Agreed. But I don't think that the health care insurance companies will risk their companies in the way that Wall Street hung themselves out, in 2000 to 2007. Wall Street knew that they were selling junk. But they got caught in their own rhetoric and sell's pitches, that they ended up buying a substantial amount of their own junk. I think that the insurance companies are a breed apart from Wall Street. They make their livings by accessing risk. At least I hope that they are.
The intrinsic truth about health care is that it will never lend itself to the market. It never has in any country in the world. There is considerable amount of evidence that the opposite is true, that the countries with the greatest amount of for profit in the health care industry are the countries with the highest health care costs.
The driving force behind any Republican health care bill will be to loose the free market on it. The power of decades of supporting a fantasy. I don't know where we can go from here.
The business model of health insurance is predicated on the premise that a person is entitled to all the health care they can afford. Health insurance simply expands this group of people, and it is a profitable model. The group contributes to the pot and takes out, as needed.
The problem arises when the premise shifts to, "all people are entitled to healthcare." A lot of people can't afford to contribute, but still need to take out. This really cuts into profits.
The GOP ideology of the free market health insurance, simply won't work, unless it restricts itself to those who can afford minimal payments. There is no way to "cover everybody" in the free market, because the profit margin drops to the point where some other opportunity will attract the capital.
If health insurance remains a private business and we have universal coverage, the only business model which works is the public utility. This means a government sanctioned and regulated monopoly, where service standards are set by law, a certain percent return on investment is allowed and efficiency is rewarded. Those who can't pay receive subsidies for their premiums. This is basically the Obamacare model, without the monopoly.
This is true. And needless to say, if you cover everybody, if you provide everyone with health care, there is no reason to do it through private, for profit insurance companies. We have more than twenty years of proof of this in the Medicare Advantage program. The Republicans passed this years ago, to prove that private, for profit insurance companies were more efficient running Medicare than the government was. Not too surprisingly this proved the opposite, that the government was much more efficient at providing Medicare than the private companies. The private companies still have to be subsidized even while they are able to cherry pick who they sign up, and the government has to cover everyone else.
The most widely used and proven model around the world is not single payer. It is the Bismark model that uses private, non-profit, community rate based companies, used since the 1870's in Germany. It was spread to most of Europe by Hitler and the Nazis into the countries that they occupied in World War II. It was continued in virtually all of the countries after the war because it is so efficient, although it is slightly less efficient than single payer.
Briefly, there are about 200 of these non-profit insurance companies in Germany. For the most part they are run by labor unions or industrial trade groups. They charge everyone the same premium, a community rate. This means that the young and the healthy subsidize the old and the sick. They pay 70 or 80% of the medical bill. The policies coverage is the same for every company like ObamaCare*. The insurance is paid for nominally half by your employer and half by you, although most employers cover the whole cost. You can chose which ever company that you want but the premiums don't vary much and most people go with the insurance company associated with their union or company trade group. You can buy a policy from your insurance company that covers your 20 or 30% co-payment and I believe that the insurance companies are allowed to make a small profit on these policies. Mine was about €250 a month. When I was in Germany around the turn of the century they didn't have any deductibles.
You can opp out of the system and buy private insurance, but once you are out you can never come back in. So the young and healthy pay less, but the old and sick pay considerably more.
I may not know about all of the options available. I was assigned a secretary to help me adjust to German ways. I quickly found out that she helped me by doing everything and informing me what she had done after she had done it. This is apparently the German way.
All of the providers are paid the same for the same procedures. These rates are set every year by three part negotiations between the providers' industry group, the insurance industry group and the government in each German state. This relieves the requirement that each insurance company has to negotiate with each provider as they have to do in the US and eliminates the US's problem of your insurance company limiting the providers, doctors and hospitals that you can go to, a requirement that the Germans wouldn't stand for.
All is not rosy in Germany, with the health care. Costs are increasing faster than the cost of living. This is because the same thing is happening there that happened in the US in the last three decades of the 20th century, the hospitals and clinics are being bought up by for profit companies.
* By the way, this saves a lot of money because the providers don't have to check coverage, and they don't have to get pre-approvals and they don't have to argue with the insurance company about billing like they have to do in the US. This is not a trivial cost. The McKinsey Group estimated that providers spent over 400 billion dollars a year doing these things in the US in 2007. This is why ObamaCare standardized the policies, not to force everyone to buy coverage that they don't want or need. In fact, in ObamaCare while men are covered for mammograms they aren't charged premiums for them, because they are males.
