That's what I'm wondering. Insurance is supposed to work when the majority of subscribers never need it, so there are large sums available for the few who do. Is that model valid for healthcare? HMOs are forcing it into the model by discouraging or preventing payouts. If they did pay claims, would it work?

I'm also inclined to think, unless proven otherwise, that corporations are set up as one entity, and that one body is socio-pathic.
Maybe something as important as life or death never should have been put in the hands of a socio-pathic corporation (even though the individuals working there are harmless and just doing their job).
Their job is to take your money! Any way possible! Quickly!
Do we really want them to make the major decisions about our life and death too?

How is it that prosecuting a war is so important it requires state funding (ie, the army) yet healthcare is left to the profit model?

If they pay, they don't make as much money - thats what they think they are there for. If they go into direct competition, then some companies will only take the much lower risk clients leaving many uninsured or paying more.

Y'know I think the market is good for driving clinical development along, but it fails miserably at delivering healthcare as it is needed by patients.

HM, there are lots of forms of insurance that are profitable. I think the biggest problem with health insurance is the loss of competition due to health insurance being a standard employment benefit. I can't reasonably change providers even if I'm unhappy with them, because my employer (my husband's employer, whatever) chooses the plan. And their main concern is cost; employee satisfaction is somewhere in there but definitely not as important.

In my ideal health care system, 2 major changes need to occur:

1.) No more employer-provided benefits. Everyone pays for their own insurance (salaries are raised accordingly to reflect this change), and they are free to shop around among providers.

2.) Catastrophic coverage becomes the norm. The insurance model in general is designed to cover disasters, not generally subsidize everything so you pay a $15 copay on your $35 prescription. No other type of insurance does this--my auto insurance doesn't have me pay a copay on my oil changes, they just cover the unexpected $2000 wreck. And auto insurance is competitive and profitable for the providers.

As a member of Tricare (the military insurance company, the closest thing we have to socialized medicine), under my father, I'll have to say... I dont think I trust the government with our insurance. They do great in Britain, France... prettymuch everywhere except here, but I dont know if we can do it. Too much bureaucracy, too much bullshit.

But there's no better solution, I don't think. The current system sure as hell's broke.

Yes, but they are against events that are unlikely. What are the chances that someone in your family will be hospitalized at some point?

The chances are pretty good. But that doesn't matter. The amount spent on them is likely to be less than the total amount of (somebody's) hospital care I pay for (one way or another) over my lifetime. You can't just pretend medical care is cheaper than it is. Someone's always paying for it.

No, that's the problem. HMO's aren't paying for it. They are denying claims in order to maximize profits - perhaps even to be profitable at all.

If the primary goal is profit, is there a way to organize things so an emergent goal is to pay all valid claims? They seem antithetical to me.

How do insurance companies make money on life insurance? Not much uncertainty there.


I know I'll never pay in more than I get out (I guess, maybe I'm wrong. But it seems like a million dollar policy would far exceed my total payments. I don't know, actually, I don't have a million dollar policy anyway.)

Million dollar policies are almost always "term" policies. They expire once you get past a certain age--usually 10, 20 years after the policy was initiated, something like that. You live past then, you basically lose all the money you paid in. And your personal price is quoted to you based on your age, health, a whole variety of risk factors. It's exactly like odds-making in Las Vegas. Most people lose a little, some people win big (er, well, their families do) and the house always wins a little. Policies that last until-you-die-no-matter-what usually only pay out ten thousand dollars or so, definitely less than you paid over your lifetime.

Only when bad customer service (i.e. not paying valid claims) = loss of profit. And that will only happen when the customers are able to dump their providers.

When I said "someone's always paying for it," I meant that there's no way around the fact that healthcare is expensive--even when it's subsidized by the government, "we" are still paying for it in taxes. People have to get used to the idea that health insurance costs about a thousand dollars a month, and just because their employers are paying that cost now doesn't mean it's not coming out of their salary in the end.

I've thought this before too, but what about the "stitch in time saves a dime" argument? If someone has to shell out $300 to have a regular preventative care doctor's visit instead of $25, they are less likely to get those regular checkups, and less likely to seek medical attention until the problem is severe and much more costly to remedy. There should be a financial incentive to take care of yourself. (I cringe typing that, because good health should be enough of a reward, but I honestly think for most people money is a bigger motivator.)

When I had no insurance, docs would routinely change their invoice to charge me less, such as turning a standard examination to a minor consultation.

The ER had no similar consideration though.

Yep, if insurance weren't such an overblown scam, a regular doctor's visit wouldn't cost $300 in the first place. Maybe it would still cost too much for some people to consider preventative medicine worth it, I don't know. But I figure those types of people wouldn't listen when their doctor told them they had to change their diet/exercise more/stop drinking anyway...