If you actually trace the cashflows, the "people lining their own pockets with the savings" are mainly not the insurers but rather the executives and shareholders for other large companies with self-funded employee health plans. Most insurance companies no longer provide much real insurance but rather primarily administer health plans on behalf of self-funded employers. Due to the minimum medical loss ratio rule, insurers actually make more profit the more claims they approve.

https://www.cms.gov/marketplace/private-health-insurance/med...

If employers wanted it, insurers would be happy to offer health plans that fully paid every claim with zero denials. This would be enormously profitable for the insurers because they could run those health plans with minimal work. But instead, most employers are constantly looking for ways to cut employee health benefit costs. This means incentives aren't aligned.

> With private insurers in the US, it means denying care for person A because they think they can get away with it and it will increase their profits.

The person at the insurer who denies a claim is not making more money because they denied it. The company as a whole might, but not the person denying it.

Right, the ones who profit are just setting up the rules, policies, and incentive structures that those people work under.

This is a really simplistic approach and you're never going to fix it.

There are numerous stakeholders who setup the rules - the government, insurance companies, hospitals, doctors, billers, etc.

All of them profit from the current system, but there is no single stakeholder who decides the overall rules.

My only point is that there are people with a lot of power to decide who gets what treatments who profit from denying treatment. That’s 100% true.

Fixing it is another matter. Of course that’s not easy.