This is at the crux of everything in America. There are zero punishments for corporations and executives but there are bureaucratic lock ins for "customers".
And the answer is not merely regulation. Why shouldn't I be able to switch health insurance at ANY time? If I am unsatisfied with United Healthcare, I should be able to get anything else right away. Why impose laws on me?
If someone could get the cheapest plan when they're healthy and then go switch to the best plan as soon as they started getting sick with something, everyone would do exactly that.
Insurance companies are required to accept patients regardless of pre-existing conditions, so there has to be something counter-balancing that to prevent people from only getting good insurance when they plan to use it.
This really is a problem only the government can solve, by continuously auditing coverage decisions at random, and sufficiently penalizing the companies that understaff at best, and intentionally deny or delay payment at worst.
Currently, years might go by until CMS audits the company, and even then, there are no consequences. Try arguing for a higher budget for more $400k doctors and $200k pharmacists in this environment.
The current situation is because one company can lower premiums by reducing quality of service, all the other ones have to also, and the buyer rarely buys on anything but price since it’s usually a third party buying it, like an employer.
It's almost as if there is nothing insurance-like about US health "insurance" but the name.
Picture health insurance models laid on top of your car. Imagine your car gets totaled:
Your insurer says, "Hey, we're going to pay out $25,000 for your vehicle. So you have a $1,000 deductible, so that's $24,000, and then your copay for a total loss is $2,000, so that brings us down to $22,000. For total losses, your coinsurance as your contribution for your vehicle coverage is 20%, which is $5,000, so here's a check for $17,000. Buttttt... that's only if you're buying a Hyundai, otherwise the vehicle is out of network and you'll get a check for $8,500 instead."
US health insurance coverage is very insurance-like, due to the out of pocket maximum.
Determining auto insurance coverage is very simple, because fixing/replacing cars is simple.
Determining health insurance coverage can't be simple, because fixing bodies is not simple. It's unknown what will and will not fix issues, how to even measure if there is an issue, and what will cause more issues and the cost/benefit of that fix.
The people who can fix the issue are a lot more rare and in demand than the people who can fix automobiles.
Also, the medicine is patented, and the seller of the medicine wants to be able to charge different prices to different buyers, hence all the games.
Well, other than that whole "out of network" thing...
> Determining health insurance coverage can't be simple, because fixing bodies is not simple. It's unknown what will and will not fix issues, how to even measure if there is an issue, and what will cause more issues and the cost/benefit of that fix.
Don't disagree - but that doesn't make what we have more "insurance-like".
Insurance cannot work if any seller can send a bill for any amount to the insurer and be owed that amount.
Mostly this all boils down to "the healthcare industry in the US needs to be comprehensively revamped in any one of several different ways or methodologies, but likely won't be".
It would be the same in healthcare if quotes were for 4 and low 5 figures with no future costs.
Not only does healthcare easily reach into the 5, 6, and 7 figures, but the health insurance company is also on the hook for myriad known and unknown issues caused by the initial costs.
I mean, this is somewhat the same in auto, too. Is one of the reasons you're recommended to go through insurance even if involved in an accident and the other party offers to give you cash for the initial quote - it's quite common that they start repair work and find other issues because they hadn't removed components or panels to give you a quote. Got cash from someone? Now you have to go back and say "Well, I know the quote said $1,500, but they took off the back quarter panel and found other issues and now it's $3,800..."
That being said, ICD codes, one of the cornerstones of billing, are predicated around "encounters", and certainly not "future costs".
> is also on the hook for myriad known and unknown issues caused by the initial costs.
There's a pretty huge asterisk to all that. Health insurers are adept at neatly sidestepping any obligations. They've fought and won many many times over in court on similar issues, "Insurer is denying me care and I'm going to die/suffer serious issues as a result!" Insurer's response, which has been held in court many times over? "We're not denying you any care at all, we're just declining to accept financial responsibility for it. You're free to get that care and be directly billed."
This might sidestep some obligations, rightly or wrongly. They clearly do not sidestep "any" obligations. The amount of money spent on healthcare claims (medical loss ratios) is public information, available in their SEC filings. It is required to be 80% or more by law.
https://www.oliverwyman.com/our-expertise/insights/2023/mar/...
Every state government has an insurance regulator that also has to approve insurance prices, which are based on the cost of claims. The regulator is not going to let an insurer increase premiums just for profit.
Also, the non profit and for profit insurers have similar premiums, with the for profit insurers having ~3% profit margins or less, indicating a highly competitive market where the revenue is barely covering costs.
Shareholders aren't making any money either (10 year returns lag SP500):
https://totalrealreturns.com/s/CVS,ELV,UNH,MOH,VOO,CNC,HUM,C...
Finally, the fact that Buffett/Dimon/Bezos tapped out on creating a competitor should really drive home how little the profit potential is in health insurance, and any less "sidestepping" of obligations would lead to higher premiums.
https://www.cnbc.com/2021/01/04/haven-the-amazon-berkshire-j...
I worked in EMS. United battled a bunch of civil suits years ago where they had denied HEMS transports (helicopter transport) from accident scenes due to "lacking pre-authorization". For a car accident.
What would that even look like?
"This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the trauma center due to extensive multisystem trauma but we need your authorization. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, I know, it's a bit loud with the jaws of life in the background... Uhh, sure, I guess I can hold for a nurse consult..."