I still don't see how your argument works. You seem to dismiss insurance itself as a "genuine" service, which is a strange claim. They're rather obviously providing a service, specifically insurance, to the people who enter into contracts with them. How you get from that to "not genuine" is elusive.
I think I've been pretty clear about denying that insurance is a genuine service. I view it as a form of wealth redistribution through risk assessment, and not an actual contribution to the healthcare system.
I think I meant to ask why think what works in your perception about Germany would work here? You have to assume at least two critical, and always un-argued points. You have to assume scale and structure invariance. You have to make the critical assumption that the things done in Germany would scale to the population size of the US. And given the political, legal, and regulatory structures in Germany, you have to assume that "health care" has some transitive property where what goes on there can just work over here. I see no reason to believe that health care is scale and structure invariant. To put it another way, it's not a safe assumption to think that just because something works in Germany that it would work here.
The German model is relatively close to ours, but seems to replace for-profit companies with non-profit funds. If your concern is that the size of the country will prevent a single-payer governmental option to function efficiently, the German model is an example of a multi-payer non-governmental alternative, so might be more appropriate. I mentioned it not merely because it appears to be working in Germany, but because it has the most in common with the system that we are already used to. Putting together a system that works for our country is a legitimate concern, but I don't work for Congress so am not sitting around trying to draw up detailed plans or anything.
You also seem to be under the impression that our system actually works and that we don't need to be thinking of replacements, which doesn't match up to reality. Deductibles alone mean that you're likely to end up having to pay everything out of pocket even if you have insurance, to the point where it's often more cost-effective to be uninsured.
People are creative. Demand creates supply (contra your previous libertarian jibe on this thread, I swiped that statement from Keynes). How they would make the arrangement work is not my concern. I could imagine many things including something as simple as the patient submits a receipt to the insurance company who reimburses them, so doctors don't have to deal with an insurance company at all.
How they would make that arrangement work actually is your concern, if you think that this is a valid objection. Why would a patient trust an illegal insurance company to actually reimburse them for anything? As it is, government regulation is necessary to keep insurance companies from not resorting to every trick in the book to pay out as little as possible, so toss out that regulation and the patients are really just asking for trouble by getting involved in this sort of under-the-table arrangement.
So your proposal wouldn't have an enforcement mechanism? Then you wouldn't abolish anything.
You would abolish (or restructure) the insurance companies.
Corporation law exists, you know. Companies can't just say, "Ta da! I am suddenly incorporated because I say so, and can now engage in whatever sort of business that I want even though I have no legal standing."
That's a different claim than previously suggested where you indicates that me entering into an insurance contract was immoral. You again assume scale invariance where what applies to the system must apply to the individual and vice versa. This is not a safe assumption.
I would of course agree that aggregate behavior can produce undesirable outcomes. But it would be fallacious to think that aggregate behavior map's to individuals and it would be fallacious to think that individual morality aggregates to groups. I could entertain that the current health care market is undesirable without the ridiculous proposition that the individuals engaging in health insurance contracts are immoral. Simply put, I doubt your assumption that morality has those sorts of aggregation properties.
I would argue that my assumption here is sound. For example, a woman might turn to prostitution because she feels that she has no alternative. Historically, this was a common situation, but the fact that her choice is understandable and even sympathetic doesn't mean that there is no moral dimension to what she is doing. She is still contributing to an "industry" founded upon exploitation, even if she herself has no better option and shouldn't be condemned for it.
Similarly, I consider the health insurance industry itself intrinsically immoral, given that it is exploiting the fact that people need medical care for personal profit. I don't recall making the claim that people are behaving immorally by entering into contracts, but that the type of contract itself is immoral, because there's something wrong with the whole industry.
No, it's not. I have a right to enter into any contract I so please, so long as it's in principle a legitimate contract and doesn't harm other people. Your proclamation of immorality is wholly unconvincing.
Are you familiar with the history of contract law? Because this is not actually true. 19th century case law was full of situations where workers contracted away their right to sue for injury. This was considered legitimate at the time, and technically speaking did not hurt anyone besides the individual worker. Labor reform grew out of this situation, and we are as a result much more sceptical of the notion of freedom of contract than we used to be.
The idea of a "legitimate" contract is very slippery, so if a country decides that something like private, for-profit health insurance is harmful to society at large and chooses to discontinue it, you would not be able to claim that you have the right to enter into such a contract anyway. You would suddenly be contracting for an illegal service, which is illegitimate. You do not have to personally agree that the underlying behavior is immoral in order for the resulting contract to be illegitimate.
So you wouldn't have an enforcement mechanism. Then you wouldn't actually abolish anything. You can call people names, con-artists, scammers, etc.., all you want. And what do you mean by "unenforceable contract?" Would you prohibit courts from hearing "breech of contract" suits? Would you prohibit both federal and state courts from doing this? Could I use third party arbitration to settle cases? I thought you were for just wholesale taking over health care, but it appears that the [claimed] German system is a little more involved. It looks like we also need to toss all of contract law out the window. But in reality, it appears you haven't thought really through "enforcement" in any sense of the word.
I am not actually "for" anything, aside from a restructuring of the system to eventually eliminate for-profit health insurance. I mentioned the German model as a potential option, given your apparent concerns about the lack of choice involved in a one-payer system.
In any case, an unforceable contract is a transaction that a court will not enforce--parties will not be compelled to perform. If an illegal insurance company enters into a contract with someone to provide services that are not legitimate, then while a court could hopefully force them to return the money paid, actual performance would not be enforceable because the service in question is not legal. There would be no need to "prevent" courts from enforcing contracts with no legal force, since that's not something they do in the first place.
In the event that a rogue company set up business and started offering people insurance, legal measures could be taken against that company. This doesn't mean that police would be knocking down the doors of private citizens to drag them away for giving money to an illegal company. That's really an absurd suggestion.
