I started with a simple question: could a city or state build its own public health insurance company?
The idea isn’t as radical as it sounds. Large employers self-insure all the time. Once an organization is big enough, it makes more financial sense to pay medical bills directly than to keep handing money to an insurance company that takes its cut before passing anything along.
You still hire companies that already have the doctor networks, the claims systems, the pharmacy relationships, all that infrastructure already built and running, because building it yourself would cost more than renting it. But you stop paying the biggest cost: the premium an insurance company charges to assume your financial risk on top of everything else. The result is the same coverage at dramatically lower cost…