Why restrict private health insurance?












9















There are several countries in which all citizens have a right to healthcare that is paid for by the government, e.g. in Canada.



Yet in some of these countries (again noteably certain parts of Canada), there are further restrictions on the sale of private health insurance. For example, private insurance can not be used for procedures that are available via the public healthcare system.



For example, prior to the 2005 Chaoulli v Quebec (AG) case, the Quebec Health Insurance Act and the Hospital Insurance Act prohibited private medical insurance in the Canadian province of Quebec.



What is the rationale for such restrictions?










share|improve this question




















  • 15





    Can you give an example of such a country?

    – Thomas
    12 hours ago






  • 3





    I'm voting to close, as I know of no such country, meaning this is pure speculation. In Canada AFAIK (and a quick google search confirms) private insurance is routinely purchased for employees by their employers.

    – Jared Smith
    6 hours ago








  • 3





    Downvoted: unless there's any example given, the question is flawed. I'm not aware of any country which prohibits private health insurance. Canada doesn't: en.wikipedia.org/wiki/Healthcare_in_Canada#Private_sector. Looks to me like the question should be "why regulate private health insurance", that's quite different.

    – Erwan
    6 hours ago






  • 3





    To rescue the question: Maybe OP had in mind that in some countries, the government-run insurance is mandatory for everyone (e.g. the "Gesetzliche Krankenversicherung" in Germany, or the NHS in the UK - you don't have to use it, but you have to pay). That means it is prohibited / not possible to have private health insurance instead of the public insurance (though additional insurance, e.g. for better care, is still allowed). Maybe that is what OP thought of? @Colin: Could you edit to clarify ?

    – sleske
    4 hours ago








  • 1





    @Graipher: Yes, I know, but I didn't want to muddle things further. I think one could still argue that in Germany, completely private insurance is "restricted" (unless you earn a lot or are self-employed).

    – sleske
    4 hours ago
















9















There are several countries in which all citizens have a right to healthcare that is paid for by the government, e.g. in Canada.



Yet in some of these countries (again noteably certain parts of Canada), there are further restrictions on the sale of private health insurance. For example, private insurance can not be used for procedures that are available via the public healthcare system.



For example, prior to the 2005 Chaoulli v Quebec (AG) case, the Quebec Health Insurance Act and the Hospital Insurance Act prohibited private medical insurance in the Canadian province of Quebec.



What is the rationale for such restrictions?










share|improve this question




















  • 15





    Can you give an example of such a country?

    – Thomas
    12 hours ago






  • 3





    I'm voting to close, as I know of no such country, meaning this is pure speculation. In Canada AFAIK (and a quick google search confirms) private insurance is routinely purchased for employees by their employers.

    – Jared Smith
    6 hours ago








  • 3





    Downvoted: unless there's any example given, the question is flawed. I'm not aware of any country which prohibits private health insurance. Canada doesn't: en.wikipedia.org/wiki/Healthcare_in_Canada#Private_sector. Looks to me like the question should be "why regulate private health insurance", that's quite different.

    – Erwan
    6 hours ago






  • 3





    To rescue the question: Maybe OP had in mind that in some countries, the government-run insurance is mandatory for everyone (e.g. the "Gesetzliche Krankenversicherung" in Germany, or the NHS in the UK - you don't have to use it, but you have to pay). That means it is prohibited / not possible to have private health insurance instead of the public insurance (though additional insurance, e.g. for better care, is still allowed). Maybe that is what OP thought of? @Colin: Could you edit to clarify ?

    – sleske
    4 hours ago








  • 1





    @Graipher: Yes, I know, but I didn't want to muddle things further. I think one could still argue that in Germany, completely private insurance is "restricted" (unless you earn a lot or are self-employed).

    – sleske
    4 hours ago














9












9








9


1






There are several countries in which all citizens have a right to healthcare that is paid for by the government, e.g. in Canada.



