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I think you need to specify this more.

In most insurance fields, it would be possible to only deny false claims. Take insurance of your house. The rates could be calculated that they can pay out all real damages to the full amount. Because the maximum damage amount is limited.

That's not true for health insurance, because the total possible damage (cost of treatments) is almost arbitrarily high, so that you cannot pay everything for everyone.

I don't want to defend the US system here. But it's not a problem that any country really solved, and one could argue about advantages and disadvantages of the different systems all day long.




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