By the way, as much as people complain about the profit seeking motives of insurers, many of them have been performing abmysally in the last six months. As it turns out, our current system is bad for just about everyone.
Some employers also offer as a bonus a sort of subscription at a private clinic, so you can see a private doctor or have an operation for a lower price or even for free.
In the USA the government health programs for people in low incomes, children and pensioners cost about as much as a typical European single payer health system. Then tax payers get to pay to be gouged by health insurance companies to get any cover for themselves.
If any regulation at all makes a market not "free", then there are no free markets as soon as we have any laws.
Like all free markets, this one is regulated. There are degrees of freedom.
This is why this isn't a free market. It's not about regulation, it's about the system being divorced from responding to market dynamics.
Aside all the insurance stuff, you cannot open an MRI imaging lab or similar without a letter of need from the local government. The supply side is quite literally gated by existing players in the market (via campaign bribes and similar).
For-profit health insurance. Which imho should be illegal.
A lot of the US' quasi free-market, in-name-only health insurance problems would be solved by:
1. Requiring all insurers to be not-for-profit (critically: also including all corporate owners of insurers too)
2. Tying financial incentives and disincentives to outcome-based KPIs
We have already seen it with things like Medicare Advantage plans doing sign-up meetings on the second floor of buildings without elevators etc.
If you want to look at them done correctly, look at the FEP program. High-level KPIs that are difficult to game (without actually improving service & outcomes) tied to financial incentivizes.
Generally speaking, you get decent outcomes with {not for profit} + {efficiency/outcome based KPI}, because the primary thing you're fighting is apathy (not for profit) instead of malicious profiteering (for profit).
And capitalism doesn't particular lend itself to running an insurance company. Fundamentally, there's not that much that should change year-to-year at insurers than {actuaries / pricing}.
Have pharmacy benefits or all the other kooky for-profit inventions really improved patient experience and outcomes?
Healthcare is one where vertical integration can be really profitable, even at the smaller scale. I used to work as a paramedic, both local agencies and private. The private ambulance company I worked for started when a man who owned a nursing home realized how much money the facility was paying for ambulance transports, so he started an ambulance company. He realized how much his ambulance company was paying to industrial/medical gas companies for oxygen, so he started a medical gas company. And so on. And went from his one small nursing home to his daughter having a $100M empire by the time he died 30 years later.