Yet in some of these countries (again noteably certain parts of Canada), there are further restrictions on the sale of private health insurance. For example, private insurance can not be used for procedures that are available via the public healthcare system.



For example, prior to the 2005 Chaoulli v Quebec (AG) case, the Quebec Health Insurance Act and the Hospital Insurance Act prohibited private medical insurance in the Canadian province of Quebec.



What is the rationale for such restrictions?










share|improve this question
















There are several countries in which all citizens have a right to healthcare that is paid for by the government, e.g. in Canada.



Yet in some of these countries (again noteably certain parts of Canada), there are further restrictions on the sale of private health insurance. For example, private insurance can not be used for procedures that are available via the public healthcare system.



For example, prior to the 2005 Chaoulli v Quebec (AG) case, the Quebec Health Insurance Act and the Hospital Insurance Act prohibited private medical insurance in the Canadian province of Quebec.



What is the rationale for such restrictions?







healthcare insurance






share|improve this question















share|improve this question













share|improve this question




share|improve this question








edited 56 mins ago









Martin Schröder

1,0371931




1,0371931










asked 12 hours ago









ColinColin

1,968723




1,968723








  • 15





    Can you give an example of such a country?

    – Thomas
    12 hours ago






  • 3





    I'm voting to close, as I know of no such country, meaning this is pure speculation. In Canada AFAIK (and a quick google search confirms) private insurance is routinely purchased for employees by their employers.

    – Jared Smith
    6 hours ago








  • 3





    Downvoted: unless there's any example given, the question is flawed. I'm not aware of any country which prohibits private health insurance. Canada doesn't: en.wikipedia.org/wiki/Healthcare_in_Canada#Private_sector. Looks to me like the question should be "why regulate private health insurance", that's quite different.

    – Erwan
    6 hours ago






  • 3





    To rescue the question: Maybe OP had in mind that in some countries, the government-run insurance is mandatory for everyone (e.g. the "Gesetzliche Krankenversicherung" in Germany, or the NHS in the UK - you don't have to use it, but you have to pay). That means it is prohibited / not possible to have private health insurance instead of the public insurance (though additional insurance, e.g. for better care, is still allowed). Maybe that is what OP thought of? @Colin: Could you edit to clarify ?

    – sleske
    4 hours ago








  • 1





    @Graipher: Yes, I know, but I didn't want to muddle things further. I think one could still argue that in Germany, completely private insurance is "restricted" (unless you earn a lot or are self-employed).

    – sleske
    4 hours ago














  • 15





    Can you give an example of such a country?

    – Thomas
    12 hours ago






  • 3





    I'm voting to close, as I know of no such country, meaning this is pure speculation. In Canada AFAIK (and a quick google search confirms) private insurance is routinely purchased for employees by their employers.

    – Jared Smith
    6 hours ago








  • 3





    Downvoted: unless there's any example given, the question is flawed. I'm not aware of any country which prohibits private health insurance. Canada doesn't: en.wikipedia.org/wiki/Healthcare_in_Canada#Private_sector. Looks to me like the question should be "why regulate private health insurance", that's quite different.

    – Erwan
    6 hours ago






  • 3





    To rescue the question: Maybe OP had in mind that in some countries, the government-run insurance is mandatory for everyone (e.g. the "Gesetzliche Krankenversicherung" in Germany, or the NHS in the UK - you don't have to use it, but you have to pay). That means it is prohibited / not possible to have private health insurance instead of the public insurance (though additional insurance, e.g. for better care, is still allowed). Maybe that is what OP thought of? @Colin: Could you edit to clarify ?

    – sleske
    4 hours ago








  • 1





    @Graipher: Yes, I know, but I didn't want to muddle things further. I think one could still argue that in Germany, completely private insurance is "restricted" (unless you earn a lot or are self-employed).

    – sleske
    4 hours ago








15




15





Can you give an example of such a country?

