> In a not for profit healthcare insurance system, every dollar not spent on patient care is considered waste, and we work to decrease it.

That’s cute. But the reality is often closer to this version:

In a not for profit healthcare insurance system, every dollar not spent on patient care is considered waste, so we give it to ourselves and find a way to call it patient care.

Or you can put them in contingency fund...

That's not hard...

US is the richest nation with poor healthcare. Think about that...

That's not how it works in countries with fully subsidized healtcare. It seems you are biased towards some intents that have been done in USA to subsidize some part, in a perverse, privatized and corrupt system.

In Spain it is the privatization of the healthcare that is "given to themselves and call it patient care", making politician friends (and politicians themselves) richer and corrupt, and selling it as a way to "fix the healthcare" that they are breaking.

> In a not for profit healthcare insurance system, every dollar not spent on patient care is considered waste, so we give it to ourselves and find a way to call it patient care.

Can you share some significant real-world examples of this happening?

Sure. In many parts of the United States, regional hospital systems have captured their local markets through consolidation and exploitation of their non-profit status. They then offer their own health insurance plans to provide access their own hospital systems, sometimes even denying access to other insurance plans. So when these insurance plans spend on patient care, they are, in effect, paying themselves at rates they have strong influence over.

For example, in western Pennsylvania, there is UPMC. According to court documents, UPMC acquired 28 competitors between 1996 and 2018. According to the Pennsylvania Attorney General's office, in 2011 UPMC announced it would stop accepting patients insured by its competitor, Highmark. This prompted the PA government to "enter into consent decrees with both UPMC and Highmark to protect access to care." Which, again according to the Pennsylvania Attorney General's office, UPMC continued to violate. This has lead to, among other things, a recent antitrust lawsuit supported by the US Justice Dept. [1] [2]

[1] https://www.attorneygeneral.gov/upmc/

[2] https://www.wesa.fm/health-science-tech/2024-10-03/justice-d...

Wow, that appears to be pure corruption. Thanks for sharing.

I wonder if there are examples of this type of thing happening in places outside the USA, like Western Europe for example.

Wait, I previously replied too submissively.

Yes, that is corruption. However, it is being punished!

If a for profit insurance/hospital group does this in the USA, taking money from patient care to profit... there is no punishment. There is encouragement. Correct?

The point is that both for- and not-for-profit systems can be exploitative and often are. And not-for-profits have extra avenues for exploitation.

> Yes, that is corruption. However, it is being punished!

In the example I shared, the evidence suggests that the punishment, as you call it, has not been adequate to solve the problem. And that problem has been ongoing for a decade and a half. And still continues.

Non profit: Every dollar not spent on patient can be donated a NGO and then laundered into your own pockets.

For profit: While company A keeps the profit, company B lowers its prices instead. Now customers are going to company B instead of A.

Im not saying that this is how it's done, but in the real world, things are not that simple.

If you think the US healthcare system is a good example of something that isn't driven by pervasive regulation, this is exactly the kind of "what the hell is water" problem I was talking about.

Let's say there were no regulations. None at all.

Wouldn't the largest private health insurer just buy up all the smaller ones, and then how exactly would competition work?