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Culture War Roundup for the week of August 3, 2026

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I agree with your point overall, but this:

health insurance companies have rather low margins (typically ... 2-5% ...)

Doesn't mean what you'd think it means. Per the ACA, health insurers have a legally mandated minimum loss ratio (ratio of payouts to revenue collected) of 80%. If they don't payout enough to 'justify' their premiums, they're forced to refund the excess, which obviously they never want to do because if the customer is willing to pay that much, which they proved they were by paying that much, refunding it is just leaving money on the table with no upside. The remaining 20% has to be split between operating costs (which will inevitably bloat due to principal agent problems and internal politics) and profit, so 5% might be close to the ceiling of what's possible. Which makes it meaningless as a metric.

To quote an earlier post of mine:

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 look exactly like you're describing.

Is this actually the root cause of healthcare prices exploding? Probably not, but the argument-from-margins doesn't prove it isn't.

When your margin is capped, the only way to increase profit is increasing revenue. Predicted exploding costs means larger premiums means higher revenue.

Okay but you’d still expect competition to try to keep costs low to compete on premiums meaning you’d expect all things equal for insurance companies to want to keep costs low.

But the flip side to that is regulatory complexity means there are large moats to entrance decreasing competitive pressures.