I have been ranting about how silly and dysfunctional it is since about the time you kissed your first girl.
Fair enough. That has been
a long time.
By the way, I just wanted to add one note to a question you posed a few weeks back.
What is wrong with private insurers competing for business, with subsidies on a means tested basis for the premiums?
As I said at the time, I have no problem with this, particularly with the means tested subsidies.
With the private insurers competing for business part, my support as based on pragmatism and a qualification. In the Bismarck systems I prefer, insurers are private, but also non-profit, meaning that they are not publicly traded. They do complete for some business, for example, in some cases, the top 10% of income earners can opt out of minimum public packages and buy special plans from them, and in others they sell competing supplemental plans atop publicly required minimum coverage. Now, granted, private insurers don't turn much of a profit in the U.S. compared to private companies of other industries. But the fact that they are publicly traded means that they do have to attract shareholders and turn a profit. And that profit-incentive naturally creates a motive to cut costs, and in this case the biggest costs are medical bills themselves, hence the Medical Loss Ratio. This, accompanied by the fragmented structure of our health care system with almost 30% of the population covered by competing government coverage that leads to such dramatic cost-shifting. is what leads to monstrous results like recision and pre-existing conditions exclusions that prevail in our country. In short, it's always seemed to me that for-profit insurance that has to draw private investment in order to survive fundamentally skews motives with regard to paying medical bills. Sure, insurers here have to offer good coverage in order to thrive in the competitive market. But they also have to make often crushing decisions about what not to cover in order to contain costs and keep investors happy, as opposed to non-profit private payers in Bismarck systems that only have to cover the costs of capital and maintain good management. This is just one of the ways that the American system does things that lands us in morally problematic ground; the profit-motives that are found in our insurance system are among the very things that lead us to ration against people who need basic coverage the most, rather than rationing against insured consumers who over-utilize or forcing ourselves to find ways to contain provider costs in various ways instead of merely defending ourselves against them by massive pooling that can be accomplished by a relatively small number of companies. So, in terms of the things I really believe in with regard to insurance; a multipayer system featuring private insurers--absolutely yes, but publicly traded for-profit insurers---well, in an ideal world, I'd rather not have them.
But this is not an ideal world, and for-profit insurance isn't going anywhere in the U.S. I'm not trying to demonize these companies, nor the many exceedingly good people who work in the industry. The choices we have made are systematic ones, and they were made decades ago. The medical bills have to be paid, and such companies pay mine well enough. So, any health care reform that will ultimately succeed in the U.S. and make it a better country has to work for the insurers we have. There are all kinds of other things that need fixing in our system--from unrestrained cost inflation related to rampant over-utilization to defragmenting public and private coverage to more rationally separating basic care, catastrophic care and supplemental care--to keep us busy and, if we find good solutions, will make huge and needed differences.
So, with those qualifications in mind, I'm ok with solutions that involve private companies competing for business--it's a feature of the American health care system that is entrenched. But, in my heart of hearts, I don't believe everything in life should be inspired by profit-motive, and paying medical bills falls into that category of things that, to my mind, shouldn't.