I do understand how insurance companies work. For example, one acceptable way to increase profits and lower cost is by having a law department that delay payment the longer as possible and write obscure clausules that would come up when you make a claim to try to exclude the more costly procedures and not payback if they can. They even hire private investigators to look for ways to get away without paying. That doesn’t happen with public health services. Also, private insurance companies usually drop off old people after years of paying because they suddenly become riskier/less profitable. That doesn’t happen with public health insurance. Everyone is covered, regardless the cost, the age or if they can afford it.
In US there are many people without health insurance, if that people get the flu and go to work, they would pass it to other people, if they take the day off and are treated, they would pass it to less people.
You make a false assumption: “Half of us don’t get sick”. This is false, because it is matter of time people grow old, old people get sick a lot. And your scenery where some people aren’t covered at all, is one where those people would be passing their illnesses to others. Also, some of those people who can afford health insurance? They are office cleaners, domestic workers who take care of elders and children, McDonalds workers who sell you food… If they go to work sick well, do the math.
Insurance companies doesn’t care about that, neither have power to do anything about that, governments do.
Ans as you agree, your hospitals recommend costly unnecessary treatments. Our public hospitals not, because our hospitals doesn’t aim to make profit. You make the false assumption that cutting cost equals maximize profits, but that is not true. You maximize profits by raising income: unnecessary treatments and a treating only the symptoms, not the root cause or allowing sick people to contagiate others which would mean more patients/customers and more money. Since public hospitals doesn’t need to make profits and just need to cut cost, the more efficient way to cut cost is create a situation with less sick people and treat the root cause just once.
You seem to think that since both private insurance companies and public ones want to cut cost, that the results would be similar. But you let out that just one want to maximize profits and need more income, while the other need “customer” (voter) satisfaction and might even accept losses to achieve that.
The results reflect this. Not only European countries have more life expectancy, they also have less maternity deaths, child deaths, people won’t become broke because a cancer, and rank higher on health services quality, to the point that the US private insurance companies are sending people to be treated here.
Now, there might be private solutions to US. Having public or private health services is a choice. But the first step is to understand how different players interact and that aim for better health is not the same than aim for more profit or even lower cost. At the end of the day, you need to balance different needs and prioritize. While the aim is to maximize profits (and all private companies have that aim), health would come second. Europeans know that a good health service is costly, we still choose health over profit. As I said, it is a matter of preference.
I would say that if you wanted a private solution for US healthcare, you would need to pit insurance companies against the pharmaceuticals and private hospitals. Right now both insurance companies, pharmaceuticals and hospitals are all going against the weaker part: the people. They are the ones with less negotiation power, since oncre you need an ambulance or a surgery, you don’t have time to go to another hospital. And if the drug/treatment you need to survive is under a patent, you can choose to not take it or just take another one. You have to pay whatever they ask.
Your only hope is that insurances are not allowed to include so many clauses, have to pay you upfront and so, they start to be interested in negotiating in the name of all their customers and going after hospitals when they offer bad treatment designed to increase the bill. And they might start lobbying for people to get healthier habits. They would still have less negotiation power than a government, but situation would be slightly better. Also, you might want to limit when an insurance company can drop you as a customer. I mean, in US people who have been paying insurance all their lives, might be drop as customers once they actually need the insurance company to pay back. Again, that doesn’t happen in Europe.
So it is possible that I understand how insurance work, but that my analysis include more variables, players and dynamics than yours. Just saying.
A comparison:
And to close, for an insurance company to lose an old customer when his medical bills are growing, means cutting losses (that is why they refuse to renew contracts with old people). If a government lose voters, they might lose elections and old people are the more reliable voters, besides, the money they “lose” is not theirs, is taxpayers’ they won’t mind operating at a loss especially if they can get electoral credit… Different aims get different results.