– Thomas
12 hours ago





Can you give an example of such a country?

– Thomas
12 hours ago




3




3





I'm voting to close, as I know of no such country, meaning this is pure speculation. In Canada AFAIK (and a quick google search confirms) private insurance is routinely purchased for employees by their employers.

– Jared Smith
6 hours ago







I'm voting to close, as I know of no such country, meaning this is pure speculation. In Canada AFAIK (and a quick google search confirms) private insurance is routinely purchased for employees by their employers.

– Jared Smith
6 hours ago






3




3





Downvoted: unless there's any example given, the question is flawed. I'm not aware of any country which prohibits private health insurance. Canada doesn't: en.wikipedia.org/wiki/Healthcare_in_Canada#Private_sector. Looks to me like the question should be "why regulate private health insurance", that's quite different.

– Erwan
6 hours ago





Downvoted: unless there's any example given, the question is flawed. I'm not aware of any country which prohibits private health insurance. Canada doesn't: en.wikipedia.org/wiki/Healthcare_in_Canada#Private_sector. Looks to me like the question should be "why regulate private health insurance", that's quite different.

– Erwan
6 hours ago




3




3





To rescue the question: Maybe OP had in mind that in some countries, the government-run insurance is mandatory for everyone (e.g. the "Gesetzliche Krankenversicherung" in Germany, or the NHS in the UK - you don't have to use it, but you have to pay). That means it is prohibited / not possible to have private health insurance instead of the public insurance (though additional insurance, e.g. for better care, is still allowed). Maybe that is what OP thought of? @Colin: Could you edit to clarify ?

– sleske
4 hours ago







To rescue the question: Maybe OP had in mind that in some countries, the government-run insurance is mandatory for everyone (e.g. the "Gesetzliche Krankenversicherung" in Germany, or the NHS in the UK - you don't have to use it, but you have to pay). That means it is prohibited / not possible to have private health insurance instead of the public insurance (though additional insurance, e.g. for better care, is still allowed). Maybe that is what OP thought of? @Colin: Could you edit to clarify ?

– sleske
4 hours ago






1




1





@Graipher: Yes, I know, but I didn't want to muddle things further. I think one could still argue that in Germany, completely private insurance is "restricted" (unless you earn a lot or are self-employed).

– sleske
4 hours ago





@Graipher: Yes, I know, but I didn't want to muddle things further. I think one could still argue that in Germany, completely private insurance is "restricted" (unless you earn a lot or are self-employed).

– sleske
4 hours ago










3 Answers
3






active

oldest

votes


















16














Universal healthcare systems can be harmed by competition from private healthcare, such as when the private companies pay more and make it difficult for the state system to recruit staff. It can also make it harder for national systems to buy medicine at reasonable prices, when manufacturers can rely on the private sector paying more and people desperate for it.



There are also issues of fairness, as when private treatment is available those who can afford it can bypass queues in the state system by getting specific procedures done privately, and then return to the state system when it suits them.



Another issue is the state picking up the bill for failures in the private sector, such as a recent incident in the UK where sub-standard breast implants fitted by a company that subsequently went bust had to be fixed at the taxpayer's expense.






share|improve this answer



















  • 4





    While these are the justifications usually given, it's worth noting that they're false.

    – Jared Smith
    6 hours ago






  • 5





    @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

    – Jared Smith
    6 hours ago






  • 12





    @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

    – user
    6 hours ago






  • 5





    @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

    – Jared Smith
    6 hours ago








  • 6





    @JaredSmith no, it's definitely your opinion.

    – user
    6 hours ago



















15














Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems.



If you have a completely unregulated private insurance sector, then the private insurers would be free to choose their customers. Given that chance they would reject anyone with pre-existing conditions, because these people would become a net cost instead of a net benefit for the insurance company. So the private insurers would grab all the "good" customers while the government provided health insurance is stuck with the "bad" ones. That means the cost for the taxpayer to provide that health insurance would increase drastically (either because the state needs to subsidize the health insurance system or because the premiums must be increased) while the private insurers make a hefty profit.



