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Is the world becoming uninsurable?

(charleshughsmith.substack.com)
478 points spking | 2 comments | | HN request time: 0s | source
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bluedevil2k ◴[] No.42733208[source]
Like we see in California, when the government sets a price ceiling, insurance companies just leave. Same in Florida. If the free market truly was allowed run normally, the insurance rates in Pacific Palisades or on the Florida coast would be so high that no one could afford to live there. Is that a bad thing? If someone was living in a house near where they tested missiles, we'd call them crazy. At what point can we say the same about people building and rebuilding over and over in these disaster areas.
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epistasis ◴[] No.42733486[source]
I've been trying to talk to people locally, a place with lots of homes built in the woodland-urban interface, about the risks of climate change and how insurance will have to change. Unfortunately these discussions almost never go well, because it seems that most people have at best a surface level understanding of what insurance is and how it works, and everyone is convinced that it's a full scam and insurance companies are fabricating everything. When in reality, insurance is one of the rare areas where risks are very well assessed, not just by the initial insurer but also by a second party when reinsurance is purchased. And often those exits from the insurance markers are due to inability to purchase reinsurance.

Of course, explaining anything in detail is likely to make people think you work in the industry (I do not) and get accused of being a shill. All of which proves to me that older generations had a much easier life because nobody so financially ignorant today is in any sort of position to be able to buy a home.

All that said, I don't think it's actually a price ceiling. It's a limitation of what factors can be taken into account to set rates, and constitutional amendment from Prop 108 prevents the legislature from changing it.

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Aurornis ◴[] No.42733549[source]
> Unfortunately these discussions almost never go well, because it seems that most people have at best a surface level understanding of what insurance is and how it works, and everyone is convinced that it's a full scam and insurance companies are fabricating everything

I have the exact same experience when discussing anything insurance related: People have wild assumptions about how much profit insurance companies are making.

When I ask people how much cheaper they think their insurance (health, home, etc) would be if we forced insurance company profits to zero they usually have some extreme guess like 50%. When you point out that, for example, health insurance profits are low single digit percentage of overall healthcare costs they just don’t believe it. The discourse is so cooked that everyone who just assumes insurers are making unbelievable profits without ever checking.

Like you said, when I try to bring numbers into the discussion I get accused of being a shill (or a “bootlicker” if the other person is young).

The environment this creates has opened the door for some really bad politics to intervene in ways that aren’t helpful. I wouldn’t be surprised if the eventual outcome in a lot of these places is that politicians pass legislation putting the local government on the hook for insurance after they squeeze regular insurers so hard they have to back out to avoid losing money in those markets. The consequences won’t manifest for several years, potentially after the politicians have left office, but could be financially burdensome. Similar to how many local governments were very generous with pension plans because politicians knew the consequences would only be felt by their successors.

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wuiheerfoj ◴[] No.42733608[source]
>When you point out that, for example, health insurance profits are low single digit percentage of overall healthcare costs

Do you have any source for this?

I’m assuming (because HN) that you had the USA in mind, and it doesn’t pass the sniff test for me given that US insurance fees are more than single digit percentages higher than other high quality care countries with privatised healthcare systems

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lotsofpulp ◴[] No.42734097[source]
These are all the publicly listed health insurers in the US, with public financials, so the numbers come from the 10-Q and 10-K reports filed with the SEC.

Note that the first one, United Health, has slightly higher profit margins than the rest because UNH has an enormous business selling healthcare itself, not just insurance (they own a lot of doctor groups and outpatient clinics and employ a lot of doctors and nurses).

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...

https://www.macrotrends.net/stocks/charts/CI/cigna-group/pro...

https://www.macrotrends.net/stocks/charts/CVS/cvs-health/pro...

https://www.macrotrends.net/stocks/charts/HUM/humana/profit-...

https://www.macrotrends.net/stocks/charts/CNC/centene/profit...

https://www.macrotrends.net/stocks/charts/MOH/molina-healthc...

The other big insurers will be Kaiser Foundation Health Plan and various plans franchised with Blue Cross Blue Shield, but they are all non profit.

https://projects.propublica.org/nonprofits/organizations/941...

