In the US insurance companies themselves are meant to fight to keep prices down, but right now due to a miscalculation during the creation of Obamacare ("Patient Protection and Affordable Care Act") they're incentivized to INCREASE medical costs...

Why? The 80/20 Rule ("Medical Loss Ratio" rule).

> The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

Meaning insurance company executive wages can only come out of 20% of your premium, so if the CEO wants that pay increase they have to increase overall healthcare expenditure, premiums, and by extension their 20% cut.

While the 80/20 rule was a fantastic idea on paper, it changed insurance company's incentives in such a way so that premium increases are good for them.

You might be thinking "but in a competitive landscape people would just switch!" but there's nothing competitive about health insurance, people cannot even pick their own (their employer does) and most employers only offer two of the larger ones from that state.

Increases in premiums have always been good for insurance companies, just like increases in revenue are always good for other companies

Insurers do actively try to reduce healthcare costs but in many cases they are at the mercy of providers

So insurance in the US wants to take even more than 20% as profit? Am I correct in thinking that this actually makes socialized systems more efficient? They never have to front any profit overhead.

No, they want to increase how much that 20% share is worth.

If premiums increase from e.g. $500 to $600/month, the insurance company makes $20 more per insured via their 20% share.

The other 80% ($480) really does go towards medical costs, but the issue is that insurance companies aren't incentivized to help you keep those medical costs down (via negotiation with hospitals/drug companies), but may be incentivized to increase them. That's a problem.

In an ideal world insurance company's incentives and their customer's goals should be aligned (e.g. both save money). That makes them the ultimate advocate for you and fighting to keep healthcare costs low, that isn't what is happening (either before or after Obamacare).

Not profit. The 20% is supposed to cover all overhead. 80% is mandated to be spent directly on claims.

No, they want to grow the costs so that same 20% represents more money.

I’m in New Zealand, have a six month old son, we paid $0 from finding out she was pregnant up until going home after she stayed three days in the hospital to get comfortable with feeding him (there were no complications, no caesarean).

All checkups + scans pre-birth were free.

It would have cost money only if we decided to go for a private obstetrician, I think it’s the same in Australia.

So if it’s one of the 90% of births with no complications, going for the free public option just makes sense.