There are basically two solutions for this problem.



Either you strongly regulate the private insurers in order to prevent them from cherry-picking their customers. You might make it illegal for insurance companies to reject customers or to take different prices for the same plan from different customers. But it's hard to outlaw things like targeted advertisement or insurance plans heavily optimized for the preferences of certain target groups.



Or you make the government health insurance mandatory for all citizens. This effectively removes the market for private health insurance and only leaves a market for "luxury" health services which go beyond the regular health care.






share|improve this answer





















  • 7





    I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

    – PhillS
    7 hours ago






  • 6





    This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

    – Jared Smith
    7 hours ago






  • 1





    "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

    – user
    6 hours ago






  • 2





    @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

    – Philipp
    4 hours ago













  • @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

    – James
    4 hours ago



















1














One reason, which is not touched upon by other answers, is that private insurance coverage would increase health care costs for everyone, including those universally covered.



One of the major points of savings in a single-payer system is the reduced administrative overhead. People automatically think of the reduced overall overhead and elimination of redundancies for a single payer vs multiple insurance companies, but what has as much impact is the reduction in administrative staff and systems needed for health care providers to handle billing.



If you have a single payer, there are only one set of reimbursements, one method of coding and bundling procedure coding for insurance claims, one set of rules and prerequisites for allowable claims. For every insurer you add, you are adding the complexity of tracking a parallel system for the differences between insurers, and then the need to track which patients align with which sets of insurance rules, so the provider and the patient don't unexpectedly get stuck with a service that can't be paid for. This administrative overhead drives up the cost of all health care for that provider, and that is reflected in the billing rates the provider will charge to all patients.



So, if you have a system that is paid for by tax dollars, allowing private insurers, to a certain degree, would require all taxpayers taking on an added burden for the benefit of that private insurer, and not just the premium paying customers of that insurance company.






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    3 Answers
    3






    active

    oldest

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    3 Answers
    3






    active

    oldest

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    active

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    active

    oldest

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    16














    Universal healthcare systems can be harmed by competition from private healthcare, such as when the private companies pay more and make it difficult for the state system to recruit staff. It can also make it harder for national systems to buy medicine at reasonable prices, when manufacturers can rely on the private sector paying more and people desperate for it.



    There are also issues of fairness, as when private treatment is available those who can afford it can bypass queues in the state system by getting specific procedures done privately, and then return to the state system when it suits them.



    Another issue is the state picking up the bill for failures in the private sector, such as a recent incident in the UK where sub-standard breast implants fitted by a company that subsequently went bust had to be fixed at the taxpayer's expense.






    share|improve this answer



















    • 4





      While these are the justifications usually given, it's worth noting that they're false.

      – Jared Smith
      6 hours ago






    • 5





      @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

      – Jared Smith
      6 hours ago






    • 12





      @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

      – user
      6 hours ago






    • 5





      @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

      – Jared Smith
      6 hours ago








    • 6





      @JaredSmith no, it's definitely your opinion.

      – user
      6 hours ago
















    16














    Universal healthcare systems can be harmed by competition from private healthcare, such as when the private companies pay more and make it difficult for the state system to recruit staff. It can also make it harder for national systems to buy medicine at reasonable prices, when manufacturers can rely on the private sector paying more and people desperate for it.



    There are also issues of fairness, as when private treatment is available those who can afford it can bypass queues in the state system by getting specific procedures done privately, and then return to the state system when it suits them.



    Another issue is the state picking up the bill for failures in the private sector, such as a recent incident in the UK where sub-standard breast implants fitted by a company that subsequently went bust had to be fixed at the taxpayer's expense.






    share|improve this answer



















    • 4





      While these are the justifications usually given, it's worth noting that they're false.

