I’m not a healthcare actuary; I am a life & investment actuary.  I did pass my health exam on the actuarial syllabus with a high score, but that was almost 20 years ago.  So, take what I say not as expert opinion, but as reasonably well-informed opinion (I hope).

I general, I believe the US needs to move away from insurance with respect to healthcare.  Let people pay directly for healthcare services, and if they must have insurance, let it be with a high deductible, like $5000/year.  If the government then wants to help the poor, let them pay on the deductible.

Wait.  That’s a non-starter.  First-dollar coverage is the holy grail.  Expensive as anything, but that is the perverted goal.

Rationing takes place in any economic/political system, it is merely a question of how the goods and services get rationed.  Price?  Time?  Need (however defined)?

So, the politicians look to cover everyone, and yet control costs in the medical system.  Covering everyone is very expensive, because for the most part, the worst risks aren’t insured.  Those that would pay the highest premiums on a actuarially fair basis don’t buy/get insurance.

Controlling costs means reducing access, limiting doctor freedom, limiting choices, delaying treatment, etc.  Preventive care is a nice concept, but the gains are negligible.

I say let people be free, and get the government out of the picture.  No corporate deduction for healthcare costs.  No HSAs or other tax-preferred benefits (I have one of those).  Scale back Medicare; it is way too expensive relative to the GDP of the US.  Finally, inculcate a culture that recognizes that we are all going to die, and that certain care for the elderly will not be available unless they can pay for it privately.  We don’t want to prolong an expensive death at taxpayer expense.