Yes, there is something wrong with the insurance industry. But there is something wrong with the hospitals, doctors and drug companies too. The whole system is broken. Hospitals try to eke out the most out of insurance companies, often providing services that are unnecessary. Pharmaceutical companies charge US patients significantly higher rates than in other countries. Don't put all the blame on insurance companies.

>Randy needed immediate psychiatric care, and as an emergency physician I knew the options. We put our trust in the mental health team at a local crisis receiving unit, and they kept Randy overnight in temporary safe housing where he could be observed. By morning they had devised a plan to transfer Randy to a retreat-like inpatient psychiatric facility that was in-network with our insurance. The psychiatrist felt Randy was very high risk, but that he could heal with eight weeks of inpatient treatment. We were told our insurance would cover it.

>But six days into Randy’s eight-week hospital stay, our health insurance company denied any further inpatient care.

>The facility appealed Randy’s case, providing psychiatrist’s notes that clearly outlined his need, but the outcome did not change. Because Randy had no prior history of mental illness, the insurance company determined he shouldn’t need to be hospitalized and stopped paying for his care. A day later Randy was forcibly discharged.

This is definitely a case where the insurance company holds the majority of the blame.

Every player in the US healthcare / health insurance "system" has adapted to the regulatory niche they play in.

If Americans had the fortitude to have grown-up conversations about what should be socialized, how care should be rationed, etc, the public could exert some control over the design of the "system". As it stands, the "system" has mostly been shaped by corporate interests while the public has been distracted by inflammatory rhetoric pumped-out by all the entrenched players designed to play to partisan feelings about "fairness" and "freedom".

John Stossel explained in _Give Me A Break_ that the US once had a variety of pharmaceutical labs researching different cures and conducting trials. But US courts allowed a frenzy of frivolous lawsuits to extract astronomical payouts on behalf of former trial participants, even demanding payouts from the companies that stocked the supply and janitorial cabinets of research companies. One by one, we bankrupted our competitive machines of innovation until the few remaining pharmaceutical companies had grown large enough to defend themselves against injury claims. Big Pharma was created by lawyers.

> often providing services that are unnecessary

Thank a lawyer. "Patient with symptom X would have survived if only the doctor had tested him for Y". Now every patient with symptom X is issued a $5600 scan for Y -- not because of medical science, but because of liability. Every time a courts awards 10 figure settlement because "that insurance company is good for it," all of society pays for it.

the problem is healthcare is run in a capitalist "free market" model, in which all actors are incentivized to increase their profits at the expense of the other actors, and where the patient is either a customer or a commodity

it's inherently the wrong model for providing a necessary feature of life (health), and combine it with a highly litigious society, and well, this is the result

NO

The insurance companies are running the system more than any of the others — it is the finance "wizards" there who put the constraints on the rest of the system. I'll agree somewhat on the pharma companies too, who are also extractive.

You even said it yourself: "Hospitals try to eke out the most out of insurance companies...". Exactly! Because the hospitals and doctors are constrained to do "WHAT IS IN THE BEST INTEREST OF THE PATIENT" — that is their charter (and BTW, that is also the magic phrase to use whenever questioning what they propose to do for a patient or escalating a case). Perhaps a few hospitals or physicians occasionally overdo it, and there are some frauds, but your accusation overall is BS.

The insurance companies have no such constraint — if they do have such a mission goal, it is to OBTAIN MAXIMUM VALUE FOR THE SHAREHOLDERS. And the insurance companies are literally so amoral that they will reward agents for killing people for profit. That is not rhetoric, it is sworn testimony before congress of a person who cut off a patient's coverage, causing their death, and got promoted.

I have seen directly and personally an insurance company deny coverage for a test ordered for a close family member by the Chief Of Cardiology at Mayo Clinic. Mayo Clinic, and that physician are so overbooked they have ZERO motivation to order anything not necessary for the patient in front of them. It took days, and significant extra expense to get it reversed.

There is no way on the planet that anyone in an insurance industry should be able to override the doctors orders of the Director of Cardiology for Mayo Clinic. Or any physician, for that matter.

Medicine is one of the things that should never be run for a profit, and if I were on Luigi Mangione's jury I would acquit on Jury Nullification.