A quick resume: I worked for the one of the world’s biggest international health care companies, providing international cover for people who travel or live overseas. I was high enough up to be familiar with the business model. I only know a little about US insurance, but I can talk comfortably about insurance in general.

BLAMING INSURANCE COMPANIES MISSES THE POINT

To me, Americans often seem to be obsessed with insurance companies, and hold them accountable for all your healthcare woes. I understand that insurers are blocking reform, and that some of them are unethical in some of their behaviors, they are just doing what they are supposed to do. Some seem to believe that insurance companies’ first responsibility is to provide cover, to enable care. This is bullshit. Their first responsibility is to manage risk in order to make a profit.

I’ve read some on Daily Kos talking about insurers "moving away from the concept of insurance" by doing things like charging higher premiums for the elderly, or denying cover for serious, chronic conditions. To me, these behaviors are slap bang in the middle of the concept of insurance, and are perfectly acceptable for an insurance company. The "concept of insurance" is that you pay higher premiums for higher risk. If the risk is too high, insurers will refuse to cover because they are guaranteed a loss.

We accept this on our home insurance or car insurance, why do we struggle to get it when it comes to health insurance? You wouldn’t expect a motor insurance company to cover a blind driver, you wouldn’t expect to get home contents insurance on a house with no roof; why would you expect a health insurance company to cover someone on long-term dialysis? Insurance by its very nature rewards those who don’t claim and penalizes those who do, with higher premiums or reduced cover. To expect any other outcome is madness.

In these denial-of-cover cases, the crime therefore is not the insurance, it’s the lack of any alternative route to getting healthcare. The crime is the stupidity of designing a healthcare system based on private insurance alone, and expecting it to meet the needs of sick people. It won’t. At best, it might meet the needs of healthy people. You’d better pray you stay healthy.

REDUCING COSTS IS GOOD FOR INSURANCE COMPANIES

In our office in London I sat next to the actuarial team, the number crunchers, who spent a lot of time shaking their heads in disbelief over the cost of American health care. When we wanted to provide a plan that gave an option of getting treated in the US, they’d do the sums and come up with a premium sometimes three times the price of worldwide cover without the US. Unsurprisingly, we didn’t sell very many.

But it wasn’t just the US. Healthcare costs are going up around the world at over three times the rate of inflation. A long time ago we stopped putting our rates up every year and started putting them up every six months. Our sales teams were tearing their hair out over trying to keep customers, let alone attract new ones. It was always a battle between the sales teams who wanted lower premiums to offer, and the actuaries who worked out the risk, or "loss ratio" and who had to make sure each plan was profitable. Balancing the two forces was a difficult game, and there was always tension around the time the loss figures came out.

So don’t believe a word of it if someone tells you that high and rising healthcare costs are good for insurance companies. In a healthy market, high healthcare costs kill insurance companies. If costs were to stabilize or go down, insurers should see their loss ratios go down, be able to start reducing premiums and increasing cover, sell more policies and make more profit.

A single payer system or public plan would dramatically reduce healthcare costs through better bargaining power. Healthcare costs are running away from us. It’s a no-brainer.

INSURANCE COMPANIES CAN CO-EXIST WITH PUBLIC HEALTH CARE

If American health insurers are pissing their pants at the thought of competing with a single payer system, they should man up and join the big boys. In the UK, private health insurers have co-existed comfortably with the NHS for the last 60 years or more, and they don’t find themselves short of a nickel.

The NHS in Britain is not perfect, but it is so beloved by us Brits that it was the policy of my company, seared into the minds of all new recruits on day one, never to criticize the NHS or to try to directly sell against its perceived flaws. Instead, we simply offered policies that gave people services and coverage that the NHS couldn’t give them. All of our six million UK customers already qualified for NHS treatment, but they liked the extra benefits, such as shorter waiting times, that we could offer them. We also found many ways of working in partnership with the NHS, to the point that it even became one of our customers, with NHS patients receiving treatment in our private hospitals.

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Sometimes it’s odd being a part of this community and not being able to fully engage in the struggle you face to impose some form of sanity on American politics. This is one of those moments. A single-payer system is so clearly, shit-in-your-face obviously the best and only option that it makes me want to come over there and slap some sense into people. But that would be inappropriate, so I’ll have to make do with this diary.

Good luck with the healthcare fight America, you have the rest of the world cheering you on. In between the moments when we pop out to see the doctor for free.