      – Jared Smith
      6 hours ago






    • 5





      @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

      – Jared Smith
      6 hours ago






    • 12





      @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

      – user
      6 hours ago






    • 5





      @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

      – Jared Smith
      6 hours ago








    • 6





      @JaredSmith no, it's definitely your opinion.

      – user
      6 hours ago














    16












    16








    16







    Universal healthcare systems can be harmed by competition from private healthcare, such as when the private companies pay more and make it difficult for the state system to recruit staff. It can also make it harder for national systems to buy medicine at reasonable prices, when manufacturers can rely on the private sector paying more and people desperate for it.



    There are also issues of fairness, as when private treatment is available those who can afford it can bypass queues in the state system by getting specific procedures done privately, and then return to the state system when it suits them.



    Another issue is the state picking up the bill for failures in the private sector, such as a recent incident in the UK where sub-standard breast implants fitted by a company that subsequently went bust had to be fixed at the taxpayer's expense.






    share|improve this answer













    Universal healthcare systems can be harmed by competition from private healthcare, such as when the private companies pay more and make it difficult for the state system to recruit staff. It can also make it harder for national systems to buy medicine at reasonable prices, when manufacturers can rely on the private sector paying more and people desperate for it.



    There are also issues of fairness, as when private treatment is available those who can afford it can bypass queues in the state system by getting specific procedures done privately, and then return to the state system when it suits them.



    Another issue is the state picking up the bill for failures in the private sector, such as a recent incident in the UK where sub-standard breast implants fitted by a company that subsequently went bust had to be fixed at the taxpayer's expense.







    share|improve this answer












    share|improve this answer



    share|improve this answer










    answered 8 hours ago









    useruser

    7,99421734




    7,99421734








    • 4





      While these are the justifications usually given, it's worth noting that they're false.

      – Jared Smith
      6 hours ago






    • 5





      @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

      – Jared Smith
      6 hours ago






    • 12





      @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

      – user
      6 hours ago






    • 5





      @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

      – Jared Smith
      6 hours ago








    • 6





      @JaredSmith no, it's definitely your opinion.

      – user
      6 hours ago














    • 4





      While these are the justifications usually given, it's worth noting that they're false.

      – Jared Smith
      6 hours ago






    • 5





      @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

      – Jared Smith
      6 hours ago






    • 12





      @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

      – user
      6 hours ago






    • 5





      @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

      – Jared Smith
      6 hours ago








    • 6





      @JaredSmith no, it's definitely your opinion.

      – user
      6 hours ago








    4




    4





    While these are the justifications usually given, it's worth noting that they're false.

    – Jared Smith
    6 hours ago





    While these are the justifications usually given, it's worth noting that they're false.

    – Jared Smith
    6 hours ago




    5




    5





    @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

    – Jared Smith
    6 hours ago





    @user lots of reasons: if the market for private insurance on top of e.g. the NHS is so large that it threatens the functioning of the universal system then the public system is obviously grossly inadequate. If a party is willing to pay more for a medicine, then the price will go up which will incentivize production (driving the price back down to equilibrium). Same for staff. "getting specific procedures done privately, and then return to the state system" what's wrong with that? They would have otherwise been done with public funds. Do you object to not having to pay for them?

    – Jared Smith
    6 hours ago




    12




    12





    @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

    – user
    6 hours ago





    @JaredSmith your personal opinion is irrelevant, the questioner is asking what are the reasons people have, not how good you consider them to be.

    – user
    6 hours ago




    5




    5





    @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

    – Jared Smith
    6 hours ago







    @user has nothing to do with my personal opinion, that's just how economics works. And I totally agree with you that it answers the OP's question as stated (although I've voted to close the question as being pure speculation). I did not downvote your answer.

    – Jared Smith
    6 hours ago






    6




    6





    @JaredSmith no, it's definitely your opinion.

