesn't necessarily mean that the government provides it for everyone. We have pretty close to "universal food" in most of the developed world, and the vast majority of the food system is delivered through the open market.
>"Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised."
A socialised healthcare system forces government and the healthcare service to write and maintain policies that consider the health of the nation. Where as a private insurance based service doesn't.
The US opoid crisis is a perfect example of this. Many of those addicts in the US moved on from prescription opoids that they had been prescribed unnecessarily to streets heroin because there was little concern of the wider public health implications. In the UK getting a prescription for addictive strength opoid pain killers has long been near impossible because the healthcare system has to be careful not to create another problem in trying to fix the first one because it's their responsibility to fix it which also means Doctors are not motivated to meet the patients wants (e.g pain free) and only fulfil their healthcare needs. This is why the UK didn't go through the same crisis
So I say that life expectancy is a good measure of healthcare systems because it forces policy makers at all levels to consider the wider impact of public policy on public health.
Again, it's debatable, but as I continued in my comment, even when charitably accepting your premise, your argument loses its strength.
A fully socialized healthcare system is one of many implementations of universal healthcare in the developed world today, and you'll have to find an answer for why the most efficient system in the world is the one that just happens to rely the most on consumer-driven market mechanisms.
Perhaps but then you also have to consider that Singapore is such an outlier that maybe comparing with them is overlooking what universal healthcare system is more likely to really be possible to politically implement.
Chasing that vision of efficency that Singapore shines a light on likely only serves to distract from other universal systems that are more commonly provided that are more realistically achievable.
Singapore is so far off the scale close to Hong Kong that it suggests they have political, social, geographical conditions that can not be replicated.
That’s not what “outlier” means. If every country attempted to implement Singapore’s system, and only Singapore succeeded, then you would be correct that it is an outlier. Instead, other nations settled for different systems and are generally satisfied. There lacks a political will to move out of the local optima.
Singapore’s path to its current system wasn’t by accident. It tried an NHS style system, which failed due to overuse, then tried a US-style system, which failed for obvious reasons, and then settled onto the system it has today.
The US is in the unique position that someone else has tried this model and we have enough data to prove its superiority. There also appears to be enough political will to reform the current system. There’s no point in settling for local optima when we have more than enough information to be able to go all the way...
There’s actually no evidence whatsoever that it “cannot be replicated”, there is little about Singapore, geographically that uniquely lends it to such a system. Suggesting otherwise is just ignoring an inconvenient data point. You’re also conveniently ignoring Switzerland, the Netherlands, and Germany which have a significant degree of privatization in their healthcare systems. Pure socialization isn’t the only way, it’s not even the best way.
So then what are the friction points of the Singaporean healthcare model that prevents other countries from adopting it?
If it were a Bill up for a vote by politicians in the US then what issues would they have with it?
Also comparing healthcare costs of Germany, Netherlands, and Switzerland with the UK from the links I posted earlier clearly shows that socialised healthcare is more efficient.
The per capita cost in Germany ia 32% higher than the UK, Netherlands it is 28% higher, and in Switzerland it is a whopping 88% higher compared to the UK.
Even France and Greece which are more socialist than the UK and both also have national insurance schemes are much better value than their private counterparts.
> So then what are the friction points of the Singaporean healthcare model that prevents other countries from adopting it?
The friction points aren't necessarily with the model itself, the friction is strictly political will. Democracy doesn't always seek out the most objectively superior solution, it simply seeks out the solution that the people want. Strict gun control might be a "superior policy", but that doesn't mean that people in America want that. Similarly, people in Denmark don't really want to change their system, even if there exists a superior system in Singapore.
In contrast, the US is in a unique position in that there is growing political will to change the status quo system, and the Singapore model happens to be one of the few that enjoys bipartisan approval. Also uniquely, the fully socialized single-payer system couldn't even get majority support among the Democratic Party. Indeed, the current nominee was the guy who explicitly campaigned on "the public option" rather than a strictly socialized system.
> If it were a Bill up for a vote by politicians in the US then what issues would they have with it?
