> It continued to be an okay way to do group insurance without facing major problems with adverse selection.
This is sort of a hot take, but there are plenty of examples of things like this in the US that have the unstated parenthetical "(because poor and minority populations were ignored by the system completely)"
Well yes, it was functioning as a health care plan featuring actual bona fide insurance, which means you paid for yourself, and you paid an amount commensurate with the risk that your health care needs might prove to be expensive. It was not designed as a wealth transfer to the needy any more than the auto insurance market.
We may need more wealth transfers to the needy so that they can pay for healthcare! You will note, however, that the recent approach to reforms, which tried to turn the vehicle of “insurance” itself into such a wealth transfer, has not exactly solved the problem!! Nor has it achieved its stated goal of making healthcare and health insurance more affordable to the general population, a mission always contradictory to its goal of being a wealth transfer!
This is sort of a hot take, but there are plenty of examples of things like this in the US that have the unstated parenthetical "(because poor and minority populations were ignored by the system completely)"