Private insurance doesn't have to be bad. Netherland has private insurance, and it works fine. Admittedly we've got probably the most expensive healthcare system in Europe, but it's still about half of what the US pays. But it does need to be tightly regulated, and more importantly, the healthcare system itself needs to be regulated. There needs to be a drive to lower costs while increasing quality. And of course the insurance company needs to take care of the costs. I see far too many stories about people having to fight their own insurance company.
The real fundamental problem I think is that the US healthcare system is primarily run for profit, and not for the health of the people. Both by insurance companies (who strongly resist paying), and by hospitals and other healthcare providers (who love to spring unexpected costs on you). That's the primary difference between the US and Dutch systems.
The Netherlands also didn't have the HUGE healthcare cartel to contend with when their system was implemented. In the US, insurance has allowed healthcare providers to charge enormous fees because they knew it would be covered. US healthcare is among the most expensive in the world, and it's not because of superior quality. Now that many people would like to change this, it's almost too late.
Single payer health care is not a guarantee that you get better results than what you have now. I think the problem in the US is the indirect relationship between the customer and the service provider. The best European system is quite the opposite:
"In 2015 the Netherlands maintained its number one position at the top of the annual Euro health consumer index, which compares healthcare systems in Europe, scoring 916 of a maximum 1,000 points. The Netherlands is the only country that has been in the top three ranking in every Euro health consumer index published since 2005. On 48 indicators such as patient rights and information, accessibility, prevention and outcomes, the Netherlands secured its top position among 37 European countries for the fifth year in a row.[15] The Netherlands was also ranked first in a study comparing the health care systems of the United States, Australia, Canada, Germany and New Zealand.[16]
Ever since a major reform of the health care system in 2006, the Dutch system received more points in the Index each year. According to the Health Consumer Powerhouse, the Netherlands has 'a chaos system', meaning patients have a great degree of freedom from where to buy their health insurance, to where they get their healthcare service. But the difference between the Netherlands and other countries is that the chaos is managed. Healthcare decisions are being made in a dialogue between the patients and healthcare professionals.[17]"
The US private healthcare system has lots of problems and I'm not trying to defend it. However, the public European model is very misleading. The reason is that most people who can afford it pay for private insurance, even in Europe. Otherwise they need to wait months for a doctor appointment.
Where does it work well? A small country with a homogenous population can pull it off but there isn't a single large country where it works.
The Netherlands has a heterogeneous population (I don't see why size matters) with strongly government regulated sector of private insurance companies and hospitals. The net result is that we pay far less per capita than citizens of the US, yet the healthcare system is judged to be much better:
In all fairness, Switzerland and the Netherlands have privatised medical insurance with universal coverage and the people are generally satisfied. Other countries, e.g. France and Germany, have mixed systems which also work well.
The flaws of ACA are not inherent to a privatised system, they are the result of this specific implementation.
To give a more nuanced prospective, I'm an American that has lived in Denmark for 3 years.
Definitely, the American system is a dumpster fire.
Denmark's isn't terrific, either, though. I remember having to call in a favor of my girlfriend's uncle (a doctor) to get a simple doctor appointment that wasn't 4 months out.
Certainly the government does have the people more in mind when making laws - that's not the case in the US. Our government cannot be trusted to have our interests at heart, unfortunately. Pushing for more regulation usually means helping the businesses and not the citizens.
Private health care is cheap and great throughout Europe. You can get an appointment quickly, have doctors that spend time with you, and spend a lot less than you would in the US. The private doctors here in Europe also tend to be better at their job - they've self selected.
The best medical care I've experienced, though, was in south east asia. Most of those countries have a pretty free market. You can even see ads in Bangkok for the price of a baby delivery - front and center on billboards even! Truly a capitalistic health care system.
I've described my own experience with SEA care here:
1) "Single payer" is not the only way to deliver universal healthcare. Germany, Switzerland, Netherlands, Singapore all have thriving multi-payer systems. In Switzerland and the Netherlands, ALL insurance is private. In Singapore, while the government covers catastrophic care, 70% of total health expenditures are private.
2) The biggest problem in the US is that healthcare is just more expensive, and American insurers end up having to pay more. An example: doctors in America earn more (PPP adjusted) than in any other country. MRI's in America cost more (even on the Medicare fee schedule) than almost any other country. A lot of this is actually caused by a series of well-intentioned policies passed over the last half century.
3) In the US, for-profit insurance profit margins are a pretty meagre 5%, which doesn't really make a dent in costs. Also, some of the biggest insurance providers are non-profits (Blue Cross Blue Shield, Kaiser)
4) Medicare fee schedules aren't that much better, in fact the part of Medicare that's actually working the best is Medicare Part C (Medicare Advantage), which relies on private payers.
For one thing, healthcare is such a mess in the US that it actually might be easier to just nationalize it rather than trying to fix the private insurance system.
Also, in a country with both, the private system can't be any worse than the public system because it has to compete with it, so the fact that the UK has good private healthcare doesn't necessarily mean that it will be easy to fix the private system in the US without the existence of a nationalized system as well.