The GOP's proposed Fair Care Act[1] happens to make one key change that moves the US closer to parity with Singapore: namely easing the rule that requires one to enroll in a high-deductible plan in order to qualify for an HSA — so that even those on low deductible plans may take advantage of the HSA. The American HSA is similar to the Singaporean Medisave system, which is a pre-tax savings account for healthcare spending only, where the savings are invested in funds. With American HSA's, they are private custodial mutual funds. With Singapore's Medisave, the fund is the Singapore sovereign wealth fund.
The Fair Care Act may get buy-in from the Left if it includes universal catastrophic coverage (analogous to Singapore's Medishield), and also making HSA contributions compulsory, just like Singapore.
Indiana's government offers its employees what is widely considered to be superior health insurance[2], in which the state deposits funds into HSA's equal to the annual deductible. This is very similar to Singapore's Medisave + Medishield system.
Another proposal that enjoys generally bipartisan approval: Medicare Advantage For All. Medicare Part C, or Medicare Advantage, is the part of America's Medicare system that is working best. Medicare Advantage plans have lower costs, broader benefits, and better health outcomes than traditional, single-payer Medicare. Today, almost 40% of Medicare enrollees are in a Medicare Advantage plan, as opposed to traditional "single-payer" Medicare[3].
So the political will is there, and the empirical results are proven by one of the US's very own states (run by the GOP, no less).
> Also comparing healthcare costs of Germany, Netherlands, and Switzerland with the UK from the links I posted earlier clearly shows that socialised healthcare is more efficient.
> The per capita cost in Germany ia 32% higher than the UK, Netherlands it is 28% higher, and in Switzerland it is a whopping 88% higher compared to the UK.\
> Even France and Greece which are more socialist than the UK and both also have national insurance schemes are much better value than their private counterparts.
"Cheaper" != "More efficient". While you're right that the nations that provide "socialized healthcare" can have lower costs per capita — Germany, Netherlands, Switzerland, and Singapore all enjoy higher average life expectancies than Denmark, UK, and Greece. Switzerland & Singapore both enjoy higher average life expectancies than Denmark, UK, Greece, and also France. The goal of these systems is to get the most bang for our buck, not strictly to just spend the least.
This is why Singapore's system shines — it enjoys the lowest per capita spending while enjoying the best health outcomes.
I'll close by saying that Singapore tried the UK's system[4] (listen at 12:35). The US also has a UK-like single-provider healthcare system, the VA — and that's been an abject failure[5]. The fact that this failure was reproduced twice, independently, suggests that UK's success might be the "outlier" (to use your framing). In contrast, we are yet to see a failed attempt at replicating Singapore's system, and thus cannot yet conclude that it is some sort of an anomaly.
Same story for education [1]. I won't be moved by cries of "we're exceptional" until the US actually tries adopting the policies that have worked so well for Europe and Canada.
This is the same old tired argument again and again. "European countries have lower costs, therefore socialism is better than capitalism."
There are two problems with it. First, the US system is completely broken. It isn't a free market system, it's a worst of both worlds compromised hellscape. It's like comparing the USSR to Colombian druglords as evidence that communism is a great system. The USSR isn't great, Colombian druglords are just awful.
Second, the European systems rely on the US to fund world medical research through its high medical costs. We're subsidizing them. That makes us look bad, but they're the ones free riding on our system. And it's obviously not possible for the US to pay lower prices by doing the same thing and offloading its medical research costs onto the US. What we could do is make the EU pay more of the R&D somehow -- that could lower our costs for sure, or improve outcomes world-wide because there is more R&D. But what does that look like? Higher costs in Europe, right?
Ultimately the problem with a private healthcare system is there is no incentive to provide appropriate affordable healthcare and every incentive to divide, marginalize, and monopolize markets in the aim of driving down competition and driving up profits.
Now that the US healthcare industry has grown so rich and powerful it can lobby and win against any serious political efforts to either increase market competition or socialise healthcare. I.don't. Know how you could politically fix a system that is essentially "every man for himself" the incentive for corruption is far too high when payouts equal political power.
