Which is the thing caused by low deductible plans. If that sort of paperwork was only necessary in cases where you're already paying for $10,000+ in medical services, the fixed overhead isn't that significant. But with low deductible plans you pay it for every little thing that ought to cost $50, and then the $50 thing costs $550 because even walking in the door requires $500 worth of paperwork.
How much more efficient would it be if you just walked in with $50 in cash in most cases, which you can take out of the thousands a year you'd save in insurance premiums?
It really is obscene and totally a waste, and it doesn't have to be this way. The notion that the free market does things more efficiently isn't always true, particularly in captive-market situations like healthcare, particularly in purely middleman industries like insurance which are actually incentivized to poorly allocate money to the alleged business purpose (covering medical services for people) because it increases their own profit margins.
But then you're not addressing the majority of the problem, because insurance company profits are only a single digit percentage of premiums.
And even the "profits" aren't all waste, because you're paying money but not getting nothing in exchange.
If you want to have patients not paying directly for care then you need somebody to process claims, and those people need an office to work out of. The investors in the insurance company paid for that office. A lot of their "profit" is just the internal rent being paid on the building. If you move that function to the government, the cost doesn't disappear because the government still has to pay for buildings to operate out of to process claims payments to providers, which had previously been paid for by investors in exchange for profits.
Health insurance companies don't generally produce above-market returns on capital, so there is no real evidence that their "profits" are introducing any avoidable cost at all. It's just a method of paying for the things the investors' money bought.
Heck, there are non-profit health insurance companies that make no profits. Where are the savings, if some existed? (Answer: They still had to raise capital, but they used loans or bonds or spent labor begging for donations instead of selling shares, and that turns out not to be much different in efficiency.)
> so therefore, insurance companies will pick out the least risky people, least unhealthy, and not allow the sick into their programs. That is exactly what you see today, because those more ill people are what saps the profits.
The premise of insurance is that you don't know who those people are yet. If you already know then the event to be insured against effectively already happened. You can't expect to switch to lower deductible fire insurance after your house catches fire but before you file the claim. But equally, if you bought it to begin with the insurance company can't cancel your policy just because you're about to file a claim.
> The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end.
How is that supposed to help? The medical providers are the ones who profit from over-providing. They have no incentive to eliminate unnecessary costs -- to them the costs are profits.
> Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.
It's because Medicare pays below amortized cost and relies on private insurance to pay higher prices and cover the providers' fixed costs. That doesn't exactly work if you get rid of private insurance.
> no it's not price control.
So let's think about this. There is one buyer. If they won't buy from you, their own customers have no alternatives, so you can't make the case that they need to buy from you or their customers will switch to their competitor who does. If they won't buy from you, you have no buyers.
The buyer can set any price they want and the provider has to take it or go out of business. That's price controls.
> Insurance companies currently all own their own little monopoly in their region/network, and hence, there's no competition for pricing the medical treatment today. You are forced into the insurance's monopoly (or face the higher ticket price hospitals charge because they can).
The existing system is all messed up, nobody is denying that. But why not fix it? Require price transparency. Stop creating tax incentives for low deductible plans that make it so nobody has the incentive to shop around and then consequently nothing is configured to enable anyone to do that because nobody does.
> Insurance companies provide efficiency in operation vs gov't perhaps - i don't know. But what efficiency they provide is taken out as profit instead of being passed on to customers.
Not in a competitive market it isn't. If insurance companies were making above-market returns then it would be profitable for rich investors to start a new insurance company that takes their customers by charging lower insurance premiums and still makes at least the market rate of return, until such time as the efficiency is getting passed on to the customers.
> And insurance company's efficiency is not in lowering the cost of medical care - it's in finding customers that don't cost them more than premiums they charge.
Neither of those is true. If an insurance company can deny a claim for a legitimate reason then it saves them money, which in a competitive market is passed on to the customers.
And insurance companies can profit by identifying higher risk customers and charging them higher premiums. The insurance company's job isn't to avoid risk, it's to accurately price it.
Meanwhile the real efficiency doesn't come from the insurance company at all, it's from not using insurance for low cost routine care, which makes the patient price sensitive. Then the patient has the incentive to choose the provider with the better price and is inclined to refuse procedures that are unnecessary or not cost effective.
i would argue the patient cannot be price sensitive. The utility of staying alive is infinite - therefore, a patient will pay _any_ price for a procedure that saves them.
I don't want to see a world where going to the GP for a cold is not free. But that's the world we live in today.
The insurance efficiency, if any, is just a drop in the bucket i suppose - because the main issue i'm talking about is socializing healthcare, so that even healthy people pay a cost. And insurance _doesn't_ help with that (and having an insurance industry certainly prevents it from existing as well).
