In that vain health insurance is never insurance.

Getting a kid is not an accident for most modern people, and should never be seen as an event that could bankrupt anybody.

Hence, deferring to the definition of insurance is futile.

Then again - the US is the only country I know of that insists that health is something you insure.

3k out-of-pocket for a random mishap could easily get many people bankrupt.

I did scratch an eyeball recently. The cost turned out to be €50 for drops which ain’t covered by single-payer insurance. 3k out of pocket would be pretty bad even naming nice salary. And could cause big issues to a massive portion of people.

> tax advantages of an HSA

The minuscule tax advantage here is that 1. you're paying for your health care costs with pre-tax dollars, but you can generally still deduct these even without an HSA, so +0 advantage there, and 2. you are allowed to invest the savings, and gains are not taxed at the federal level (but may be taxed at the state level), so the advantage here is your savings account size x your effective tax rate. The premiums for a HDHP also tend to be slightly less than PPO or other plans.

For most of us that tax advantage is tiny. I would rather have an insurance plan that actually covered my costs minus a copay, even better one without a copay, even better Medicare For All where I don't even have to worry about an insurance company or pay insurance premiums. HDHP + HSA is pretty much the worst of the bunch.

Right, but it's also nuts that a lot of people are on a health insurance plan that encourages avoiding medical care because it offers tax-advantaged investing. You get how that's nuts, right?

It's not that people don't expect to pay. It's that plans like HDHP do not have predictability. An average person getting an average number of injuries cannot reasonably work out how much it will cost them to treat these injuries and whether the HSA is enough. The fact that there is the distinction between in-network and out-of-network means the deductible isn't a constant.

Your idea that insurance is only for things that are catastrophic to your finances is wrong. Health insurance is mandatory for the common good, even if your net worth is in the millions. You can't forgo health insurance just because you are rich enough. There have been long debates about ACA that led to mandatory health insurance that I will not rehash. And auto insurance is another example: you are still required to buy it even if covering liability for accidents and covering the loss of your car would be completely affordable for yourself.

What we have in the US is the opposite of insurance; the insurance companies tend to pay for normal health-care and then suddenly find a reason to not pay when something catastrophic happens.

Insurance is for unexpected expenses that (a) you cannot foresee and (b) would be catastrophic to your finances

I do not agree with that view, and I'm not sure that is how it is used in the US at least. In the US, for many people, health insurance is the only realistic means to obtain any healthcare, not just catastrophic care.

I get injured at least annually due to mostly-outdoor physical activities, and have a chronic health issue or two, so the prospect of paying thousands of dollars out of pocket before my insurance even kicks in, doesn't sound great (and wasn't, when I had HDHPs for years).

I think the issue is that pretty much everything which isn't preventative care is considered "catastrophic" under this logic (because it requires paying hundreds or thousands out of pocket), even non-major issues, so "catastrophic" happens a lot.

> in-network (non-specialist) referral for a same-day appointment

My HMO takes 5-10 business days to approve a non-emergency referral; 3-days for an emergency one doesn't matter what my GP does. Though it's partly moot by the fact that I would have to drive hours to find a specialist that isn't booking many weeks out, it's exacerbated by the fact that no specialists let one schedule an appointment prior to the referral being approved.

> Surely it's better for both of us if you just find a new GP?

Or I can just go to urgent care if I have an urgent issue?

That's interesting because my co-pay at urgent care is the same as with my GP. Maybe there are regional differences? (ER on the other hand I know I won't walk away without many thousands of dollars in bills, on top of a much larger copay, because even though the ER is "in network" none of the contractors working there are)

"make an appointment for several months for now or get treatment this week" is maybe a better explanation.

your GP is good if you have a long term medical issue you want to ask about, less so if you think you've just gotten injured or sick in some way.