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
    24·
    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.

    • chillinit@lemmynsfw.com
      9·
      8 days ago

      Amica is mutual insurance company for auto, home, and life. But, they don’t obstruct and deny legitimate claims like State Farm. Also, real humans answer the phone. The catch is that they’re fairly risk averse.

      I state this example because I don’t want people to equate mutual with shitty products and service.

      • litchralee@sh.itjust.worksEnglish
        4·
        8 days ago

        Thanks for pointing this out. I offered State Farm as an example because they’re the largest auto insurer in the USA, but with just that example, I can see why someone might get the impression that mutual == bad. I happen to be a happy State Farm customer, but I’m aware this isn’t universal.

        I’ve added Amica and Liberty Mutual USA as additional examples to address this.

        • chillinit@lemmynsfw.com
          3·
          8 days ago

          One really couldn’t hope for a better response than yours, even in details like also adding Liberty Mutual.

          State Farm’s adjustors act upon a universal ideology. Their captive agents have nearly zero influence over them. The only difference in service that you’re likely to experience is in communication between yourself and the captive agent.

          You’re seem both knowledgeable and rational. My paragraph above is flawed or you’ve some sort of exceptional situation. If it’s flawed then please teach me why.