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Do you think it's always a tradeoff between who gets treatment, never a tradeoff between profit and treatment?
That trade-off certainly exists sometimes, but is overdetermined. Under Obamacare they're heavily regulated and their profits are bounded.
It's not totally grim of course, they can earn a return on the parked capital and the float on premiums but it does complicate the picture. And they are incentivized to scale.
In the limit they actually prefer "the standard of medical care" to go up[1], because it means premiums go up, because the pie is bigger and the 15% of the bigger pie is more absolute profit.
Nevertheless, these corporations may be big, and profit-seeking, but you would not get rich quick by investing in them.
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That is a destructive question. The tradeoff between profit and treatment is discussed ad nauseam. The gradual accumulation of treatments that extend life, without restoring its quality, and are expensive, is painful to think about. So we don't. But we need to, and the profit question helps us procrastinate and never get round to the uncomfortable issue :-(
I frame it with an equation life-span = health-span + grim-span. Modern medicine is extending the health-span. But for every extra year of health-span, we get three or four years more grim-span. (3? 4? I'll admit that I'm guessing wildly. I just don't want to follow my grand-mother and my parents down the care-home, dementia-unit, nursing-home, route.) Expensive grim-span.
We are well down the road of nibbling away at the quality of the health-span with taxes (or insurance premiums) to pay for expensive medical treatments. When do we say: there is a cash limit. That is a scary thing to say. Perhaps I will fall ill, find out that there is a treatment to save my life, find out the cost is over the cash limit, and get told "sorry, you'll have to die". Maybe the cash limit will be low because I decide to opt out of insurance for expensive treatments, enjoy spending the money I save, and die when my luck runs out.
There are two battles. One is around opting out. If I opt out of paying for the more expensive treatments for others, and therefore (by fairness) for myself, can I change my mind when I fall ill? Obviously not. Can I still whine about it, or must I die quietly? The other battle is about the future. More expensive treatments are coming. When is the breaking point when the money runs out?
Returning to the profit question, the British National Health Service (the NHS) is funded out of general taxation and free at the point of use. Do we Britbongs escape the profit issue? We should, because the NHS is a non-profit. But it doesn't work out like that. At constant funding there is a tradeoff between the wages of doctors and nurses and treatment. At constant funding, higher pay means fewer doctors means less treatment. Alternatively there is a tradeoff between funding and taxes. The politicians in charge need to keep in touch with fluctuating public sentiment. What will get them re-elected? More taxes and more health care? Lower taxes and scandals about people dying waiting for treatment? Perhaps the warning sign of the impending breaking point is no-one can get re-elected. The low tax politicians cannot get re-elected because of the deaths. The health care spenders cannot get re-elected because of the taxes.
We need to learn to memento mori least we build a world in which we spend our lives working long hours in health care, before eventually falling ill and taking a very long time dying, kept alive by the strenuous efforts of many younger people.
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I don't have enough insight into their inner workings to be able to answer this. But my guess is they are targeting some positive profit margin (since they would have to) and creating actuarial rules to target this number. Then claims etc are mostly following an algorithm. But then again given as I have alleged the "non-insurable" nature of health, they are probably having to constantly tweak this.
I doubt they're frequently making individual case-by-case decisions to deny somebody for the sake of let's-get-rich-and-do-coke, but maybe I inappropriately assume people aren't monsters.
In any case I'd want to see evidence of such backroom decisions because it's quite an allegation. But that would be hard because I'd also want to see that it's not just "this guy is trying to spend infinite money to eke out another month and unfortunately we don't have that" sort of thing. Like my point is it's actually really hard to prove actual malice here.
I think directionally, yes. It’s just good resource allocation to look at the actuarial data and say “this drug might marginally improve your life for a few months, but you’re old or in bad shape physically and thus your treatment makes no sense.”
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