By my understanding, private insurance in the UK is supplemental to NHS coverage. You might never use it in practice, but you don't relinquish it either. Basically, having NHS coverage is the default state below which you cannot fall.

Not ever having worked in the UK, I can't know this for certain, but I'm going to make a guess:


It seems to me that providing group health insurance is a perk, akin to a free gym membership: something that you might say "ooh, that's nice" in reference to.

Most of us in the US would simply refuse to take a job that didn't provide health insurance. It's a virtual requirement for an employer to attract any qualified employees. Notably, this leaves out positions for which there are little to no qualifications, like minimart clerk, or burgerflipper.

You can have that competition in the UK because it's not really a big deal for someone not to have access to group coverage and also be denied for or priced out of individual coverage.

But it is a big deal in the US because we don't have that base level of care. And that's the problem we're trying to solve, but the proposed solution is not to have an all-encompassing NHS-like service, because it's politically unfeasible.

The current proposed solution is to make the entire US populace a group and let them choose from amongst competing plans, just as if your employer provided multiple options, which many, especially the larger ones, do. However, a large portion of these people don't have individual insurance for a reason: that they're a bad risk. If you let the good-risk people get individual plans, you have an all-bad-risk group left, and that means that their premiums would be very high, and the costs would be unaffordable, and more people would have to be subsidized, costing the taxpayers that much more. So if this tenet wasn't in the legislation, we'd have people (probably the same group of people) complaining that it'll cost too much.

I feel like I'm not making my point well. Let me know if that makes sense or not.