[gen220]

Yep, this is a huge caveat that this thread missed. Thank you for raising it.

For health insurance, the rule is:

> Health Insurance companies must spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

As a health insurer, you can lower premiums while increasing spending on "Quality improvement", to provide a better experience at a lower rate, and increase your market share. This is one dimension of competition that is only beginning to be competitively explored.

If you can get quality improvement at lower marginal costs (which is ultimately a tech problem), you're a more competitive health insurance company.