Individual insurers pay out tens of billions of dollars in claims every year, frequently have non-profitable years, and are the counterparty on pretty risky contracts.
There are lots of problems with our current approach to healthcare, but insurers aren’t charging you way more than the cost to counterparty on that contract should be.
A graph of the stocks for UnitedHealth, Elevance (formerly Anthem) and Cigna shows that they're all on the growth track for the last five years.
If a subscriber pays them what they do, and they don't have money to pay a claim declared medically necessary by a medical doctor, but do have the money to forward to a retirement fund, they are charging too much.
Most of the rest of the industrialized world seems to grasp this concept, and their people live longer.
> graph of the stocks for UnitedHealth, Elevance (formerly Anthem) and Cigna shows that they're all on the growth track for the last five years
Stock price ! profitability, but you're still correct. UnitedHealth's operations have churned out cash each of the last four years [1], as have Cigna [2] and Elevance [3]. Underwriting gains across the industry have been strong for years [4]. The only story I can think of where American health insurers lost money was Aetna with its underpriced ACA plans [5].
That said, whimsicalism is also partly right in that insurers aren't the cause of the unaffordability of American healthcare. They by and large pay out most of their premiums. (With some variance.)
I was referring to insurance writ large, but yes it's true recently health insurers have been profitable - but not massively, more like 3-4% average margins. [0]
> If a subscriber pays them what they do, and they don't have money to pay a claim declared medically necessary by a medical doctor, but do have the money to forward to a retirement fund, they are charging too much.
If it is only legal to lose money on providing insurance, nobody would do it.
> Most of the rest of the industrialized world seems to grasp this concept, and their people live longer.
I agree that there are problems with cost/performance in our healthcare market. I think it is largely due to overutilization & misallocation, combined with some poor genetic/cultural luck around opioids and obesity.
The United States spends more per capita on socialized medicine than any other nation on earth[0]. US socialized medicine spending per capita is more than any other nation spends total between both public and private in fact, it just fails to provide it to anyone but the very poor, very sick and elderly.
You'd think the healthy working population wouldn't be that much of a burden to care for as well, but they have to go out of pocket and get insurance to provide for themselves after providing for everyone else.
There is a lot of graft going on for this to be the case. It may not be the fault of insurance companies but someone is stealing a great deal of money from the American people.
Now here's the million dollar question; are you aware of this obvious fact? Have you ever heard someone frame the socialized medicine debate in this way: "If we could be as efficient as the UK we could give you free healthcare AND cut your taxes!". If not, why not?
graft but also overutilization/misallocation, ie. we will publicly spend massive portions of our GDP treating old people who are slowly dying but little on younger people who have some crippling illness, mostly because older people vote and triage is an uncomfortable concept to people
Every other nation on earth somehow finds a way to deal with that. Given the US is 48th in life expectancy[0] behind all these other nations that spend much less, that explanation doesn't seem to hold much water.
> Every other nation on earth somehow finds a way to deal with that.
well not every other nation, but i know what you mean.
other nations are much better at managing overutilization by denying care where it is not needed. the US insurance system shields people from cost and encourages overutilization due to a number of stupid policy choices (aka refusal to have 'death panels' like in Canada/UK but also refusal to do away with massive publicly subsidy for health expenditure).
for a personal story, my parents basically get free MRIs from the state for little reason whereas people I know have to pay an arm and a leg for MRIs because their insurance is worse. at minimum, we could at least also make my parents have to pay an arm and leg for useless MRIs and doctors would stop encouraging them or lose patients.
MRIs only cost that much in the US[0](2015 prices: $1,145 in America and $138 in Switzerland), everything is inexplicably ten fold more expensive here. That more expensive care doesn't result in ten fold better outcomes as all the health measures you can find indicate. That's the root of the problem and the thing is no politician[1] is really willing to address it and they don't really cover it clearly on the news[2], I wonder why?
Correct, you have identified the problem. Prices are high because there is no agent in the US system looking to allocate spending on the basis of cost and health returns. The closest we come is the much hated insurance denials.
