[kortilla]

Denying is not for shareholders, it’s for policyholders. A health insurance provider that doesn’t put guardrails on treatments will fail because the required policy rates will go up so much that the healthy people will go to a lower cost provider.

People are happy saying the insurance provider should just pay for everything until the bill comes due in higher monthly premiums.

Insurance companies are doing the only thing they can to exist in this fucked up system where people can bail when prices increase.

[zer8k]

This is a function of limited risk pooling. Health insurance companies are state-locked. In the limit they function as options sellers in a stock market. If they can’t hedge off volatility with a larger risk pooling strategy they do something you can’t do at the market - simply deny care.

This problem is due to manufactured monopolies and regulatory capture. Open up cross state healthcare, allow larger risk pools, and use this to hedge off the risk of the 1/10% of customers who represent the highest risk pool. Costs go down for everyone and quality of care goes up. It’s not quite single payer but it’s simple probabilities. I find it hard to believe they wouldn’t lobby for this unless it’s vastly more profitable to stay state locked and deny care.

Of course though you are correct, in that a treatment still should have utility. But the average person being denied something as simple as a PET scan does not represent a maximization of utility. That is greed.