Kathryn,
Sorry for the triple post, but.... also I think this idea that people "don't want" health insurance is absurd. They want health insurance. But it's expensive. If you are a responsible person who doesn't have a lot of money, you save it wherever possible. Do you really need that yearly checkup? Do you really need that $2,000 colonoscopy every 5 years to check for colon cancer? It might be a perfectly reasonable and sound decision for an individual to forgo these things, if they don't have a lot of money.
But that individual's decision is not a sound decision for our society as a whole. The problem is their PERSONAL decision affects the rest of us. When they get colon cancer, EVERYONE has to pay for it (because we don't just let people die), whether it's family/friends, or higher premiums for people on private insurance, or taxpayers (last resort). And that costs many times more than if we all chipped in to provide free colonoscopies for all at-risk persons. When people are bed-ridden in hospitals dying of cancer it costs tens of thousands of dollars per day. And then of course there are all the costs associated with people taking off work to grieve, and the social costs of more people sick/dying. And the cost of having more doctors specialize in colon cancer, instead of being in general family, preventative care. Because that's by far the most efficient way to combat cancer, heart disease, etc. is to have people go to a family doctor, regularly, and get preventative advice, treatment, tests, etc.
Private industry CANNOT take these things into account, no matter how well-intentioned the people who work in that industry, because they are constrained by the interests of one thing: short-term profit. The stockholders are only interested in that bottom line. They are very "efficient" in getting that, but this should not be confused with "efficiency" in the broad sense, as in, healthier people, lower health costs, longer life expectancies, higher satisfaction, less complexity/ambiguity of plans, etc.
The other thing about private industry is it cannot adjust costs for the poor, like the government can. So for example, we all pay (let's say) 5% of our income for taxes that pay for the fire department. We all contribute what we can, if you're poor you pay less because 5% of your income is less than 5% of a millionaire's income. But the idea is we all get the same basic fire department services that are necessary for a happy society. If one person's house catches on fire, that harms everyone, so we want to chip in and make sure everyone is protected from fire, because that protects everyone. And if you're rich, you can buy more than the basic public service, you can buy a fancy fire alarm system if you want. Private industry can't do this, in general, public programs can.
So we could have a public insurance program that is fair, where people pay what they can (X % of their income) and everyone gets the BASICS, preventative check-ups and cancer tests. If rich people want more, they can pay for a private insurance plan that covers more stuff (like cosmetic surgery or something) or they can pay out-of-pocket, like they already do. We will all save a lot of money by no longer having to pay for the incredibly expensive, private insurance plans for basic care, which don't actually deliver on basic care. Every civilized country in the world (except the US) includes basic health insurance as part of the deal you get for paying taxes, even if you're poor, just like roads, public transit, education, police, etc. In the long-run this lowers costs, even for the rich, who will pay higher taxes in the short-run. And it is FAR more ethical, and more fair than our current system, and we will be healthier and happier.
And by the way, there is NO reason a simple, basic test (like a colonoscopy) that can save lives should cost $2,000 to individuals.