Its likely true that more procedures are performed and more prescriptions written, but why are those procedures and prescriptions many times more expensive?
Economies of scale should make them cheaper. An MRI machine and technician that sits there unused half the day has to charge more per visit than one used all day long. Have too many customers? Get more machines and techs, now the MRI manufacturer is making more units, offering volume discounts...
Rationing of care doesn't explain why the individual units of care are themselves much more expensive. Compare inhaler prices in Canada vs the US, $10 in Canada $100 here[0], that isn't because too many of them are given out. It's theft.
Addendum: Further, the young and healthy ration their care quite a bit under the current system, they are taxed too heavily (to pay for the care of the elderly) to afford it for themselves so they go without.
Why charge $138 when your customers will pay $1,145 and keep coming back?
you need someone willing shop and pick the cheaper options for competition to bring down prices. You also need someone willing to say "that's too expensive, I wont buy it" and walk away. Same is true for the inhalers. If someone will pay $100 before switching to the generic, that is what they get charged. In Canada, the state is only willing to pay $10, so that is the price. This is the demand side of the problem.
There is also a supply problem, where the state provides medical company monopolies through "certification of need". It is basically illegal to open an MRI clinic that would compete with an existing one in many jurisdictions.
> you need someone willing shop and pick the cheaper options for competition to bring down prices
You think consumers wouldn't do that if they were able to do so? You call the facility and everyone says the price is "it depends". They decide what they are going to charge you after you have left. Is any other industry allowed to do that? Hire someone to paint your house and he comes up with the price after he is done?
> There is also a supply problem, where the state provides medical company monopolies through "certification of need"
I'm well aware of this. Isn't it interesting that the people who give some of the largest campaign contributions have these sort of laws carved out for them? Charge whatever you want, decide the price in a opaque manner after the fact, competitors aren't allowed to establish themselves without their permission, importing drugs from other countries is forbidden. The list goes on and on.
Then you would think, if there is this much rampant and obvious corruption the fourth estate would step in right? Oh, they receive billions a year to advertise prescription drugs. Advertisement that can't be that effective, sometimes for pretty rare conditions, things your doctor should be made aware of but really odd to tell people about in a massive ad campaign.
The mainstream media and both parties are paid handsomely to allow this to continue. The problem isn't people are fat, or death panels or any of the distractions. The debate isn't about socialized medicine vs private. It's not about "keeping your doctor". There is just massive corruption to the tune of trillions of dollars in the past decade. There needs to be criminal investigations.
It seems like we agree on the many problems with the current system.
I agree that no matter if we go to a more private or socialized system, a whole system of broken regulation needs to be removed, and this will be the main point of resistance from those who benefit from the status quo.
it is generally not true that more demand causes things to be cheaper, economies of scale generally doesn't function for a whole industry but rather an individual firm
the overutilization story is what explains this, you cannot simply walk into Switzerland and say "I want an MRI here is my $138", but that is essentially what you can do (delta a bit of doctor shopping) in the US. there also is a lot of bad price transparency in the US so the listed price is not the price ended up paying, again this is due to the problem I identified above about shielding costs.
When's the last time you tried that here in the US?
It's like when people claim that other countries have worse medical systems because they have to wait, as if my friend didn't just wait 2 months for a simple injection recently, and my mom isn't waiting 2 weeks for an MRI after a stroke.
The vast majority of people who insist we have the greatest healthcare don't even go to the doctor's regularly. Because they were raised in a system where going to the doctor is something you have to weigh the cost of! We have worse medical outcomes simply because people wait until a cheap situation turns into a shitty and painful and expensive situation.
i don't think we disagree that much to be honest. i just think that a lot of the issues you are identifying (like long wait time for critical care) are due to price insensitivity due to insurance & overutilization. ie. every MRI my parents have is one that contributes to inflexibility in scheduling for truly urgent cases and also raises the price for those urgent cases.
human intensive things like medical care are characterized by diseconomies to scale when viewed from the whole industry perspective and baumol cost disease. overutilization makes the problem much worse
There are lots of problems with our current approach to healthcare, but insurers aren’t charging you way more than the cost to counterparty on that contract should be.