• PugJesus@lemmy.world
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    9 days ago

    Unfortunately, you’ll quickly find that the structure of the system will crush ‘generous’ insurance companies in short order.

  • RecallMadness@lemmy.nz
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    9 days ago

    New Zealand’s largest private health insurance provider (Southern Cross) is “run on not-for-profit principles”.

    It’s not terrible, and seems to work. I guess the caveat is that their competition is a (mostly) functioning public healthcare system.

    • jqubed@lemmy.world
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      9 days ago

      I’m not sure if it’s still the largest in the state, but Blue Cross Blue Shield of North Carolina is a non-profit, but they don’t seem to run in a very not-for-profit way. A long time ago, maybe 20 years ago, the board tried to switch it to a for-profit organization with the stated goal of going public and issuing stock options. The state didn’t allow them to do that, so the board started giving themselves lavish pay raises and arranging executive “retreats” in prime vacation destinations like Hawaii.

      I don’t know how their denial rate compares to for-profit insurers, but they are a giant pain to deal with, and we have no other real options for the doctors we see and medications we take.

      • Spitefire@lemmy.world
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        8 days ago

        I’ve worked for the non-profit insurance subsidiary of a charity hospital system, and part of the problem is that ANY of the competition is for profit. What that means is that the for-profit companies are effectively setting the baseline of coverage. Healthy people (or the HR department at the company) aren’t as concerned with richness of benefit as they are with the lowest premium. Sick people, though? They’ve got a list of doctors and drugs they want to make sure are covered. So if the non-profit benefit is too rich it attracts all the sick people and suddenly the operating costs of the non-profit skyrocket and they go out of business. It’s a weird model that can’t be AS good as the mission wants to be.

        In my case the hospital system actually created a generic drug manufacturer themselves to undercut for-profit drug manufacturers. THAT was less daunting than trying to impact the insurance side any more than they already do.

  • MystikIncarnate@lemmy.ca
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    9 days ago

    Oh. Can it be run by the government, and provided to anyone who pays taxes (either currently, in the past, or someone that will in the future, like a child)?

    That would be great.

    I think you just invented socialized healthcare.

  • AlternatePersonMan@lemmy.world
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    9 days ago

    Maybe start with clearly defined maximum pricing, publicly visible numbers, and strict punishment for denying doctor recommended claims. Also no “out of network”. If your hospital accepts insurance, they are in network.

    The venn diagram of massive profits and legit health care is just two circles that don’t touch.

  • Jesus@lemmy.world
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    9 days ago

    Kaiser Permanente is not for profit and not publicly traded. It’s not perfect, and it’s not cheap, but having dealt with America’s other insurance options, IMHO, it’s the best option in the US… if they’re in your state, and if you take the time to learn how to navigate an HMO.

    Its not cheap, but it’s not nearly as expensive as the alternatives, and the don’t deny claims as much.

    • Clay_pidgin@sh.itjust.works
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      9 days ago

      I had Kaiser for several years and it’s the best version of the US healthcare system I’ve seen. It was reasonably cheap (compared to other insurance), they didn’t jerk me around for referrals to their specialists, they have optometrists and pharmacies and stuff on site so you can get a few appts done in a day. It was convenient. Now, I’m sure some people have had a terrible time with them and I don’t deny their experiences, but it worked for me.

      • Jesus@lemmy.world
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        9 days ago

        Same. I feel like, a few decades ago, you could make a good argument that PPO land gave you more choice in exchange for higher fees. But these days, the good private practices are completely slammed, and I honestly think it’s faster and easier to find a good doctor or specialist in Kaiser.

        The crazy thing is that my spouse works for one of America’s PPO insurance companies, and she’s rather use my Kaiser plans. The care is better and the out of pocket is way less.

  • zxqwas@lemmy.world
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    9 days ago

    While it’s good that you’d want to improve the system you’ll have to look deeper as to why.

    First results from my search:

    Health insurance has about 3.3% net profit margin. United had 3.6% last data I found. (The rest of US industry average is 8.54%.)

    The profit margins of insurance alone can’t explain why your healthcare costs 40% more than any other country.

    • nieminen@lemmy.world
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      9 days ago

      Considering insurance, and medical facilities negotiate to set their costs every year, I don’t trust that their profit is so low.

    • Diplomjodler@lemmy.world
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      9 days ago

      I’d chalk this up to the kind of “creative accounting” they do in the movie industry. But that’s just a guess, I don’t have any knowledge on the matter.

    • Wolf314159@startrek.website
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      9 days ago

      A small percentage of hyper inflated prices over a large consumer base still equates to MASSIVE profits. It is a fundamental ethical flaw that we even allow for-profit medicine that is compounded by obvious cartel organization structures and corruption.

    • Krzd@lemmy.world
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      9 days ago

      Some of that is “clever” accounting, the rest is that healthcare insurances don’t have bargaining power with the providers. In Germany the state insurance companies have collective bargaining power so that for example an ambulance ride costs 500€ instead of 15000.

    • Squirrelanna@lemmynsfw.com
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      8 days ago

      Even if I took this at face value it only confirms to me even more that for profit insurance is a ghoulish waste of resources. So much pain and suffering just to milk people in need of a pittance of a profit margin (relatively speaking) is atrocious.

  • shoulderoforion@fedia.io
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    9 days ago

    Approved claims, and no profits. Once you start approving claims, the hospitals and healthcare companies will continue charging whatever they want to. The Insurance game is a losing proposition if claims must be paid, it only works if they’re allowed to deny claims. It’s a nonstarter. Which is why in a nation with a functioning public healthcare system, Insurance companies aren’t necessary. Healthcare costs will always outpace the income an Insurance company will charge.

  • Possibly linux@lemmy.zip
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    7 days ago

    You should’ve left the original.

    “I’m going to start my own health insurance company with blackjack and hookers”