Unfortunately, it takes only a limited excursion into lawful evil(when writing up the policies) and either neutral evil or chaotic (when interpreting them) to make health insurance pretty useless even then.
I’ve certainly not seen the the worst of it(given that I’m neither dead nor bankrupt as yet); but there is…room for flexibility…when the game is “give your money to the guys who write and interpret the rules on when you are eligible to get money back; hope for the best”. (Naturally, Serious Economists treat ‘moral hazard’ as something policyholders inflict on insurers by gobbling up that delicious ‘free’ medical care(because we all like needles and side effects, right; rather than the obvious temptation on the insurer’s side to just take the premiums and tell you to fuck off).
Aside from the limitations you can legally sneak into policies; the massive structural advantage of the insurer is that they already have your money, so they win as long as they aren’t actually forced to reimburse anything; and it is relatively elementary to build a byzantine bureaucratic-defense-in-depth apparatus that keeps you tangled in the phone trees(quite inexpensive per hour, especially if you only get human for a small fraction of the time); with opaque denials and ‘appeals’ if you do get beyond those.
I had one delightful situation where it took over a year to obtain pre-authorization for a procedure(despite the agreement of all doctors consulted that it was the correct approach and approximately a decade worth of treatment records); by which time the insurer had changed which hospitals were in-network and rendered the exercise moot. With experience gained from that round, the next try only took 6ish months; followed by another 4 months of trying to figure out why, despite the pre-authorization, the insurer had mysteriously declined to cover certain aspects of the process(despite covering most others of the same type, just a few chosen apparently at random were declined).
Now that that fiasco is out of the way I’ve been beating my head against a blank wall as to why the insurer is, without comment, just not covering some prescriptions(curiously, the one that has been off patent for ages).
Unless you have copious time and some knowledge of the process; or specialist assistance, preventing an insurer from just fucking with you is frustratingly difficult.
This is obviously a worse situation than one where insurance actually worked; but given the fun I’ve had getting an insurer to cover some not-actually-all-that-expensive stuff I’m sympathetic to the perspective of people who see “pay your premiums; still go bankrupt if you get cancer or something” as a worse option than “don’t pay premiums, go bankrupt if you get cancer or something”.