I doubt the US is subsidizing medical research as much as you'd think. The Pharmaceutical industry for example is very profitable compared to other industries. A socialised healthcare service would enable more competitive prices eating into industry profits for these products due to market scale like we see in the UK due to the buying power of the NHS.
"Among the largest 25 companies, annual average profit margin fluctuated between 15 and 20 percent. For comparison, the annual average profit margin across non-drug companies among the largest 500 globally fluctuated between 4 and 9 percent."
> The large majority of the money isn't going to the insurance company, it's going to healthcare providers.
I have upvoted you but on HN, the prevailing belief is that doctors are gods and insurance companies are evil.
The data clearly shows that, on the average, insurance companies lose money while hospitals charge a 10000% markup - that's right, a 10000% markup.
I have written extensively on this topic (see my Quora) but I am finding it incredibly challenging getting people to see the reality.
Because I am often a contrarian here I am no alien to the downvote silence system here on HN - it's likely you can't respond to this comment of mine because HN won't let you for a few hours.
My email is in my profile, would love to connect with you - a person aware of reality.
you've cleverly argued in a way to make hidden the major point i wanted to make - which is that insurance companies making a profit is a loss to the payer. I'm purely talking about the insurance system, and not the medical provider system (hospitals/doctors etc).
> The large majority of the money isn't going to the insurance company, it's going to healthcare providers.
Any money going into insurance as profit is a loss to the payer - insurance doesn't _provide_ value. If the gov't is the one "doing the insurance" as you say, then any profit from that operation will count as a lowered cost of providing medical treatment.
> allows people to make risky/unhealthy choices and socialize the costs of those choices, and therefore why high deductible insurance is more efficient by introducing at least some price sensitivity.
so therefore, insurance companies will pick out the least risky people, least unhealthy, and not allow the sick into their programs. That is exactly what you see today, because those more ill people are what saps the profits.
The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end. Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.
> This is equivalent to legislating prices. They can already do this regardless, but it's a bad idea for the same reason price controls in general are
no it's not price control. It's buying power, from a single entity that is not profit-driven. The market for medical treatment is unchanged under my model. Insurance companies currently all own their own little monopoly in their region/network, and hence, there's no competition for pricing the medical treatment today. You are forced into the insurance's monopoly (or face the higher ticket price hospitals charge because they can).
> why wouldn't the insurance companies be doing it too?
> ... if the government really is so much more efficient then they should easily be able to out-compete the insurance companies
Insurance companies provide efficiency in operation vs gov't perhaps - i don't know. But what efficiency they provide is taken out as profit instead of being passed on to customers. And insurance company's efficiency is not in lowering the cost of medical care - it's in finding customers that don't cost them more than premiums they charge. They are more incentivized to keep medical costs high to force people onto insurance plans (that they negotiate using their purchasing power)!
There is no real place in the world for a profit-making medical insurance company imho. Or, if there is, they will be _in addition_ to a tax-payer funded universal healthcare system, and they can provide non-medically necessary operations that are not covered by the universal system.
It's really even worse than that. The amount of money spent on medical billing is just obscene. It isn't "profit" for anyone, but it's vast inefficiency.
> The amount of money spent on medical billing is just obscene. It isn't "profit" for anyone, but it's vast inefficiency.
Which is the thing caused by low deductible plans. If that sort of paperwork was only necessary in cases where you're already paying for $10,000+ in medical services, the fixed overhead isn't that significant. But with low deductible plans you pay it for every little thing that ought to cost $50, and then the $50 thing costs $550 because even walking in the door requires $500 worth of paperwork.
How much more efficient would it be if you just walked in with $50 in cash in most cases, which you can take out of the thousands a year you'd save in insurance premiums?
Extreme inefficiency. Extreme amounts of money spent simply on accounting and legal teams to keep track of all the plans, in companies which often have at least a dozen different plans per state. And every doctors' office and hospital and urgent care must hire or contract these services. Before beginning to serve a patient they and/or the patient must do paperwork to look up in-network specifics and insurance coverage terms.
It really is obscene and totally a waste, and it doesn't have to be this way. The notion that the free market does things more efficiently isn't always true, particularly in captive-market situations like healthcare, particularly in purely middleman industries like insurance which are actually incentivized to poorly allocate money to the alleged business purpose (covering medical services for people) because it increases their own profit margins.
