I find the phrase "Don't A/B test with people's lives" to be in search of something catchy, or a zinger. The reality of big insurance has always been to be paid more than they pay out. Simple. You've always been a number to an insurance company.
> The reality of big insurance has always been to be paid more than they pay out.
Well yes, that's how a company stays solvent...
The problem with health insurance is that it's been perverted into a discount club rather than being insurance for catastrophic occurrences. It divorces consumers from the true cost of services and hence service providers are free to play with the costs all they want. Hell, you can't even really get an upfront estimate for a procedure...
Car insurance covers accidents, theft, etc. That's it. Can you imagine how much e.g., an oil change would cost if it were commonplace to use car insurance for such routine maintenance? That's what really went wrong with health insurance in the US, and we're too far down that road to fix it.
I've always viewed it as an arms race to see who can get away with what between providers, insurers, and patients (and before ACA, employers to a degree).
The true cost of service at this point includes having staff and systems (with their own support staff) to negotiate and calculate the cost on both the insurer and the provider side.
So, in a way, if you have one particularly tough to deal with insurer, that cost gets distributed among all patients, and their insurers as well. In addition, the basic cost of any visit now includes some of that administrative overhead.
In the oil change analogy, if you had to walk into the shop, and there was a base price of $50 to cover the administrative costs, you had to wait until you saw a mechanic to decide if you really needed an oil change, and they charged $50, and then you paid the $20 dollars for the oil change, you can bet by now someone would have started marketing a per-visit copay style insurance for cars too.
None of this is to say I disagree with you, just that it's even worse than I think we all think it is.
Comparing cars to human beings is disingenuous. A car is a machine with a finite number of parts and well-documented methods of action.
A human body is an enormously complicated set of systems that can mysteriously fail at anytime for no reason at all, and then fix itself without intervention at times. There is a reason doctors are "in practice."
If insurers didn't make money, they wouldn't coordinate insurance plans.
They're middlemen, like so many HN readers aspire to be, because there are efficiencies to be found in the middle. Insurance is a way of crowd-funding risk, though we rarely talk about it in those terms.
