Systems flow down slopes determined by their incentives.
With insurance, the incentive is to prevent disease. Insurers make money when their clients stay out of hospitals. In Germany, where everybody has insurance, I have seen this in action. One could reduce their insurance premium through regular visits to the gym or by clocking 10,000 steps a day on a fitness tracker.
For health care providers, the opposite is true. Hospitals and doctors make money when patients walk in thorough their doors in search of a cure. Even at an unconscious level, providers are likely to push their patients towards a cure – by administering tests, recommending surgery and prescribing pills.
I am not blaming doctors and hospitals here. Nor am I praising health insurers. It is just that they are positioned on opposite ends of a road that every patient traverses. A road where prevention is better than cure. Insurers walk downhill on this road, while healthcare providers trudge uphill.
Universal health insurance makes it easier for an entire country to put prevention ahead of cure.