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Comment by craigmccaskill | Hacker News Reader

If there is a silver bullet, the first step would be getting rid of the for profit mechanisms.

Instead, because despite data linked in this thread that profit margins are only a few percentage points, Healthcare is an incredibly lucrative field that extracts a lot of money into the private market without delivering results commensurate with the cost to the public.

Add to that lobbying making it incredibly simple and cost effective to influence policy (which comes out in the P&L as a cost of doing business and so isn't tracked as profit FWIW), we are stuck with this situation despite overwhelming evidence that it's a bad deal.

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Kaiser Permanente, Providence Health, all the insurers in the BCBS franchise except Elevance, and many others are non profit.

Yet they are unable to provide lower premiums than UNH/Elevance/CVS/Cigna/Humana/Centene/Molina.

Kaiser is a full vertical, you buy insurance from them, you see their doctors and nurses in their outpatient clinics and hospitals, you get medicine from their pharmacies. So why is everyone not choosing Kaiser?

Edit to respond to below since posting limit hit:

UNH had $371B in revenue, not profit, therefore it is irrelevant. If the claim is UNH is excessively profiting, then profit margin is the only metric relevant to the discussion.

Kaiser's managed care organization IS non profit, so it is relevant here. It clearly shows that the managed care portion of the business is not sucking out outlier amounts of profit, because Kaiser's premiums are not different to UNH or any other MCO's premiums. Also, Kaiser's annual revenue is $100B or so, not $4B.

https://about.kaiserpermanente.org/news/press-release-archiv...

If a managed care organizations being for profit or non profit was the straw that was breaking the camel's back, then it would show up as non profit managed care organizations being able to offer much lower premiums.

>say that for profit is the way to go because if Kaiser can't do it then nobody can.

I am not claiming for profit is the way to go (or the opposite). I am saying, within the confines of the US healthcare system, for profit managed care organizations are not THE source of higher healthcare costs.

Kaiser had an income of 4.1B in 2023 vs. UHG's 371.6B in an industry of 4.8T [1]. I'm not sure the point you're trying to make or why it's relevant unless you're asking me to read between the lines on the efficacy of Kaiser as a non-profit vs. their for-profit counterparts (which is what seems to be the case).

edit: I think I missed the last part of your comment in an edit, so to attempt to answer my own questions, it's not a fair comparison beyond just the almost 100x size difference to compare a different business model and scope, provider network, risk pool and geographic presence yet ignore every other developed country in the world and say that for profit is the way to go because if Kaiser can't do it then nobody can.

[1] https://www.reuters.com/business/healthcare-pharmaceuticals/....

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