A doctor I know worked in the US and then returned to Canada. In his US clinic, each doctor had 2-3 employees devoted to billing (patient-paid and insurance). In his Canadian clinic, they had 1 employee doing the billing for 4 doctors.
Even the various single payer models in Europe and asia still have insurance companies.
The difference is that in these systems the government has some stake — whether it’s providing the public insurance fund, or owning the company itself — so that the government is financially incentivized to reduce costs.
In the US case everything is private so all parties are incentivized to increase costs as much as possible.
We really should to copy the Bismarck model. Public owned “public fund”, heavily regulated private insurance and care.
Competition among insurance companies in most other systems (like the Bismarckian system) is far more constrained and so consumes far less capital. A huuuuge portion of health insurance premiums just go toward spending on ads to pull members from other insurers and otherwise retain your own (especially while they are paying into the plan rather than pulling from the plan, at which point you’re happy to lose them).
1. Your $3.7 billion figure is about auto insurers
2. I misspoke and meant "marketing" broadly, not ads in particular. This all fits under administrative overhead which is one of the major sources of inefficiency between private health plans in the US compared to Medicare/Medicaid.
I believe there should be a government backed, credit union style, non profit operating in every industry as a baseline for companies to compete against.
I don’t think that would work. The big insurance companies would find a way to undermine that. But also, the government insurer would end up with the most expensive patients who can least afford premiums, and then the libertarian types will use that to show how the government isn’t as efficient as the private sector.
I have no idea what the actual solution should be, though.
When you have the state as a single payer then all those expenses just vanishes.