[continued from previous message]   
      
   for my needs than politicians deciding one plan for everyone. What do   
   you think—would you prefer zero options or dozens tailored to different   
   situations?   
      
      
      
   >   
   >   
   >> budget, and preferences, with options for add-ons like dental or   
   > vision.   
   >> Single-payer is one-size-fits-all, dictated by bureaucrats, often   
   >> resulting in rationing and long wait times. See Canada's system where   
   >> median wait times for specialist treatment are over 27 weeks vs. under   
   > 4   
   >> weeks in the US for similar care.   
   >>   
   >> Incentives for quality: Profits motivate insurers to approve claims   
   >> quickly and invest in preventive care to avoid bigger payouts later.   
   >   
   >   
   >       You have it backwards. Insurance companies   
   > don't profit from paying claims, they profit   
   > from DENYING claims. The knee-jerk rejection of   
   > claims is so rampant that even Republicans have   
   > urged government to intervene.   
      
   The idea that insurers primarily profit by denying claims isn't   
   accurate. The business model is the opposite. Insurers make money by   
   collecting premiums and investing them, then paying out claims. They   
   profit from the "float" and underwriting (premiums > claims + expenses).   
   Under the ACA's Medical Loss Ratio (MLR) rule, they must spend at least   
   80-85% of premiums directly on medical care and quality improvements—or   
   rebate the difference to customers. Denying legitimate claims might save   
   short-term money, but excessive denials lead to appeals (over 50-60%   
   overturned), lawsuits, regulatory scrutiny, lost customers, and   
   reputational damage in a competitive market.   
      
   Furthermore, most denials aren't "knee-jerk" profiteering: Many are for   
   administrative reasons (coding errors, lack of prior auth,   
   out-of-network), not medical necessity. When appealed, a majority get   
   paid—showing the system catches errors. And profit margins are   
   razor-thin (see above). That's not a "denials bonanza"—it's tight cost   
   control overall.   
      
   Government programs deny too. Traditional Medicare has lower initial   
   denials (~8-10%), but Medicare Advantage (private insurers running   
   Medicare) is similar to commercial plans (15-17%). No system's   
   perfect—both have gatekeepers to prevent fraud/waste.   
      
   Back to incentives tho. Private insurers invest in preventive care   
   (wellness programs, early screenings) because keeping you healthy means   
   fewer big claims later—aligning with paying out efficiently. A   
   single-payer monopoly removes that competition, often leading to   
   rationing via wait times (e.g., Canada's median 28+ weeks from referral   
   to treatment per 2025 Fraser Institute data, vs. US averages around 4   
   weeks for specialists).   
      
   Denials suck in any system, but competition pushes private plans to   
   balance cost control with customer satisfaction (or lose business). A   
   government-run one replaces profit incentives with bureaucratic ones—no   
   escape if it goes wrong. Thoughts on that trade-off?   
      
      
      
   >   
   >   
   >   
   > States try to rein in health insurers   
   > claim denials, with mixed results   
   > MARCH 25, 2025   
   > https://stateline.org/2025/03/25/states-try-to-rein-in-health-insurers-   
   > claim-denials-with-mixed-results/   
   >   
   >   
   >   
   > Health Insurers Deny 850 Million Claims a Year   
   > Feb. 12, 2025   
   > https://tinyurl.com/mr2bt5ep   
   >   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)