What do you think of insurance companies in a general sense? is really a difficult question to answer...rather like asking what does one think of grocers or automobile manufacturers. There are a great many insurance companies, all or which, in one way or another, seek to make some sort of return on the investments of their owners/stockholders. Some are certainly more rapacious than others; the worst are those who are like the sub-premium mortgage brokers, who draw their customers from the ranks of those who have no viable alternatives.

My own best guess (and I'm sure the numbers are out there, but I don't really feel like looking them up) is that the health insurance companies which cover the largest number of people do so through some kind of employer contract - for example, Blue Cross/Blue Shield or Kaiser. Employers and employees share the cost; the employer share is generally well above half. Because of their sheer volume, they are able to negotiate rates with doctors, hospitals and other medical providers that are much lower than what "private pay" people are charged. For example, a physician might charge $98 for an office visit, but their "reasonable and customary" rate is $32, and that's what they pay. By agreeing to be part of that company's provider network, the doctor agrees to accept that fee and not go after the patient for the balance. I rather doubt that this figure ever represents a loss for the provider! The difficulty comes when a patient lives outside a metropolitan area, where there are few providers who will accept an insurance company's payment as payment in full; then the patient gets stuck with the balance. My own experience with Blue Cross is that they rarely question a charged service...other people have had different experiences with other companies.

The Medicare program in the US covers the elderly (65 and over) and a few special category people. It is basically the same as a group insurance program - there are premiums, Medicare negotiates a rate with providers, there are often "co-payments" that the patient must make (over and above what Medicare pays) and not all providers participate in the program - again, this issue is more acute outside of urban areas. Medicaid covers the poor, generally at no cost to them. The largest group that we need to "fix" is those whose income is too high to qualify for Medicaid, yet whose employers don't have a medical insurance program in which they can participate or one which they can afford.