    – user
    6 hours ago





    @JaredSmith no, it's definitely your opinion.

    – user
    6 hours ago











    15














    Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems.



    If you have a completely unregulated private insurance sector, then the private insurers would be free to choose their customers. Given that chance they would reject anyone with pre-existing conditions, because these people would become a net cost instead of a net benefit for the insurance company. So the private insurers would grab all the "good" customers while the government provided health insurance is stuck with the "bad" ones. That means the cost for the taxpayer to provide that health insurance would increase drastically (either because the state needs to subsidize the health insurance system or because the premiums must be increased) while the private insurers make a hefty profit.



    There are basically two solutions for this problem.



    Either you strongly regulate the private insurers in order to prevent them from cherry-picking their customers. You might make it illegal for insurance companies to reject customers or to take different prices for the same plan from different customers. But it's hard to outlaw things like targeted advertisement or insurance plans heavily optimized for the preferences of certain target groups.



    Or you make the government health insurance mandatory for all citizens. This effectively removes the market for private health insurance and only leaves a market for "luxury" health services which go beyond the regular health care.






    share|improve this answer





















    • 7





      I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

      – PhillS
      7 hours ago






    • 6





      This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

      – Jared Smith
      7 hours ago






    • 1





      "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

      – user
      6 hours ago






    • 2





      @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

      – Philipp
      4 hours ago













    • @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

      – James
      4 hours ago
















    15














    Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems.



    If you have a completely unregulated private insurance sector, then the private insurers would be free to choose their customers. Given that chance they would reject anyone with pre-existing conditions, because these people would become a net cost instead of a net benefit for the insurance company. So the private insurers would grab all the "good" customers while the government provided health insurance is stuck with the "bad" ones. That means the cost for the taxpayer to provide that health insurance would increase drastically (either because the state needs to subsidize the health insurance system or because the premiums must be increased) while the private insurers make a hefty profit.



    There are basically two solutions for this problem.



    Either you strongly regulate the private insurers in order to prevent them from cherry-picking their customers. You might make it illegal for insurance companies to reject customers or to take different prices for the same plan from different customers. But it's hard to outlaw things like targeted advertisement or insurance plans heavily optimized for the preferences of certain target groups.



    Or you make the government health insurance mandatory for all citizens. This effectively removes the market for private health insurance and only leaves a market for "luxury" health services which go beyond the regular health care.






    share|improve this answer





















    • 7





      I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

      – PhillS
      7 hours ago






    • 6





      This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

      – Jared Smith
      7 hours ago






    • 1





      "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

      – user
      6 hours ago






    • 2





      @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

      – Philipp
      4 hours ago













    • @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

      – James
      4 hours ago














    15












    15








    15







    Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems.



    If you have a completely unregulated private insurance sector, then the private insurers would be free to choose their customers. Given that chance they would reject anyone with pre-existing conditions, because these people would become a net cost instead of a net benefit for the insurance company. So the private insurers would grab all the "good" customers while the government provided health insurance is stuck with the "bad" ones. That means the cost for the taxpayer to provide that health insurance would increase drastically (either because the state needs to subsidize the health insurance system or because the premiums must be increased) while the private insurers make a hefty profit.



    There are basically two solutions for this problem.



    Either you strongly regulate the private insurers in order to prevent them from cherry-picking their customers. You might make it illegal for insurance companies to reject customers or to take different prices for the same plan from different customers. But it's hard to outlaw things like targeted advertisement or insurance plans heavily optimized for the preferences of certain target groups.



    Or you make the government health insurance mandatory for all citizens. This effectively removes the market for private health insurance and only leaves a market for "luxury" health services which go beyond the regular health care.






    share|improve this answer















    Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems.



