41–50 of 122 posts
I will say this: profit margin % is not the yardstick by which we should measure whether insurance companies are responsible for high health care costs in the US.
Earlier quoted context omitted.
It’s neither a matter of profits nor costs. It’s a matter of incentives. The basic principle of capitalism can’t work if the buyer doesn’t have a choice, if the buyer is not the one who usually pays, and if the payer has a way of avoiding responsibility to pay. The privatized health insurance system is truly and completely fucked up.
By definition a free market in healthcare requires forcing some people to die from a treatable injury or condition to discover the optimal price. That's part of the definition.
Free market usefully means both sides can choose to participate in transactions which means price is how they do that. It is a useful concept but it doesn't cover everything, like what you mentioned and things like if emergency patients are shopping around hospitals or if the average consumer is capable of being well informed in such a market.
I've worked in the healthcare space for a decade and I have asked some tough questions of my leadership and I got a response I'll never forget: "Everyone in healthcare is a little bit evil"
They are not solely responsible, but of course they bear some responsibility. ACA has a Medical Loss Ratio that requires insurers to spend 80% or 85% of premium revenue on medical services "thereby limiting administrative costs and profits to the remaining 15-20 percent."[1] In other words the only way for them grow profits is to increase cost. This guy is way out of his depth. [1] https://www.rand.org/pubs/external_…
I'm on ACA. I get between $100 and $150 on a gift card to do my annual PCP visit even though my premium is $0/month. Why? Obvious if you know about the perverse incentive tqi mentions
I had an ACA "marketplace" plan back for my family back in 2017 when I was self-employed. My premiums were >$15K / year for a >$10K deductible and no tax credits (because of my income).
It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. Healthcare needs to be provided as a matter of course, and “competition” won’t improve it or control it because there is always a supply side shortag…
The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss fo…
I propose allowing buy into medicare at 5 years before regular eligibility. And a long phase in of lowering the eligibility age. Drop it by 6 months every year for 10 years, then 1 year every year for 10 years, then 2 years every year until everyone with work credits is eligible.
At the same time, start covering all kids up to some age with Medicaid (after all, kids tend to have no income, so if eligibility was based on their own income instead of household income, they'd qualify). First year, kids get covered until 6 months, next year until 1 year, etc.
When the Medicare and Medicaid ages meet, we have universal health care. It would take a long time to get there on my schedule, but it would be gradual, so everyone could adapt. And if future legislation could adjust the timeline as needed.
Also, clearly someone needs to add more residency slots.
Earlier quoted context omitted.
The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss fo…
The fact that a single person is "in charge" of the government, with the other two branches largely deferring all power to that one person, is a recent aberration from the norm in the USA. I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader.
And I want to win the lottery, marry a princess, and for my childhood dog to come back to life.
We all want things.
When we're advocating for government changes we need to be realistic and make good choices. Right now throwing an enormous amount of power at a dysfunctional government (public health care) is an insane bid completely disconnected from reality.
We need people to care about the basic functionality of government and for it's various pieces to do their duty. They aren't, so maybe let's shelve the idea of handing over control of our healthcare to them until they can deal with their cowardice in front of an aspirational king.
When arguing that health insurance isn't that inneficient he talks about "But when we look at United Health Group’s operating costs in the diagram above, they’re only 22.6% of the actual cost of medical care.". 22.6% for a middleman is not insignificant! Also providers have to spend a lot dealing with insurance so it's certainly an undercount of their total cost. This makes the burden of insurance seem like a huge %…
Earlier quoted context omitted.
> the only way for them grow profits is to increase cost. And, of course, things like spurious denials drive up costs for them and for the providers. More direct costs, more costs at the provider they have to cover... From the insurance company perspective, it's a win-win!
> things like spurious denials drive up costs for them and for the providers Spurious denials? Or improperly filed claims?
It's easy to find documentation of this. For example:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10391242/
https://phrma.org/blog/70-denied-how-insurance-denials-are-d...
https://www.forbes.com/sites/joshuacohen/2026/05/04/independ...
Anecdote is not the singular of data, but when my late wife was dying of cancer, the oncologist was attempting to follow standard care procedures. Preauthorizations were denied even after physician consultation with the insurance company.
My research showed me that the insurance companies contract with other companies (who they may or may not own) to handle the dirty work. It was only after learning the magic incantations to directly contact the "third-party" company that I was able to get traction.
"We do not believe this treatment is warranted."
"Well, her doctor believes it, so she's going to get the treatment. The only question is whether you pay now, or after I file a small claims case."
It was miraculously authorized at that point. It's the same fucking thing with car insurance. The poor people who can't fight really get screwed.
The problem is that people knee-jerk blame the one who they are giving money to. People think the teams are "Me and doctor vs. greedy insurance" whereas the reality of the situation is much more "Me and insurance vs greedy doctor".