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nradov ◴[] No.42734303[source]
Some Blue Cross Blue Shield Association members are for-profit corporations now.

As for UnitedHealth Group, much of their profit comes from a large software business which is separate from their insurance, care delivery, and PBM businesses. If that software business was spun out it would be one of the 20 largest US tech companies.

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lotsofpulp ◴[] No.42734378[source]
> Some Blue Cross Blue Shield Association members are for-profit corporations now.

In this list, I couldn’t find a single for profit BCBS licensee other than Elevance. They all seem to be mutuals/member owned/non profit.

https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Associa...

> As for UnitedHealth Group, much of their profit comes from a large software business which is separate from their insurance, care delivery, and PBM businesses. If that software business was spun out it would be one of the 20 largest US tech companies.

Interesting, I didn’t know UNH sold software!

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inferiorhuman ◴[] No.42735064[source]

  In this list, I couldn’t find a single for profit BCBS licensee
  other than Elevance.
Keep in mind Anthem/Elevance absorbed a bunch of licensees. So, for instance, Empire BCBS was for-profit but as of 2024 is part of Elevance.

At a quick glance Highmark and Wellmark are for-profit. And I believe the South Carolina licensee is as well. Mind you a few of the "non-profit" BCBS licensees have been sued over claims that they ought not be considered not-for-profit.

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lotsofpulp ◴[] No.42737508[source]
Highmark is non profit:

https://projects.propublica.org/nonprofits/organizations/821...

Wellmark is a mutual insurance company (profits go back to policyholders, seems not comparable to a for profit insurance business, and for this discussion, is not going to have a profit margin that results in higher costs to policyholders):

https://en.wikipedia.org/wiki/Wellmark_Blue_Cross_Blue_Shiel...

https://en.wikipedia.org/wiki/Mutual_insurance

>Mind you a few of the "non-profit" BCBS licensees have been sued over claims that they ought not be considered not-for-profit.

I see no successful lawsuits, though. Still seems like Elevance is the only for profit BCBS licensee.

>In 2014, BC/BS of Illinois (Health Care Service Corporation) was sued over its nonprofit status. The lawsuit was dismissed, with prejudice, and the dismissal ruling was upheld on appeal.[62] Similar suits occurred with similar results in other states such as Oregon.[63]

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inferiorhuman ◴[] No.42737736[source]
To be clear if Elevance is the only remaining for-profit BCBS licensee it's because they bought the others.

Highmark got labeled as for-profit on its Wikipedia entry likely because they own a variety of for-profit companies including e.g. Highmark BCBSD Inc. and Celtic Hospice LLC.

https://projects.propublica.org/nonprofits/organizations/453...

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lotsofpulp ◴[] No.42738000[source]
But Highmark, the parent organization, is still a non profit. Based on their revenue and expenses on their 990 going back a decade, the entire organization is not delivering profit to any owners, it’s just spending money earned in its for profit subsidiaries elsewhere in its org.

Specifics aside, I think it is conclusively shown that no health insurance / managed care organization earns a ton of profit margin. No one is going to become billionaire rich by starting up a managed care organization, because they will spend almost all they earn.

It’s such a low profit margin business, that Buffett, Dimon, and Bezos abandoned it:

https://www.healthcarefinancenews.com/news/haven-disbands-en...

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1. inferiorhuman ◴[] No.42739027{3}[source]

  But Highmark, the parent organization, is still a non profit.
So? The Mozilla Foundation is non-profit but Mozilla Corporation is for profit. They're delivering profit, just with an added layer of indirection. In this case the Highmark parent is technically a non-profit but e.g. Highmark BCBSD, the Delaware arm, is a for profit BCBS licensee.
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2. lotsofpulp ◴[] No.42739580[source]
> They're delivering profit

To who? Are there shareholders profiting? Employees on the take?

> Unlike the non-profit Mozilla Foundation, and the Mozilla open source project, founded by the now defunct Netscape Communications Corporation, the Mozilla Corporation is a taxable entity. The Mozilla Corporation reinvests all of its profits back into the Mozilla projects.

https://en.wikipedia.org/wiki/Mozilla_Corporation

It’s the same with Highmark, assuming there isn’t massive fraud happening.