I would hope that a Medium reader would know better than to respond to a mathematical argument with an anecdote. I can match your anecdotes until the cows come home and the exchange would prove nothing except perhaps to the cows.
I live in the borderlands, the cultural melding between the US and Mexico. Like every other jurisdiction I know anything about, Texas has made liability insurance mandatory in a basic amount meant to cover X percent of accidents causing damage.
There is a class of coverage called uninsured/underinsured motorists, meant to cover having an accident with an individual who is not insured (and therefore driving illegally). There is a big problem with not issuing driver licenses to undocumented immigrants because the license does not just guarantee a minimal skill level for sharing the road, it is also the choke point for enforcing the requirement of liability insurance.
The problem with this legal picture is too often driven by racism but it is mathematical. The premiums for uninsured motorist coverage are much, much higher in the borderlands because we create the certainty of a substantial population of drivers who are often less skilled but always unable to respond in damages for the harm they cause. The lack of reliable public transportation in Texas is the product of another policy choice
When you have a fender-bender with a person you overhear speaking to the investigating officer in Spanish the thought races to your mind unbidden: “Oh shit, I hope this lousy driver has insurance because if I have to use my own there is a deductible.”
You can define the problem as Mexicans.
Or you can define the problem as the legal regime put together by fools who don’t want to be accused of having sympathy with Mexicans. The premiums we have to pay to cover the uninsured Mexicans do not care what we think of Mexicans; they just chug along under the iron law of insurance, which dictates that the cost to each member of a pool is — all other things being equal — determined by the size of the pool among which the risk is being spread.
Your fantasies about how various abstract ideas sold by politicians play out cannot move the mathematics of insurance.
To despise communism or to despise capitalism is like despising (to grab an irresistible image) a hammer or a sickle. Tools are tools and they have different functions. This would be why every nation on the face of the earth with one possible exception has a mixed economy. If politicians grab the wrong tool for the problems in front of their nations because they have demonized the correct tool they can’t wish away the mathematics and so they make things worse.
Both sides in the fake confrontation called the Cold War did what I am criticizing in this response and it is what you are doing. Your fantasy does not move the cold numbers generated by the size of a risk pool. The gremlin who enables your anecdote is packed into “all other things being equal.” There is something acting on the costs outside the decision to cover the people you don’t like, and the rational response is to chase down that gremlin rather than visit harm on others blindly.
It’s possible that you may isolate the gremlin and decide he’s more expensive to control than the expense of providing urgent medical care for adults and routine medical care for children in trauma centers.
Most docs I’ve heard opine claim that the most expensive option for treating sick people is the emergency room. People who claim letting illness run its course without treatment and without regard for contagion inevitably find that policy dog won’t hunt because, among other reasons, the professional ethics of the doctors stand in the way.
Holding the requirements of medical ethics constant, the comparative cost of treatment in the emergency room is, like the cost of chasing down and vanquishing the gremlin in the system, not a matter of opinion. Rather, it’s a matter of arithmetic. The proper policy response or even the array of options on the table for our choice cannot be sussed out by attacking the iron law of insurance.
If you honestly think you can prove that insurance serves some function instead of or in addition to risk-spreading, you need to write up your proof and submit it to the blind referee process that will both get you published and make you famous in a minor way.
If you honestly think that the cost to each member of a risk-spreading pool is not — other things being equal — directly related to the size of the pool, then you are offering such a dramatic offense to simple arithmetic that you are unlikely to get past the editor and to the referees.
I understand that the pot shots at the NHS are a favorite game in British politics…unless and until somebody trots out abolishing NHS, at which point the heat gets great enough to scare most pols out of the kitchen. The serious fights about how to run NHS take place on a much more realistic level than the public conversations in the US.
The proper metrics, in my opinion, are costs per participant at one end and the classic medical care metrics (morbidity and mortality rates, days spent in hospital, life expectance, etc.) at the other end. At this time, the US is close to the top in the former and the numbers for the latter do not support a narrative of cost efficiency.