    If you have a completely unregulated private insurance sector, then the private insurers would be free to choose their customers. Given that chance they would reject anyone with pre-existing conditions, because these people would become a net cost instead of a net benefit for the insurance company. So the private insurers would grab all the "good" customers while the government provided health insurance is stuck with the "bad" ones. That means the cost for the taxpayer to provide that health insurance would increase drastically (either because the state needs to subsidize the health insurance system or because the premiums must be increased) while the private insurers make a hefty profit.



    There are basically two solutions for this problem.



    Either you strongly regulate the private insurers in order to prevent them from cherry-picking their customers. You might make it illegal for insurance companies to reject customers or to take different prices for the same plan from different customers. But it's hard to outlaw things like targeted advertisement or insurance plans heavily optimized for the preferences of certain target groups.



    Or you make the government health insurance mandatory for all citizens. This effectively removes the market for private health insurance and only leaves a market for "luxury" health services which go beyond the regular health care.







    share|improve this answer














    share|improve this answer



    share|improve this answer








    edited 3 hours ago

























    answered 7 hours ago









    PhilippPhilipp

    40.6k14121148




    40.6k14121148








    • 7





      I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

      – PhillS
      7 hours ago






    • 6





      This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

      – Jared Smith
      7 hours ago






    • 1





      "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

      – user
      6 hours ago






    • 2





      @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

      – Philipp
      4 hours ago













    • @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

      – James
      4 hours ago














    • 7





      I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

      – PhillS
      7 hours ago






    • 6





      This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

      – Jared Smith
      7 hours ago






    • 1





      "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

      – user
      6 hours ago






    • 2





      @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

      – Philipp
      4 hours ago













    • @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

      – James
      4 hours ago








    7




    7





    I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

    – PhillS
    7 hours ago





    I don't think the last point holds up. The UK has in effect mandatory health insurance (although the NHS is funded from general taxation / national insurance contributions, rather than as a specific health insurance charge), but there is still a pretty large private health sector for people who want to pay more for better treatment / shorter waiting lists. But that's kind of tangential to your main point.

    – PhillS
    7 hours ago




    6




    6





    This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

    – Jared Smith
    7 hours ago





    This contrasts private and public sector insurance, but the two are orthogonal: one could purchase a private policy to "top up" the public one. The crux of the question (as I understand it) is why a polity would prohibit such a possibility.

    – Jared Smith
    7 hours ago




    1




    1





    "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

    – user
    6 hours ago





    "Universal health insurance which is affordable for everyone can only work when the healthy people subsidize the people with chronic health problems." That is incorrect, for example in the UK it is funded from income tax so it is the wealthy subsidising those who would otherwise not be able to afford healthcare.

    – user
    6 hours ago




    2




    2





    @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

    – Philipp
    4 hours ago







    @user The UK is an example of a country which goes for mandatory health insurance for everyone. This is required for income-based insurance fees to work, because on an unregulated free market, private insurance providers would have no reason to charge people based on their income. So for high-income people, private insurance would likely be a far better deal in such a system. Again, all the "bad" customers go to the government and all the "good" customers go to the private insurances.

    – Philipp
    4 hours ago















    @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

    – James
    4 hours ago





    @Philipp "Good" customers, by your definition, would invariably be the young as they have, on the whole, fewer health issues. However, they generally lack the funds or the risk appetite to demand health insurance.

    – James
    4 hours ago











    1














    One reason, which is not touched upon by other answers, is that private insurance coverage would increase health care costs for everyone, including those universally covered.



    One of the major points of savings in a single-payer system is the reduced administrative overhead. People automatically think of the reduced overall overhead and elimination of redundancies for a single payer vs multiple insurance companies, but what has as much impact is the reduction in administrative staff and systems needed for health care providers to handle billing.



    If you have a single payer, there are only one set of reimbursements, one method of coding and bundling procedure coding for insurance claims, one set of rules and prerequisites for allowable claims. For every insurer you add, you are adding the complexity of tracking a parallel system for the differences between insurers, and then the need to track which patients align with which sets of insurance rules, so the provider and the patient don't unexpectedly get stuck with a service that can't be paid for. This administrative overhead drives up the cost of all health care for that provider, and that is reflected in the billing rates the provider will charge to all patients.



