A primary reason that I turned against pool insurance was that I discovered that the gatekeepers of the pool were using intimidation to discourage policy holders from using care. For example, with employer based health insurance, one has to go to the HR clerk or union boss to request care. This entails confronting a person who has direct control over your personally well being in order to get care.
This intimidation has a big effect in preventing people from getting the basic care that could improve health and personal productivity, while reducing long term costs.
The HSA (a savings account and high deductible insurance) gives people a little more control over their care. One only needs to confront a gatekeeper for expensive medical concerns. However, the system really doesn't encourage people to seek preventative care. For that matter, the high deductible insurance creates a disincentive for seeking preventative care. People with high deductible insurance are likely to schedule their care in accordance with the calendar year of the policy and not their personal health needs.
The Medical Savings and Loan is the only system that directly confronts people with the long term consequences of their health spending and life style choices. When faced with a choice of spending now or spending more later, the person enrolled in the MSL will have the incentive to spend now.
This incentive for preventive care even applies to people whose health needs exceed their income as borrowing a little money now saves having to borrow even more money later.
As people own their whole health history, there are no gatekeepers to navigate nor are there perverse incentives to put off care.
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