As a European who lives in Japan now, the regulated-private system also has a lot of pitfalls. Costs are regulated, so hospitals will drag out procedures over more visits than are required to milk extra money out of the public insurance to game the system (they're professional enough not to avoid important stuff, but it's especially pronounced in stuff like dental care where stuff can wait). I still prefer it over the completely fucked-up US system, but it has both advantages and downsides compared to the European systems that deserve to be debated.
I wouldn't say any country has healthcare "solved", but I don't know how anyone can look at the US system and say that it's a good situation for a developed country.
The US healthcare system has just enough private ownership to allow private interests to profit from it, just enough public involvement to get taxpayers to pay for it, and just enough regulation in the right places to conceal who pays for treatment and to disconnect incentives.
Go all public and expand Medicare and move to a single-payer system like Canada and the UK. Or go all private by killing Medicare altogether, fixing Medicaid as a public backstop, and heavily regulating pricing and doctors' salaries and insurance premiums like Germany and Switzerland. But anything is more humane than the weird mix the US has come up with.
Not only that, many Americans seem to believe their system of having insurance companies as middlemen improves the system somehow.
My girlfriend is a doctor here in Europe (though she has worked in Mexico). As such she has worked with private and public systems (generally in Europe, you are automatically part of the public system. You can pay private yourself and generally have to wait less).
Anyway, both her and her boss pointed out that if you have anything serious, go to the public system. Why? Because insurance companies always want to pay the least for the cheapest drugs / treatment. The doctors don't enjoy working for the private, because too much of it is trying to justify using the more expensive treatment to the insurance companies.
At the end of the day the public healthcare system exists to help people get better. The private healthcare system exists to make money.
Based on what I've heard about US healthcare from people I know, it holds a much higher quality than European healthcare for those who can afford the best insurance. European healthcare fluctuates between bad and adequate, US healthcare fluctuates between terrible and excellent. Neither solution should be immune to criticism.
The USA system is particularly broken. Just because healthcare is private doesn't mean it needs to be ruinously expensive, most other countries manage.
The Netherlands and Switzerland both have functioning private insurance systems. There are also several functioning hybrid systems, like Germany and Israel.
But the primary reason you don't see more successes is the lack of attempts. It's not as if there is a long list of countries with failed free market healthcare systems, either.
That may work with a system where the consumer has a choice. Basically clients don't and end up overpaying and getting the run around by private insurance.
Best is a balanced system with a mixture of private and public with public providing most of the infrastructure.
US life expectancy is lower than most northern European countries (plus Canada) or Northern Asian countries and costs are higher.
That said some EU countries like Switzerland have mostly private systems.
The only downside of government healthcare is generally taxes are added to unhealthy foods, tobacco and booze.
40% of hospitals in Switzerland are private vs 69% in the US (21% for-profit). Most hospitals in Netherlands are private (non-profit). Both have all private insurance, although Switzerland requires it to be non-profit. Obamacare subsidizes and regulates insurance in the ways you stated, but could be made stronger. Perhaps not pure capitalistic healthcare, but a strong role for the private sector.
Please do note that I put "health care system" in quotes. That was not an accident.
I worked in insurance for over five years. They are not in the business of taking care of people. They are more like some version of Las Vegas but all the "winners" first have to lose an arm or get run over by a car. I am not a huge fan of insurance.
I was a homemaker for many years. I also was studying to go into urban planning when my life got derailed by divorce and health issues. Urban planners used to plan pedestrian-friendly spaces in part with an eye towards health of the community members. I have also read a fair amount about the differences between how Europe handles things and how the U.S. does. Europe is generally more family-friendly and people friendly, which is good for the health of it's people.
Medicine is not about making people healthy. Eating right, exercising and living right are what foster good health. Medicine is crisis management when things go wrong. Viewing medicine as "health care" is fundamentally fubarred. You cannot crisis manage your way to good health. It simply cannot be done. Good health is built over a long period of time, with every bite you put in your mouth, every time you fail to become a drug addict or alcoholic, every time you find a way to get your sexual needs met that does not expose you to high risk of infection from strangers with unknown personal habits, etc.
So when the U.S. reduces discussions of "fixing our health care system" to the question of "who should pay for it?", the situation is already essentially hopeless. It cannot be fixed from that starting point.
As for who should pay for medical care (which is not, in my mind, "health care"): The government. Insurance is not in the business of taking care of people. It is a numbers game and, like Las Vegas, in order for the house to even keep it's doors open, much less make the occasional big payout, there have to be a great many more losers than winners. It's simple math in that regard and the actuaries look out for that end of it like vigilant hawks. And when the actuaries decide the company is paying customers too much money for X benefit on X policy, the policy gets sent to the legal department and they "clarify" what the paragraph in question means and the claims department gets retrained to "pay this benefit correctly" and we start sending denial notices to the customer for things we used to cover. That will never, ever, ever, ever, ever make this country healthier.
And I worked for a good insurance company with a very ethical reputation. From what I gather, a lot of other insurance companies are far more gruesome.
The real fundamental problem I think is that the US healthcare system is primarily run for profit, and not for the health of the people. Both by insurance companies (who strongly resist paying), and by hospitals and other healthcare providers (who love to spring unexpected costs on you). That's the primary difference between the US and Dutch systems.
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