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Culture War Roundup for the week of December 8, 2025

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these health insurance ceos need to be reigned in so they aren't causing so much damage to society

But they're not. US healthcare is overpriced, but the money is flowing to doctors and hospitals, not to the insurance industry, whose profits are small. The insurance industry are just the middle man, paid to redirect the customers' ire from those lovely doctors and nurses.

Although your misunderstanding does really highlight how bad the 'randomly execute people I assume are responsible for my problems' method of political activism is.

This is a more complicated question than it sounds.

It's true health insurance companies have very thin margins: almost always <5%. And it's even true that the ratio of premiums paid out to revenue collected (the 'loss ratio') is rather high across the board: >80%. ...But the reason it's strictly >80% is that that's the legally mandated minimum per the ACA. If they fall below that number, they have to issue rebates to customers to meet it.

On the face of it this sounds like a good thing, right? I've argued in the past that corporations aren't always eager in practice to maximize profit (principal-agent issues where employees and not owners are making most of the decisions), but they largely do try to maximize their own size. The law limits administrative bloat!

Except... it doesn't. It limits bloat to a percentage of payouts. If they negotiate well and push prices down, they reduce their profit/operating budget! Unless it's compensated by more custom, of course; the normal competitive pressures do still exist. But this rule absolutely acts against that pressure.

This is a classic example of Goodhart's Law. Without this requirement, loss ratio is a good measure of efficiency; since a company will always try to minimize their expenses (the ones that involve sending checks to other businesses and don't benefit any employees, anyway), high loss ratios just mean there's adequate competitive pressure to keep them lean. But now? Who can say? The number is going to be >80% no matter how much or little competitive pressure they're under. If competition is insufficient, they'll just throw money at doctors and hospitals, because that's the only way they're allowed to raise profit/operating budget (via higher premiums). And if they were, it would exactly like you're describing.

But are they? I'm really not sure. Loss ratios were often lower before the ACA (sometimes as low as 60%), but a lot has changed about the healthcare market since 2011. Health costs are going up everywhere, not just the US. It's a murky subject and I don't think there are many easy answers to be found.

But they're not. US healthcare is overpriced, but the money is flowing to doctors and hospitals, not to the insurance industry, whose profits are small.

I don't see any numbers in that linked post, or in the posts linked from that, that compare hospital profit and insurance industry profit.

And even some of the links from that post blame the problems on the insurers when you seem to think they don't.

The bloat is not necessarily "profit". For instance, when insurance companies and hospitals hire armies of bureaucrats to argue over the claims, all those bureaucrats get paid and none of that is "profit" to either side.