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For the majority of Americans with no significant health problems, not smoking or drinking excessively, eating well, not obese, and not involved in really dangerous activities (e.g. reckless driving), with savings above $50K, having health insurance is a very bad choice, in terms of ROI.

This actually applies to the self-employed or employees not receiving health insurance from their employer. For these people, not having health insurance is a good decision, from a risk management point of view. Here's why:

  • Insurance companies have to pay salaries to their employees (including expensive actuaries) and have other high overhead costs such as real estate and compliance. These costs are factored in your premium.
  • Put it differently, if an insurer manages to be profitable despite all these costs, it's because they charge you indecent premiums. But it could make sense to get a policy from a company that is not profitable - their losses could be your gain.
  • Insurers do not very smartly manage your money, you can do a much better job at that if you have an analytic mind, by saving / investing money every month for your future health expenditures, rather than paying insurance premiums.
  • It can make sense to have an health insurance policy with an extremely high deductible (> $25K) if the premium is below $50/month.
  • The money you save can be used to grow your business, and gives you an advantage over competitors. This is particularly true when you launch a start-up: in my case it helped me launch my start-up without borrowing money.
  • Not having health insurance is particularly attractive if you focus on prevention rather than curing problems, go as little as possible to the doctor, and use alternate cheaper medicines (or drug purchased in India) whenever possible, and don't need coverage for pregnancy.
  • You might be able to leverage medical advice provided online, at no cost, if you can discriminate between bad and good information. This is called crowd-sourcing diagnosis and treatment.
  • There are many insurance products that are more important than health insurance for the population segment in question, but that don't exist: insurance against unemployment, bankruptcy, divorce, discrimination, lawsuits, tax audits, excessive bureaucracy, burn-out, etc.
  • Data security and privacy issues. What if your medical information is sold to potential employers or government agencies?

With the new Obamacare individual mandate, how can we avoid this inefficient, ill-designed system? What about passing for a very expensive patient that will be rejected by all insurers (you claim that you smoke four packs a day, drink three bottles of brandy a day, do drugs, practice unsafe sex, and have very severe mental problems). In my case, I've joined mathematology, since you can refuse health insurance based on religion principles.

And there's some sort of mild religious belief in my decision: preference to natural solutions, antibiotic avoidance, mistrust in doctors (their incentive is to keep you sick, not to cure you), costs are three times above than what they should be (due to poor analytics and other issues), unecessary costly medical exams, refusal to do business with companies that are very poorly run, gigantic bureaucracy, and frankly even if I wanted to be insured - I don't even know how to find a good doctor or obtain a legit health insurance policy.

What about you (especially if you are self-employed, e.g. a statistical consultant)? What do you think?

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Vincent

Your car policy is still insurance and the original arguments apply to it, apart from the third- party component. Your expected financial return on a policy which covers you and your car compared to a third party only policy is negative.

There are a variety of health systems in industrialised nations and although they cost less than the US system they are not 1/20th of the cost (which I assume is what you mean by 20 times less expensive)

The car insurance that pays for ER visits (in case of a collision) is different from health insurance policies, for the following reasons:

  • The premium is 10 times below typical health insurance plans ($100/month vs. $1,000/month)
  • They don't ask you questions about your health to be enrolled, so you could smoke 200 cigarettes a day and still have a very low premium (but they check your driving records to compute your premium)
  • They recover some / all of the ER expenses from the guy who was responsible for the collision (so this policy is not expensive if you never cause car accidents - but you won't be accepted if you are a bad driver)
  • In short, coverage and premium is not related to health status

You cannot be more right: USA is first in terms of percentage of GDP spent on Healthcare. In practice, Americans taxpayers already pay more than any other industrial countries, but for most of them, the return is quite low.

Some other oddities of the US system:

  • Doctors work in offices, have secretaries and lots of various staff, unlike doctors in Belgium who receive patients at home and have no staff. This office renting and staff salaries increase cost of health care in US
  • Doctors, just like people who work in offices, it's Monday-Friday 9am to 5pm. Outside these hours, you need to go to ER and spend $$$ 
  • The fear of litigation is big, it costs tons of money in terms of malpractice litigation insurance, and in some ways there is more justified litigation than in Belgium because of all the under-qualified staff performing many medical procedures with various errors (dosage errors, delivering the wrong medication etc.)
  • Non-profitable pharmaceutical research is abandoned, and we've recently experienced drug shortages for various medical conditions (cancer)  

It appears that here in America we do many things "the hard way." That may be why so many processes are flawed. 

The best way to cope with the insurance problem is to have national insurance or, at least, state insurance. In the UK we have a national insurance scheme which is roughly 11% of your income. However, that is just an additional tax as healthcare, unemployment benefits, state pension are all paid for out of the Treasury funds (tax receipts). This, of course, is not practical. It means that there is a huge burden placed on future tax payers rather than the current insured. Insurance, in its essence, is shared risk, just like healthcare in the UK is socialised but introduce an insurance fund with contributions based on income rather than risk of claiming means that overall there is cover for all.

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