>Again, I fail to see the legitimacy of a regime in which I must either pay a for-profit corporation for the privilege of preventing my doctor from doing what is in my own best interest or be wealthy enough to pay everything out of pocket.
The "legitimacy" lies in the fact that that is what was politically possible to accomplish. I put legitimacy in quotes because I assume you mean legitimate in the context of some type of moral or ideological sense, which I do not find terribly interesting in this case, where there are many real world constraints at play.
At the very root of it all is the fact that demand for healthcare greatly dwarfs supply of healthcare, starting from the simple fact that changing bedpans is a highly undesirable task and going all the way to the fact that medicinal knowledge is very difficult and costly to acquire. And so politics will be involved in how healthcare is distributed.
You can even go back to your statement of
>from doing what is in my own best interest
99% of people have no idea how to evaluate what is in their own best interest when it comes to medicine. Even doctors outside of their specialty probably do not know, and the tiny minority that do would acknowledge that at some point they are also guessing at the machinations of something complex like the body.
The for profit (and not for profit) labeling is mostly a distraction. Doctors do not treat people without a profit, programmers do not program without a profit, and a managed care organization does not sell its services without a profit.
These 2 big constraints shape how much and what kind of healthcare system we can afford:
-low supply of healthcare relative to demand - requiring a system of allocation of resources
-medicine being extremely difficult and possibility of doctor making mistake or being corrupted requiring second opinion - i.e. doctors and pharmacists employed by managed care organizations
Obviously, everyone would love if everyone could get all the healthcare they could ever want at anytime they want. But our parameters do not allow for that. Back to the original question of why a for profit managed care organization needs to be involved at all? It does not, except politically, that was the solution the leaders agreed upon. I suspect politicians also like MCOs in the middle because it keeps the heat on the MCOs and deflects from them.
We could have gone the NHS way with taxpayer funded healthcare, and the NHS handling all the administrative functions that managed care organizations do. But there was significant political opposition to that, probably because a lot of politically influential classes stood to lose in that proposition. So we have what we have.
Note that to counteract excessive profit incentives, the ACA implemented minimum medical loss ratios and a healthcare exchange so that companies could compete for customers and hence have an incentive to keep premiums lower (presuming the existence of sufficient competing MCOs). Why not just cut all that out and let government deal with it? Because that is what was possible.
https://www.healthcare.gov/health-care-law-protections/rate-...