Drew
Forum MVP
I think to a degree that's true... but some of that is self-inflicted as well. In the US, there SHOULD be the opportunity for huge economies of scale. But, our employer-provided model means that negotiation with insurers occurs at the company, and not state or federal level, for most Americans. There are the state exchanges... but insurance regulation in the US doesn't really allow insurers to compete across state lines, which also severely hinders the opportunities to build economies of scale.Whenever I see those kinds of comparisons, I can't help but think that when your population is 10x ours, and divided and administrated in a completely different (and I think more complicated) way, that has to have a major impact on how the spending has to work, making any 1-to-1 numbers comparison difficult to draw meaningful value from.
Honestly, the single biggest argument I see for a public option isn't removing profit from insurance, it's removing all the overhead that requires, say, Blue Cross Blue Shield to operate as 50 separate insurers rather than as one.
(to be fair I think this is one of the reforms that is/was supposed to be part of the ACA, so this may no longer be true. I'd love it if someone could fact check me and prove me wrong... but I did search to see how many states BCBS operates in and their language was very clear that they're a consortium of insurers rather than a single company, so I don't think it is)