Earlier quoted context omitted.
It's more about making a fair assessment of whether servicing a market via private or public enterprises is more or less efficient. What you mention is a comparison between different markets, not a fair comparison of the same market run either publicly or privately. Health care insurance companies definitely "tax" you for their inefficiencies (through higher costs) and they are definitely something you "need to do bu…
Health insurance is so regulated and so intertwined with public policy aims, that ostensibly private health care companies are themselves essentially an arm of the government. Indeed, the fact that I "have to do business with" them is itself a consequence of particularly-complicated government regulation. The American health insurance system is one of the most unpleasant (sets of) bureaucracies I personally have to d…
COBRA is always an option when you leave a job and don't have another one lined up that will give you another insurance plan without a gap.
Yes, it's annoying to have to make the switch in general to a new employer's plan, since your existing slate of doctors might not be covered by your new plan, deductibles reset, and you have to navigate a new-to-you bureaucracy.
> I wish I could just pay for ordinary health care in a way completely unrelated to my job and that my job had nothing to do with
You can, you just aren't going to like the price tag. ACA marketplace plans are open to everyone, even if your employer offers health insurance. You can always decline the latter and sign up for your own plan. Depending on where you live, you might be able to get a barebones plan for as low as $350/mo, but in some markets your cheapest option could be hundreds of dollars more. And that's going to be a HMO-type plan with a high deductible, so you'll be paying out of pocket to the tune of thousands of dollars for anything other than preventative care, and your choice of providers will be limited. If you want something similar to what an established tech company offers (for example), you'll be paying north of $1k/mo in most situations.
(Source: our COBRA just ran out a couple months ago, we don't have jobs that offer health insurance, and I went down this rabbit hole and spent hours researching options.)
> I don't have a grand theory of how best to reform the entire American health insurance system, but I'm in favor of doing so
I'm with you there. What we have sucks. We (or our employers, which we end up paying for indirectly) pay much more for care than people in other developed nations with socialized medicine, and our outcomes are not meaningfully better, or at least not anywhere near better enough to justify the added cost.
> more medical procedures paid for out of pocket at point of use by ordinary people - which is something I try to do right now anyway when I can
That's good that you're able to, but in the absence of an insurance system, and no state-supported subsidy, healthcare would be something only a relatively privileged few would be able to afford in the US.
While our private insurance system does cause inefficiencies that raise the price of care, eliminating it won't solve enough of the cost problem to matter.
I don't think there are better options than some sort of single-payer, government-subsidized healthcare system. Those systems do of course have their flaws (some of them quite significant), but they tend to provide care to everyone more or less equally, with generally good outcomes, and completely avoid the problem of people facing a choice between foregoing needed care and bankruptcy.