No, not extreme...
at all if the context is solving the problem for the end user and ultimate payer. In the end we will either go your way or go bankrupt. The free market faithful will cry ou against this but that is religion and not economics. I absolutely agree with taking profit out of the picture and with it the states rights thing too. States are just an artificial entity-big deal, none of them do such a bang up job that we should lose sleep over their diminished responsibilities.
But more to the point. Back prior to the Health Reform, the health insurance industry was in thrall to Wall Street (they still are) like everyone else and in this way; there is a standard way to express the portion of each premium dollar paid that actually goes to direct patient care, it is called the 'medical loss ratio' The name is telling because it identifies this ratio for discussion purposes but also calls it what it really is to the insurer-that is to say they see anything spent on patient care as a loss. And reasonably so because they are all mostly public traded companies where the free market in equities rewards those companies with the best 'medical loss ratios', meaning they spend the least on medical care and the most on overhead and, more important, profit. Now, Wall Street punishes those companies who do not keep up. If their loss ratio is too high then dollars flow to competitors. Obvious and true. When Bill Clinton took office the average medical loss ratio was 90% , when Obama took office it was 77% and headed down. The actual provision of care was rising and so how were the insurers to keep up the high margin? Partially by rationing of care, partially by negotiating costs and mainly by increasing premiums faster than actual costs. That way they could not only maintain their ratios but actually better them. Because insurers represent virtual monopolies, duopolies or oligoplies in most states and are sequestered by states they have little resistance to ever increasing premiums.
The health reform pegged the medical loss ratio at between 80-85% ( I don't know what the range is about) but it is still there as an inherent part of the equation even when established by law it is still a ratio and all that is likely to happen is that premiums will still increase apace with costs and there will be greater incentive to increase costs which will put more absolute dollars in the insurers pocket. And what does the patient get? Hard to say, certainly no inherent pressure to contain costs because if you as the insurer is only ever going to get 15% then you sure as hell want to get 15% of the biggest pie you can arrange. Better care? Why would you when the whole enterprise is about profit? The wise insurer would find ways of rolling part of the medical loss into his own pocket, which I am sure they are trying to do as we type.
