It would be nice if health insurance were, well, insurance, and not some bastard mix of cost sharing and collective bargaining. The closest you get to "catastrophic only" insurance is an obamacare bronze and/or a high deductible plan with an HSA. Same service, same networks, but you pay less premiums and thus keep what you don't spend.
Health catastrophes are more likely than you may think, so I would suggest a HDHP+HSA at the very least. It's very difficult to self insure against a cancer diagnosis that may blow a million dollars in a year.
I'm a fairly high net worth individual with a high deductible plan. Setting aside the deductible amount in savings (often, tax free with the HSA) and keeping it every year you have good health is OP.
> this paradigm completely fails for almost anyone with an income that isn't above the 50th percentile
I'm in Wyoming, and our threshold is under 200% the poverty line. That's $53,300 for a family of 3 [1]. Median household income–nationally–is $84k [2]. In Wyoming, it's $75k [3].
I don't know, I think there's some benefit to health insurance being more than insurance.
I think there's public-health benefits to subsidizing preventative/routine care, since
1. People are dumb and will decline to pay the $100-$300 it takes to decide
whether something needs treating even if they can afford it
2. It's just kind of inhumane to make people struggling on the edge actually do the math on whether they should pay sticker price to get e.g. an ingrown nail treated or just wait and hope it doesn't get infected, costing them vastly more or losing them a toe, and that's even if the probabilistic and cost information was readily available.
3. Even if we assume a perfectly informed and rational populace, rational individual decisions aren't the same as rational societal decisions. For example, a lot of people actually probably shouldn't pay $1000 for a given vaccine, since their risk of infection is pretty low as long as enough other people are vaccinated and pretty high if enough other are not, whether or not they're vaccinated. However, across a society, paying ~$1,000 per head to get everyone vaccinated might be worth it to get to the break point where we go from 250 million lost workdays and 1 million deaths to 1 million lost workdays and 1 thousand deaths. And then if you're making 300 million vaccines instead of 500 thousand, you can probably get the price down to at least $500, maybe less.
Maybe these things shouldn't be a function of health insurance. Maybe we should just directly subsidize the specific care we want to be widely available. But a lot of other countries seem to have decided it makes sense to gather public health expenditure and cost-sharing into one umbrella also called "insurance," so I'm not convinced it would make that little sense for us.
Health catastrophes are more likely than you may think, so I would suggest a HDHP+HSA at the very least. It's very difficult to self insure against a cancer diagnosis that may blow a million dollars in a year.
I'm a fairly high net worth individual with a high deductible plan. Setting aside the deductible amount in savings (often, tax free with the HSA) and keeping it every year you have good health is OP.