A huge amount of people that come in for medical care (especially in the ER) are the type that you don’t want to hire to do anything.

And besides, that essentially makes a hospital into a debtor’s prison work camp.

No one in the healthcare market actually likes that idea… not doctors, not nurses, not hospitals, not the insurance companies, and certainly not the unions or the patients.

Other countries insurance schemes hide the price from the patient too… yet they are still far cheaper. So relative to the rest of the advanced world that’s not the problem.

Small insurance polls, by definition of how insurance works, are just worse than large pools. The larger the pool, the more the risk is spread, the better.

I’ll concede the first point about the preconditions…. I’ve never seen such a thing but I can accept that it very well could exist.

As far as large organizations aggregating people into pools, it’s possible that churches and such could do it but there’s not reason to believe that they’d even be able to equal the performance of a large private employer and it still makes you beholden to your membership in that particular organization. What do you do if you move to an area with no suitable church (of the right denomination) or what do you do if you’re not church going?

I doubt bowling leagues have the same longevity that a large business would have. And do you really want people signing up for your bowling league just to get the insurance?

Tying health insurance to work was essentially an incentive to get people to work for large businesses. Now that people desire to be much more entrepreneurial it makes sense to separate health insurance from employment. But the problem is that people still want to be in a huge pool.

But really this whole discussion is pointless….

The only workable solution is to have a non-profit insurance or state-by-state single payer. Many states have already gone the non-profit route (i.e. virtually all medical care in Minnesota is non-profit including the Mayo Clinic). Like it or not, people *really* like healthcare benefits and will gladly pay whatever they’re currently paying per month for private insurance toward single payer insurance.

And once people get a taste of single payer insurance they never want to leave it or change it (witness the medicare debates that don’t touch anyone already on Medicare). Free market health care is a doomed concept in general… the VA, SCHIP, Medicare, Medicaid, and several states/counties going single payer are just a slow descend into national single payer.

The “we can’t afford it” argument only works while we’re fighting off a recession. Once the economy improves or at the height of the next bubble that argument won’t work anymore and we’ll take another step towards single payer. Remember, even the GOP expanded Medicare during the last bubble.

The economy will bust again, the debt will skyrocket but they still won’t repeal the healthcare stuff they enacted during the last bubble… it’ll be political suicide.

Imo the healthcare debate is a lost cause for conservatives.

with regards to health care. That’s the core issue.

Anyone can just walk into the hospitals and get treated regardless of their ability to pay. The market can not function well under those conditions and so now you must socialize the system. The same goes for universal coverage. If you believe in this lefty ideal then you need a lefty solution to create it.

Conservatives are just lying to themselves saying that their free market (righty) ideas will bring about lefty results, they won’t.

But to the points you made:
Define “hasn’t really worked all that well”? The three countries you mentioned have better outcomes than we do (Canada’s is only slightly better than us but England and especially France are way better) and do it at a much lower cost per capita.

Americans also head to Canada and other countries for medical treatment, it’s called medical tourism. For instance, Toronto is world renowned for their open heart surgery and the reimportation of prescription drugs discussion should shame every American.
In fact, one of the big stories of the NBA off-season was Kobe Bryant heading to Germany to get his knee and ankle worked on because they have an awesome procedure that we don’t have here yet.

But all of this is a red-herring because now we’ve moved from Health Insurance to Health Care Delivery.

But yes, insurance by definition is collectivist (the spreading of risk among a group). Free market for-profit health care insurance is bound to fail at providing universal coverage because universal coverage is not the most profitable business model.

So you can either have free market health care and all the pitfalls that come with that (and due to the virtually unlimited demand there will be many) or you can have some from of socialized coverage. The closer you get to universal coverage the more gov’t has to get involved, period.

There isn’t anywhere in the first world where that isn’t the case.

So if you’re a Ron Paul libertarian and believe that it’s okay if people die, go completely broke, or wait for charitable donations when they get sick then fine… but pretending that you can achieve the goals of the left (universal coverage and low out of pocket costs among others) with a non-lefty solution is just talk.

Buy why go through the process of giving them care then trying to track them down when you could just deny them in the beginning? That’s probably what the free market would do.

Socializing the system isn’t the answer, it’s the means to the answer. The answer is rationing. Your biometric solution is rationing by price. England/France/Canada/Medicare etc. ration by need.

The socialist solution often involves using a portion of the money in the system towards training an excess of doctors to reduce the need for rationing but I’m not sure how much this actually works. The only place where we know it works for sure is Cuba and obviously that’s a non-starter politically.

But let’s ignore that for a second and go back to your c?est la vie solution. How do you sell that to the public? Remember a huge portion of the people that will be denied care or tracked down by the debt collectors are actually voters. They surely won’t vote for such a system. Family members of those people likely won’t vote for it either. A lot of people who could pay but fear that they might not always be able to or that paying would significantly hurt their future prospects (lose their house, car, job, business etc.) will not vote for it either. And it will be comically easy to run human interest stories on the news every night to swing a lot of other voters too.

So how are you going to sell this to anyone that isn’t a libertarian?

I think you basically have to lie about the system and tell people that it does everything the socialist system would do (universal coverage, low out of pocket costs, preventative care etc.) because you know people like to hear that.

And that’s why I believe GOP candidates have such spotty records with regards to free market healthcare. It’s just not an easy sell or politically expedient.