[rayiner]

Trying to understand why healthcare in the U.S. is so expensive is like trying to understand why building subway in New York is so expensive: https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-.... The issues lend themselves to facile explanations ("insurance companies are greedy," "NYC's government is wasteful") but those are driven by ideology not analysis.

[autoexec]

What we can say for certain is that heath insurance companies in the US stuff their pockets with tens of billions in profits each year and that Americans are paying far more while getting less for their money than other developed nations. I don't think those two things are unrelated.

[gmoot]

What is the profit margin of a health insurance company? Google suggests 2-4%, with United at about 6%. This does not seem that extravagant.

[nradov]

Something around half of UnitedHealth Group (UHN) profits come from other business units that aren't directly related to UnitedHealthcare insurance plans. They have a huge software business under the Optum brand that would be one of the top 20 largest US tech companies if it was broken out separately.

[rayiner]

That means the insurer part makes even less profit.

[rayiner]

U.S. healthcare spending is over $5 trillion a year. That’s $5,000 billion. So the “tens of billions in profits” you’re pointing to accounts for very little of what people spend on healthcare.

That’s what I mean when I refer to facile ideological reactions. For many people, “profits” are the problem, and they don’t care that health insurers on average are less profitable than Subway franchises. It’s just the mirror image of people who say the New York MTA is a disaster because the government is running it, and don’t care that governments in other countries manage to run cost-efficient train systems.