Comment by flohofwoe
12 hours ago
I think the main reason why high income Germans switch to private health insurance is less about service quality, but because they may actually pay less than public insurance (at least until they get near pension age). Can't talk for US citizens of course.
US health care is screwy, because one of the equitable things it tries to create is equal price regardless of age/sickness.
As a consequence, insurance companies generally try to sign up mixed-pool, younger, healthier (read: employee plans) over older, sicker, opt-in insurance (read: ACA).
There are ways they can and can't legally do that, but it's always the goal. In the same way that retail order flow is targeted by HFTs.