Not sure you're understanding. The insurance companies can't gouge by jacking up profits because that's illegal. They can't ever become a big component of healthcare spending nominally, but they can be the actor that causes a big component of health care costs to baloon.
The way insurance companies might gouge is by jacking up healthcare prices, since they act as a government-captured oligopoly block and thus don't have normal free market forces. That is how they could increase nominal profits without increasing % profits.
They could jack up health care prices massively while only being measured as a small % of the total. Whether this is actually the case or not, I'm not sure, but the incentives demand that they do it if they can. It should be impossible to pull off such a cartel in any unregulated market, but due to the way healthcare works it seems more likely it could be true.
The overwhelming majority of the money they'd be diverting by doing that would be going to health providers, not to payers and underwriters. Therefore, the hypo you're offering isn't interesting to me. I'd still be starting by looking at the institutions that actually end up with the money.
>The overwhelming majority of the money they'd be diverting by doing that would be going to health providers, not to payers and underwriters.
Yes exactly. Imagine for a moment you have a market where every payer has to pay every healthcare provider, and a free market of health care providers. It would be impossible to create a cartel of buyers raising the price.
Then imagine, say you have universal healthcare insurance. The insurance provider is capped at say, 1% profit. Since they have a monopoly, they can walk up to the healthcare providers and say "hey, please jack your costs 3x" so we can get 3x the profit. And then you can turn around and do a study and say, well insurance profits haven't changed -- and then wrongly conclude the insurance companies aren't to blame for the inflated prices, as they are only capturing 1% of the health care industry despite being responsible for 200% price increase.
I believe the nature of health insurance industry probably leaves them somewhere in a gray area in-between these two extremes, especially when you consider the insurance companies also often own under an umbrella company health care providers.
Seems like motivated reasoning. I'm looking at a single-page spreadsheet that tells a very different story, and I'm going to stick with that rather than the hypo.
Based on what you've told me so far I'm not understanding how you can be sure of that. After the ACA caps was passed (limiting % profit) nominal health care spending went up significantly.
The way insurance companies might gouge is by jacking up healthcare prices, since they act as a government-captured oligopoly block and thus don't have normal free market forces. That is how they could increase nominal profits without increasing % profits.
They could jack up health care prices massively while only being measured as a small % of the total. Whether this is actually the case or not, I'm not sure, but the incentives demand that they do it if they can. It should be impossible to pull off such a cartel in any unregulated market, but due to the way healthcare works it seems more likely it could be true.