The vast majority of healthcare is non-emergency care. It's either preventive health checkups, or planned treatments. The price elasticity of demand in healthcare is virtually identical to the price elasticity of demand in food. The utility of not starving to death is infinite — therefore a patient will pay _any_ price for food that nourishes them, right?
The huge flaw with that argument is that the value to the patient might be infinite, but the cost to provide it is not. In an open market, competition brings down the cost to the minimum possible value — unless you have barriers to entry or a cartel.
What's going wrong with the system of perfect competition with insurance companies?
The biggest problem is the regulatory incentives for employer-provided insurance. This creates indirection (a corporation is choosing the insurance plan rather than the patient) and whatever is spent is tax exempt, which creates the incentive for employers to provide the most expensive low-deductible plans that are also the least efficient and involve the insurance bureaucracy in the smallest dollar value medical procedures.
The other users have already mentioned that insurance profit margins, on average, are about 5%. But you should also know that a lot of insurance carriers in the US are non-profit — including Blue Cross Blue Shield and Kaiser Permanente.
> The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end. Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.
That's true, in theory, but in practice Medicare fee schedules aren't that much better than private insurers. Additionally, providers themselves are starting to charge out-of-network rates that are LOWER than Medicare fee schedules. For example, Wal-Mart has launched healthcare in Georgia, charging $25 for a cleaning[1], which is significantly lower than the amount for a cleaning (procedure code D1110) set by Medicare/Medicaid. You can look it up yourself by visiting the FAIR Health code lookup tool (https://www.fairhealthconsumer.org/dental/results), and setting the ZIP code to that of Carlton, GA (location of the Wal-Mart clinic), 30627. The average allowed amount is $64.
Finally, the US government has historically been pretty bad at setting prices, as a monopsony buyer. The US military spends more per capita on the military largely because it pays more per-soldier, per-fighter jet, etc than any other nation on the planet. You would think that, as the sole buyer of US defense sector fighter jets, it could negotiate better rates. The F-35 is expected to cost $1.5 trillion (!!) over its lifetime, and the US enjoys monopoly/legislative powers over that cost.
Another example: NASA's planned SLS moon mission is a bit of a disaster — way over budget and way behind schedule. Because the boosters aren't reusable, each launch is expected to cost $1B (with a B) dollars — EACH launch! Meanwhile SpaceX's target cost-per-launch is $50M.
So while you're right that, in theory, a monopsony can extract the lowest possible price, there's absolutely no guarantee of this, indeed American empirical evidence has at times proven otherwise.
[1] https://www.bloomberg.com/news/articles/2020-02-25/walmart-t...
> The large majority of the money isn't going to the insurance company, it's going to healthcare providers.
Any money going into insurance as profit is a loss to the payer - insurance doesn't _provide_ value. If the gov't is the one "doing the insurance" as you say, then any profit from that operation will count as a lowered cost of providing medical treatment.
> allows people to make risky/unhealthy choices and socialize the costs of those choices, and therefore why high deductible insurance is more efficient by introducing at least some price sensitivity.
so therefore, insurance companies will pick out the least risky people, least unhealthy, and not allow the sick into their programs. That is exactly what you see today, because those more ill people are what saps the profits.
The price sensitivity is at the wrong end - it should be at the medical provider end, not at the insurance end. Why do you think the cost for treatment is low when you're covered under medicare (for low income people)? It's because medicare is such a large buyer that hospitals are able to sell their services at that low a price.
> This is equivalent to legislating prices. They can already do this regardless, but it's a bad idea for the same reason price controls in general are
no it's not price control. It's buying power, from a single entity that is not profit-driven. The market for medical treatment is unchanged under my model. Insurance companies currently all own their own little monopoly in their region/network, and hence, there's no competition for pricing the medical treatment today. You are forced into the insurance's monopoly (or face the higher ticket price hospitals charge because they can).
> why wouldn't the insurance companies be doing it too? > ... if the government really is so much more efficient then they should easily be able to out-compete the insurance companies
Insurance companies provide efficiency in operation vs gov't perhaps - i don't know. But what efficiency they provide is taken out as profit instead of being passed on to customers. And insurance company's efficiency is not in lowering the cost of medical care - it's in finding customers that don't cost them more than premiums they charge. They are more incentivized to keep medical costs high to force people onto insurance plans (that they negotiate using their purchasing power)!
There is no real place in the world for a profit-making medical insurance company imho. Or, if there is, they will be _in addition_ to a tax-payer funded universal healthcare system, and they can provide non-medically necessary operations that are not covered by the universal system.