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They can't do that.
The ACA requires large health insurers to spend 85% of their income on health care providers. If they don't (eg because they start paying less to anesthesiologists) then the savings must be used to reduce premiums or give rebates to customers.
Hmm I didn’t know this. But is there anything stopping health insurers from spending the money on businesses they own (i.e. their own clinics, pharmacies etc)? If not I still fear they’ll run off with the savings.
United Health actually bought a bunch of health care providers, so they basically own a good chunk of the entire 'vertical' and somehow still ended up denying record amounts of claims.
What I don't understand is why Americans are still looking to the federal government to solve the issue, instead of getting together and building a non profit co-op to deal with health care. Do the insurance part, gain market share by being the ones that actually don't deny valid claims, start/take over hospitals, start making your own generic medicine, etc. If you don't have to make a profit and appease shareholders you can take over the entire market. Local/state governments could provide some of the seed capital for this and make it the 'public option' in that state.
You're surprised that normal people don't just start up their own multi-billion dollar corporation with assloads of liability and assloads of government oversight?
It's how it's done in many countries. You can bootstrap off unions, churches, etc.
The Blue Cross Blue Shield insurers are either nonprofits or mutuals (the shareholders are the policyholders). So are many smaller insurers.
But nonprofit insurers are subject to many of the same pressures as other insurers. They need to keep premiums low, and they would go bankrupt if they paid every claim.
Likewise, the vast majority of hospitals are nonprofits. But nonprofit hospitals have to pay for medicines, doctor salaries, etc too. Most are barely scraping by and can't fund clinical trials into novel genetic medicines.
Why would hospitals need to run clinical trials? Just provide the basic health care.
Oops, I read "generic medicine" as "genetic medicine". I thought you were suggesting that hospitals start competing with pharma over new mRNA designs!
Yeah, you don't need a clinical trial to make generic medicine. But you do need special facilities, which most hospitals probably would be unwilling to pay for.
It initially said genetic because of autocorrect, I just fixed it. And hospitals wouldn't need to be making medicine, you need to start a corporation, like those guys that are trying to make a generic insulin. If you start selling those with even a small profit margin everything else would come down. The issue is that profits get extracted by every middle man in the system.
Well, when you deny a claim from a clinic you own then it's very likely your "savings" are losses for your clinic.
I was thinking more along the lines of deny claims for clinics you don’t own but approving claims for clinics you do own. Effectively shifting premiums away from outside clinics and into your own pockets all while staying under the 80/20 rule.
Insurers already divide providers into in-network and out-of-network. They deny or pay very little for out-of-network providers, because they want their policyholders to stay in-network. The reason they prefer in-network providers is that they negotiate reduced/discounted rates with those providers.
Sure, they could outright hire those providers as employees, but that means they would have to start paying their entire salaries rather than just discounted fee-for-service. And that's not necessarily a good idea, because health care clinics are not very profitable. Basically, this is the same question facing everyone who has to choose between hiring an employee and paying a subcontractor.
That said, some insurers do run their own clinics and hospitals, notably Kaiser Permanente.