[getnormality]

> why smaller insurance companies aren't popping up to deliver better quality

I am no expert, but my impression is that it would be very hard for the insurer's customers (e.g. employers) to know an insurer was better, and many might not care. There's so much opaqueness and indirection in the system, it's not surprising it's both inefficient and heartless.

That said, all systems ration in some way or another. We need to come to grips with that.

[yencabulator]

It's like a bank claiming they are "better". How would you even notice? You only become aware of the not-better aspects after they hit you.

[getnormality]

And you might hope that reviews or consumer surveys might help, but all health care companies seem to provide the same mostly mediocre, unpredictably terrible service.