> you've cleverly argued in a way to make hidden the major point i wanted to make - which is that insurance companies making a profit is a loss to the payer. I'm purely talking about the insurance system, and not the medical provider system (hospitals/doctors etc).
But then you're not addressing the majority of the problem, because insurance company profits are only a single digit percentage of premiums.
And even the "profits" aren't all waste, because you're paying money but not getting nothing in exchange.
If you want to have patients not paying directly for care then you need somebody to process claims, and those people need an office to work out of. The investors in the insurance company paid for that office. A lot of their "profit" is just the internal rent being paid on the building. If you move that function to the government, the cost doesn't disappear because the government still has to pay for buildings to operate out of to process claims payments to providers, which had previously been paid for by investors in exchange for profits.
Health insurance companies don't generally produce above-market returns on capital, so there is no real evidence that their "profits" are introducing any avoidable cost at all. It's just a method of paying for the things the investors' money bought.
Heck, there are non-profit health insurance companies that make no profits. Where are the savings, if some existed? (Answer: They still had to raise capital, but they used loans or bonds or spent labor begging for donations instead of selling shares, and that turns out not to be much different in efficiency.)
> so therefore, insurance companies will pick out the least risky people, least unhealthy, and not allow the sick into their programs. That is exactly what you see today, because those more ill people are what saps the profits.
The premise of insurance is that you don't know who those people are yet. If you already know then the event to be insured against effectively already happened. You can't expect to switch to lower deductible fire insurance after your house catches fire but before you file the claim. But equally, if you bought it to begin with the insurance company can't cancel your policy just because you're about to file a claim.
> The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end.
How is that supposed to help? The medical providers are the ones who profit from over-providing. They have no incentive to eliminate unnecessary costs -- to them the costs are profits.
> Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.
It's because Medicare pays below amortized cost and relies on private insurance to pay higher prices and cover the providers' fixed costs. That doesn't exactly work if you get rid of private insurance.
> no it's not price control.
So let's think about this. There is one buyer. If they won't buy from you, their own customers have no alternatives, so you can't make the case that they need to buy from you or their customers will switch to their competitor who does. If they won't buy from you, you have no buyers.
The buyer can set any price they want and the provider has to take it or go out of business. That's price controls.
> Insurance companies currently all own their own little monopoly in their region/network, and hence, there's no competition for pricing the medical treatment today. You are forced into the insurance's monopoly (or face the higher ticket price hospitals charge because they can).
The existing system is all messed up, nobody is denying that. But why not fix it? Require price transparency. Stop creating tax incentives for low deductible plans that make it so nobody has the incentive to shop around and then consequently nothing is configured to enable anyone to do that because nobody does.
> Insurance companies provide efficiency in operation vs gov't perhaps - i don't know. But what efficiency they provide is taken out as profit instead of being passed on to customers.
Not in a competitive market it isn't. If insurance companies were making above-market returns then it would be profitable for rich investors to start a new insurance company that takes their customers by charging lower insurance premiums and still makes at least the market rate of return, until such time as the efficiency is getting passed on to the customers.
> And insurance company's efficiency is not in lowering the cost of medical care - it's in finding customers that don't cost them more than premiums they charge.
Neither of those is true. If an insurance company can deny a claim for a legitimate reason then it saves them money, which in a competitive market is passed on to the customers.
And insurance companies can profit by identifying higher risk customers and charging them higher premiums. The insurance company's job isn't to avoid risk, it's to accurately price it.
Meanwhile the real efficiency doesn't come from the insurance company at all, it's from not using insurance for low cost routine care, which makes the patient price sensitive. Then the patient has the incentive to choose the provider with the better price and is inclined to refuse procedures that are unnecessary or not cost effective.
> not using insurance for low cost routine care, which makes the patient price sensitive
i would argue the patient cannot be price sensitive. The utility of staying alive is infinite - therefore, a patient will pay _any_ price for a procedure that saves them.
I don't want to see a world where going to the GP for a cold is not free. But that's the world we live in today.