    So, if you have a system that is paid for by tax dollars, allowing private insurers, to a certain degree, would require all taxpayers taking on an added burden for the benefit of that private insurer, and not just the premium paying customers of that insurance company.






    share|improve this answer




























      1














      One reason, which is not touched upon by other answers, is that private insurance coverage would increase health care costs for everyone, including those universally covered.



      One of the major points of savings in a single-payer system is the reduced administrative overhead. People automatically think of the reduced overall overhead and elimination of redundancies for a single payer vs multiple insurance companies, but what has as much impact is the reduction in administrative staff and systems needed for health care providers to handle billing.



      If you have a single payer, there are only one set of reimbursements, one method of coding and bundling procedure coding for insurance claims, one set of rules and prerequisites for allowable claims. For every insurer you add, you are adding the complexity of tracking a parallel system for the differences between insurers, and then the need to track which patients align with which sets of insurance rules, so the provider and the patient don't unexpectedly get stuck with a service that can't be paid for. This administrative overhead drives up the cost of all health care for that provider, and that is reflected in the billing rates the provider will charge to all patients.



      So, if you have a system that is paid for by tax dollars, allowing private insurers, to a certain degree, would require all taxpayers taking on an added burden for the benefit of that private insurer, and not just the premium paying customers of that insurance company.






      share|improve this answer


























        1












        1








        1







        One reason, which is not touched upon by other answers, is that private insurance coverage would increase health care costs for everyone, including those universally covered.



        One of the major points of savings in a single-payer system is the reduced administrative overhead. People automatically think of the reduced overall overhead and elimination of redundancies for a single payer vs multiple insurance companies, but what has as much impact is the reduction in administrative staff and systems needed for health care providers to handle billing.



        If you have a single payer, there are only one set of reimbursements, one method of coding and bundling procedure coding for insurance claims, one set of rules and prerequisites for allowable claims. For every insurer you add, you are adding the complexity of tracking a parallel system for the differences between insurers, and then the need to track which patients align with which sets of insurance rules, so the provider and the patient don't unexpectedly get stuck with a service that can't be paid for. This administrative overhead drives up the cost of all health care for that provider, and that is reflected in the billing rates the provider will charge to all patients.



        So, if you have a system that is paid for by tax dollars, allowing private insurers, to a certain degree, would require all taxpayers taking on an added burden for the benefit of that private insurer, and not just the premium paying customers of that insurance company.






        share|improve this answer













        One reason, which is not touched upon by other answers, is that private insurance coverage would increase health care costs for everyone, including those universally covered.



        One of the major points of savings in a single-payer system is the reduced administrative overhead. People automatically think of the reduced overall overhead and elimination of redundancies for a single payer vs multiple insurance companies, but what has as much impact is the reduction in administrative staff and systems needed for health care providers to handle billing.



        If you have a single payer, there are only one set of reimbursements, one method of coding and bundling procedure coding for insurance claims, one set of rules and prerequisites for allowable claims. For every insurer you add, you are adding the complexity of tracking a parallel system for the differences between insurers, and then the need to track which patients align with which sets of insurance rules, so the provider and the patient don't unexpectedly get stuck with a service that can't be paid for. This administrative overhead drives up the cost of all health care for that provider, and that is reflected in the billing rates the provider will charge to all patients.



        So, if you have a system that is paid for by tax dollars, allowing private insurers, to a certain degree, would require all taxpayers taking on an added burden for the benefit of that private insurer, and not just the premium paying customers of that insurance company.







        share|improve this answer












        share|improve this answer



        share|improve this answer










        answered 43 mins ago









        PoloHoleSetPoloHoleSet

        11.9k12857




        11.9k12857






























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