Oh how it tickles to shop for private health insurance. Nationalize me, will you?! What I’m finding is that: comprehensive health coverage is very affordable for young expats. Most of the plans I’ve examined feature no co-pay at all for outpatient or emergency procedures, and even cover acupuncture and moxibustion at elite Chinese medicine clinics. These are available through most major multinational insurers and allow one to go to international-level hospitals anywhere in the world (outside of the US), and run about USD1,300-1,800 per year, which is certainly less than 17% of income. If the plan includes US coverage, it goes up by about 60%. These plans do not provide coverage for procedures relating to pre-existing conditions for a 24-month moratorium.

Americans are a rather unhealthy people, which might be one of the reasons why we spend 17% of income on healthcare. Yet here I am, an unhealthy American, outside of the US, and actuarial giants such as AXA, AIG, and Ping’an are telling me (through a price mechanism) that I’m going to pay much less purely by the fact that I’m not in the US.

This is probably some part of a wider argument on healthcare policy in general. It does seem that if moratoriums on pre-existing conditions were illegal, insurers would need to raise prices significantly across the board. Effectively they would need to assume everyone is slightly less healthy than previous actuarial models suggested. This is because healthy people will generally know their health condition (or the converse, marginally unhealthy people will probably have better access to that information than a potential insurer), the optimal course of action would be to have a very inexpensive, emergency only plan to begin with. If something that is considered a pre-existing condition emerges, immediately switch to a higher priced, more inclusive plan. If insurers are prevented from price discriminating on the basis of (already limited) actuarial information, they will inevitably be forced to raise prices on all participants in the scheme to make the system solvent. Whether there is some efficiency loss between the two regimes is an empirical question, one which I’m not remotely qualified to address. If no efficiency loss: nationalize everyone. Even better, cover everyone in the world, since the best rates would be possible by covering as large a population as possible (and you get better data). If there is an efficiency loss, then the (socially equitable) course would be to have healthy people pay a tax to subsidize the difference in cost to provide coverage for the unhealthy people. Doing so would, it seems, maintain actuarial standards and provide better pricing across the board.

All theory anyway, and entirely unfeasible given path dependence. If one is young and healthy and American: leave North America and get health care elsewhere. Chances are you won’t need bypass surgery. Foreigners do most other health procedures rather well. In the meantime ancillary factors (walking everywhere) will probably make one happier and healthier. Return home *after* smog induced lung cancer develops.