Is Health Insurance Even Worth It Anymore?

ACA, HSAs, and Pre-Existing Conditions

• Some argue “repeal Obamacare, go back to HSAs,” claiming pre‑ACA individual plans were cheaper and regulation drove costs up.
• Others counter that pre‑ACA was only “working” for the healthy; denial and pricing of pre‑existing conditions were described as a moral catastrophe.
• Several note ACA did not kill HSAs, but Bronze/Catastrophic plan design often made them incompatible until very recently.
• A middle view: ACA’s guarantee of coverage for pre‑existing conditions is its main success; much of the surrounding regulatory machinery is seen as overcomplicated and cost‑inflating.

Is Going Uninsured Rational?

• Young, healthy people increasingly consider skipping insurance, paying cash for routine care, and relying on bankruptcy or debt settlement after catastrophes.
• Commenters warn this only “works” if you stay lucky; many share stories of sudden cancer, surgeries, or chronic disease that would have instantly destroyed savings.
• Some suggest leaving the U.S. or using medical tourism; others are tied to family or point out the complexity and risk of foreign systems.

Catastrophic vs Routine Coverage

• Strong sentiment that U.S. “insurance” is really prepayment for routine care plus catastrophic coverage, which bloats costs and bureaucracy.
• Many want true catastrophic-only plans with high deductibles and HSAs; others note Bronze plans are already close to that but still very expensive because underlying care is expensive and risk pooling is broad.
• Several emphasize that insurance is inherently a wealth transfer from young/healthy to old/sick; you can’t avoid that if you want a functional system.

Direct Primary Care and Partial Workarounds

• Direct Primary Care (subscription primary care) is widely praised: more time with doctors, dramatically lower prices for labs, and no insurance games.
• However, commenters stress DPC doesn’t address big-ticket items (surgeries, hospitalizations, biologic drugs), so it must be paired with some form of catastrophic insurance.

Incentives, Pricing, and Profit

• Many describe U.S. healthcare as a “capital extraction” system: fragmented billing, inflated list prices, coding games, and overuse of marginal or unnecessary procedures.
• Others note major insurers’ profit margins are modest and argue most excess money flows to providers, hospitals, pharma, and system-wide overhead, not just insurers.
• Negotiated rates are viewed as one real value insurers provide; without them, cash payers often face absurd “retail” prices.

International Comparisons and Universal Care

• Multiple comments contrast U.S. outcomes and costs with universal or single‑payer systems, arguing those countries spend less per person and get better life expectancy.
• Skeptics raise concerns about wait times and rationing, but data-linked replies say delays are mainly for elective procedures, while Americans often get no care due to cost.
• Political resistance to “socialism,” lobbying, and generational interests (e.g., Medicare vs working-age costs) are blamed for blocking systemic reform.

Moral and Social Dimensions

• Debate over “paying for others’ bad choices” (obesity, smoking, etc.) runs into pushback: many illnesses are genetic, environmental, or structurally driven, and moralizing is seen as both inaccurate and cruel.
• Several highlight how fear of losing insurance locks people into jobs and likely suppresses entrepreneurship.
• Personal stories—medical bankruptcy despite “good” insurance, constant battles over approvals, or effortless Canadian hospital discharges with no billing—underscore both the financial and psychological burden of the U.S. model.