Ah, but how would insurance companies profit off of that?!
Generally I think insurance is an unwise hedge. I can see how in certain circumstances it’s a good thing to have. But of course over the long run you have to lose–you have to pay something to mitigate the risk.
I wonder if there are any insurance companies that are run as co-ops. That would seem to be a step in the right direction.
Point 1: QUESTION: How can insurance companies profit off of that? ANSWER: They don’t. They profit off the private 1/3 of the system, which is entirely free of government control. The doctors are “out of the system” and so is insurance. You buy what insurance you think you want or just pay your own if you can. It is somewhat instructive that a lot of the best physicians are in the “private system”. But the French government also pays for medical education, so the doctors don’t have enormous debts to pay off. It also expands or contracts admissions to medical schools based on the population’s perceived need. It’s presently in an expansion mode due to the aging population. Unfortunately, in our own system, medical admissions are totally controlled by the universities, which have counter-incentives to expansion, not the least of which is that they lose money on medical schools. Medical schools are enormously expensive and are “subsidized” by those portions of the university that require little more than a chalk board, a professor and a room. A very big subsidizing segment for medical schools are the law schools, which are big money-makers due to the high tuition and low (name removed by moderator)uts. That’s a big part of the reason why we’re short of doctors and long on lawyers in this country. (less than 50% of law graduates end up in private practice) The cost of operating medical schools keeps climbing, which is why universities keep expanding their law schools (and other chalkboard/professor/room grad schools).
My favorite doctor friend and I were once discussing the concentration in American medical providers. I asked him whether he thought that trend would also be felt in other professions, like dentistry or law. It was his opinion that dentistry would to some degree, but nothing like medicine, and law not at all. I asked him why he thought that. “Because, he said, not everybody has dental coverage, so a lot of it is self-pay. When it comes to law, in most instances, people actually have to pay 100% of what it costs.” That, he said, leaves little for the big organizations to profit from in dentistry and almost nothing in law.
Now, for the most part, dentists and lawyers are not as crucial as physicians to our well-being (unless you need them badly enough, then it seems like it) But dentists, to some degree, and lawyers almost entirely, have to gear what they charge to what people can pay themselves. So, people will resist paying exhorbitant fees in those fields, whereas in the medical world nobody cares what they charge as long as somebody else is doing the paying.
I’m not an expert at any of this, but I do think too many people have too little “stake” in their own medical care. Because of what I do, I read a lot of medical charts of people on Medicare and Medicaid, and the overutilization is just breathtaking, particularly with Medicaid.
Point 2: Sure. Insurance is a gamble, like going to Vegas. You’re hoping you win, (only sort-of with medical insurance) but most of the time you lose because, most of the time you’re paying the medical expenses of those who use it (properly or improperly) a lot. To me, that’s one of the reasons Obamacare is so awfully wrong. It encourages overutilization without actually having adequate incentive for those who don’t want to throw their money at the medical roulette wheel, to do so. And for the most part, it’s unnecessary anyway. Yes, there are the “uninsurables” with preexisting conditions. Well, if those people are employable with companies with ERISA qualifying plans, (which is almost all of them) they can only be excluded for a year anyway, and then only for the condition in question. That has been the case for a long, long time. If they’re not employable, then there’s a good chance they’re receiving Medicare or Medicaid anyway. If they’re not employable but don’t qualify for either of those, they can get “Fair Plan” insurance. Fair Plan coverage is high, but perhaps, then, that’s where any new subsidies ought to go instead of to everybody making up to $88,000/year (family of four) as provided by Obamacare, most of whom had employer-based coverage anyway.
Point 3: Maybe coops would help. But I have purchased other kinds of insurance through mutual companies that are supposed to be coops, and I can’t tell the difference in what they charge. I live in a rural area just outside a town. A private utility and a coop (REA) utilty meet right about at my house. I’m on the private and my neighbor is REA. There is no difference in what we pay. So, I’m not sure that’s an answer. Well, when you get down to it, almost every hospital and clinic in the U.S. is “not for profit”. But that doesn’t mean nobody profits. Those who run the place, not stockholders, get the profit. Look up the earnings ratios of health insurance companies. They’re not all that stellar. And unless I’m mistaken, Mutual of Omaha is, in effect, a coop. It’s good insurance, but I don’t think it’s any cheaper than any other health insurance.