The insurance efficiency, if any, is just a drop in the bucket i suppose - because the main issue i'm talking about is socializing healthcare, so that even healthy people pay a cost. And insurance _doesn't_ help with that (and having an insurance industry certainly prevents it from existing as well).
> i would argue the patient cannot be price sensitive. The utility of staying alive is infinite - therefore, a patient will pay _any_ price for a procedure that saves them.
The vast majority of healthcare is non-emergency care. It's either preventive health checkups, or planned treatments. The price elasticity of demand in healthcare is virtually identical to the price elasticity of demand in food. The utility of not starving to death is infinite — therefore a patient will pay _any_ price for food that nourishes them, right?
The huge flaw with that argument is that the value to the patient might be infinite, but the cost to provide it is not. In an open market, competition brings down the cost to the minimum possible value — unless you have barriers to entry or a cartel.
But none of these things are happening in US, you have double the cost of healthcare for a lower life expectancy than countries of comparable living standards who have universal healthcare.
What's going wrong with the system of perfect competition with insurance companies?
> What's going wrong with the system of perfect competition with insurance companies?
The biggest problem is the regulatory incentives for employer-provided insurance. This creates indirection (a corporation is choosing the insurance plan rather than the patient) and whatever is spent is tax exempt, which creates the incentive for employers to provide the most expensive low-deductible plans that are also the least efficient and involve the insurance bureaucracy in the smallest dollar value medical procedures.
> Any money going into insurance as profit is a loss to the payer - insurance doesn't _provide_ value. If the gov't is the one "doing the insurance" as you say, then any profit from that operation will count as a lowered cost of providing medical treatment.
The other users have already mentioned that insurance profit margins, on average, are about 5%. But you should also know that a lot of insurance carriers in the US are non-profit — including Blue Cross Blue Shield and Kaiser Permanente.
> The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end. Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.
That's true, in theory, but in practice Medicare fee schedules aren't that much better than private insurers.
Additionally, providers themselves are starting to charge out-of-network rates that are LOWER than Medicare fee schedules. For example, Wal-Mart has launched healthcare in Georgia, charging $25 for a cleaning[1], which is significantly lower than the amount for a cleaning (procedure code D1110) set by Medicare/Medicaid. You can look it up yourself by visiting the FAIR Health code lookup tool (https://www.fairhealthconsumer.org/dental/results), and setting the ZIP code to that of Carlton, GA (location of the Wal-Mart clinic), 30627. The average allowed amount is $64.
Finally, the US government has historically been pretty bad at setting prices, as a monopsony buyer. The US military spends more per capita on the military largely because it pays more per-soldier, per-fighter jet, etc than any other nation on the planet. You would think that, as the sole buyer of US defense sector fighter jets, it could negotiate better rates. The F-35 is expected to cost $1.5 trillion (!!) over its lifetime, and the US enjoys monopoly/legislative powers over that cost.
Another example: NASA's planned SLS moon mission is a bit of a disaster — way over budget and way behind schedule. Because the boosters aren't reusable, each launch is expected to cost $1B (with a B) dollars — EACH launch! Meanwhile SpaceX's target cost-per-launch is $50M.
So while you're right that, in theory, a monopsony can extract the lowest possible price, there's absolutely no guarantee of this, indeed American empirical evidence has at times proven otherwise.
that's the wrong way to think about it. The above makes an implicit assumption that by doing this you "save" $5000/yr because the insurance company is "more efficient".
That's wrong - you actually cost $5000 (this being the "profit" the insurance company makes if you _didn't_ need the medical treatment that year). Under the gov't version, if you were healthy, you're "free". You only cost when you actually need the medical treatment.
Healthcare should not be done under a private insurance model. Any profit made by the private insurer is a cost to providing medical treatment, and does not contribute to the outcome. By making medical treatment a tax payer funded scheme, the cost of an unhealthy society is spread out amongst all. Not only does this give the gov't buying pressure to lower the margins of all medical treatments, it also makes a policy pressure for gov't to give preventative measures for good health outcomes (like legislating low sugar foods, or incentivize exercise and good diet etc).