How long do you think your vaunted HMO would remain in business if all, or even one-half its members had your health claims history? Do you think they "made money" on you? If not, how exactly did they turn a profit? Do you have any idea how many claims were denied (read: "Deemed not medically necessary") for your fellow members so that you could enjoy your benefit?

It is not a net zero game. Profitable health insurers *do not* spend 100% of total premiums on the delivery of health care. By design a minimum of 20% of health care premiums are *never* spent on anyone's health care. They're *supposed* to spend 80% of the premiums they receive on health care but with creative accounting voodoo many do not. By the way, if your HMO is a for-profit entity, do you know how much profit they made last year and what percentage that was of premiums received?

I'm not picking on you or your HMO. And, giving the devil his due, the 20% cut-off for "Administrative Services" was a part of the PPACA. Further, at least in the first year, many firms ended up giving refunds for exceeding this amount. But when you have $1,000 deducted from your check are you conscience of the fact that the maximum you are contributing to the cost of your health care is a sum of $800 whilst kicking in $200 to the insurance company?

Capping the medical loss ratio at 80% you likely view as a good thing. But, think about that for a minute. Medicare's administrative costs are around 2%. Given that the administrative costs of private, for-profit companies is around 16%, we have codified, in law, 4% of premiums paid going directly to the profit line of private insurers. Is it a good thing that a minimum of 4% of the over $700 Billion (over 28 Billion) spent in health care premiums in this country is legally ear-marked for profit?

Our disagreement appears to be concerning the true purpose of a health care premium. I submit (and I think Ben would agree) that health insurance premiums are monies spent for health care. If that's true, then clearly the at least 28 Billion ear-marked for profit is clearly from money spent for health care that was never delivered.

Why? Because only the folks priced out of the private market will buy into it, making it unsustainable. Medicare's current problem is that roughly 70-80% of all medical costs for Americans are incurred during their final handful of months alive. Guess how old they are, on average? Medicare does not currently have the healthy people in the pool and so the risk is dramatically higher than anything in the private sector. There's a reason why, for all the Harry & Louise advertisements, the private insurance sector never talks about taking over the above 65 population. Private health insurers are not in the business of paying medical claims. They are in the business of collecting premiums.

Bernie's plan incrementally expands Medicare until it covers everyone, just as it was originally designed. But the public option will be loved by the private sector for when it inevitably fails they can say, "See. Single Payer will never work here."