Health insurance at its core is very simple. You put money in, you go to doctor, insurance pay doctor. But in the USA, the insurance denies everything they possibly can. Money put in doesn’t ever see a doctor or your health costs, it goes right to the stockholders…

So why doesn’t someone just make a non-profit health insurance company where there’s no stock, no executives, just public servants and aggressive price negotiation where your medical bills are actually paid with the money put in?

  • litchralee@sh.itjust.worksEnglish
    241·
    8 days ago

    Health insurance at its core is very simple. … But in the USA…

    I wrote this lengthy post a few months ago about why the American health insurance system is not efficient in comparison to the auto insurance system:

    So to answer your question directly, the costs for healthcare in the USA continue to spiral so far out of control that it causes distortions in the health insurance market, to everyone’s detriment. Specific issues such as open-enrollment periods, employer subsidies, and incomprehensible coverage levels all stem from – and are attempts to reduce – costs.

    The auto industry has examples of “mutual insurance” companies, where the company at-large is partly or wholly owned by the policyholders (eg State Farm, Amica, Liberty Mutual USA). And that mostly achieves the objectives you’ve described for a non-profit automobile insurance pool. Sadly, this just doesn’t work in the USA for health insurance, for the aforementioned bottom-line reason.

    Hospitals and doctors go through intense negotiations with insurers to come to an agreement on reimbursement rates, but the reality is that neither has sufficient actuarial data to price based on what can be borne by the market. So they just pass their costs on, whatever those may be, and insurers either accept it into their calculations, or drop the provider.

    When prices for service are opaque, how can any insurance company – even the most benevolent – properly price their policies? To stay in business would require always overestimating than underestimating. The extra revenue becomes either profit or float. But this float can’t even be beneficially used or paid out, in case the next quarter has more expensive claims to pay. Which brings us full circle to opaque pricing.

    In this environment, the only remaining prudent thing for a benevolent health insurance company to do is to hold huge reserves. But that is not competitive against profit-seeking insurance companies that can undercut the benevolent company, who had tied one hand behind their back. Benevolent companies rarely survive.

    • EssentialNPC@lemmy.worldEnglish
      1·
      3 days ago

      Blue Cross Blue Shield of Massachusetts is a not-for-profit health insurance company. I am not sure that it is a full mutual company, but they have no profit incentive. Consequently, they are the best health insurance we have ever had by a wide margin.