How often do health insurers say no to patients? (2023)

Elected representatives answerable to their constituents would be a vast improvement in health outcomes.

How would it all be paid for if not by increasing premiums (like what happened with ACA)?

The sheer amount of overhead induced by insurance is staggering. For example, the sum of the net profits of all insurers represents money extracted from the system without contributing to health. And the amount of time doctors spend documenting patient care over and above what’s medically necessary purely to make insurers happy is time not spent seeing patients. Clinic staff spending hours on the phone each day arguing against denials is wasted money. (Anecdote: an insurer refused to authorize an MRI for a patient until my wife xrayed their damaged tendon, which doesn’t show up on xrays. She had to conduct a useless medical procedure on the patient before they’d pay for one with actual diagnostic value.)

The whole overhead imposed by the useless rent seekers is money not spent on making people healthier.

Health insurance companies do not provide any medical services. They are the middle man between patients and the places/people that actual do provide medical services. So when they deny coverage, they just keep all the premiums paid by the patient. That money is sucked up by the middle man. So you don't need to raise premiums, you need to lower profits at health insurance companies. Every billion they make in profit is a billion paid by patients and not received in services.

You could say the are negative medical services providers as they remove doctors from practicing medicine in order to have the doctors do non-medical insurance coverage work.

Have you actually checked any of these numbers?

What do you imagine is the profit margin of a health insurance company?

According to this report by the national association of state regulators, the profit margin of the health insurance industry in 2023 was 3%, or $25 billion.

Compared to over $1T of premiums, and over $4T of total healthcare spending in the US, that doesn't seem "staggering" to me.

https://content.naic.org/sites/default/files/topics-industry...

Yes. I owned a medical practice. These numbers affected how much money we took home every month, and I know them with far more personal interest than almost anyone else weighing in here.

Elected representatives should determine what healthcare I get?

Really?

Yes. Indirectly.

Profit margin is the wrong metric in this debate. The person you are replying to is saying that the insurance companies as a whole is a waste, including all the salaries paid to their employees.

The waste is not "every billion they make in profit". It's every billion they make.

> They are the middle man between patients and the places/people that actual do provide medical services

This is the same way Medicaid/Medicare works too. Maybe they are the Neutral Good whereas insurance companies are the Neutral Evil.

Yeah. They should manage the organization that directly decides, like the current arrangement with CMS managing Medicare.

The US could copy virtually any other health system in the world and get lower costs.

> Health insurance companies do not provide any medical services.

This is substantively not true (though literally true at the level of a company, due to separate companies within the Kaier consortium) of the nation’s largest managed core organization, the Kaiser consortium consisting of the Kaiser Foundation health plans and the Kaiser Permanente Medical Groups.

> No when they deny coverage, they just keep all the premiums paid by the patient. That money is sucked up by the middle man. So you don't need to raise premiums, you need to lower profits at health insurance companies.

Something like limiting retained profits at the plan level to a fixed fraction of costs covered, and requiring refund of excess premiums to members?

Irrespective of how healthcare is financed, they are going to do that (well, the government is, it is possible that the government may not be comprised of elected representatives), the question isn’t whether they should, but how many other actors that are neither you nor your doctor should.

If I can reliably sell people $1 bills for $1.03, in extremely large quantities, I'll be very, very happy.

Low margin, high volume is very different than low margin, low volume. The Walton family is very pleased with their tiny margins and the wealth it has delivered them.

> requiring refund of excess premiums to members

The solution is to provide the medical services people bought the insurance to cover and not reflexively deny claims counting on at least some people to give up or die.