Editing Openai/692cb885-da9c-8002-9696-e985fae204bd (section)

==== Envisioning all health insurers as non-profit (or even government-run) organizations would be a transformative shift. In a non-profit model, insurers would no longer have shareholders expecting quarterly profits or stock price growth. Any surplus revenue (“profit”) an insurer generates would be reinvested in the organization or returned to the insured members rather than paid out as dividends or share buybacks. Essentially, policyholders would become the primary stakeholders instead of stockholders. This approach parallels how some cooperative or mutual insurance companies operate, where customers are members who may receive dividend rebates in profitable years. It’s also analogous to certain international systems: for example, Switzerland legally requires basic health insurance to be provided by private '''non-profit''' insurers, who must use any excess funds to benefit enrollees (while only supplemental plans can be for-profit)commonwealthfund.org<ref>{{cite web|title=commonwealthfund.org|url=https://www.commonwealthfund.org/international-health-policy-center/countries/switzerland#:~:text=age%2C%20and%20disability%20insurance%2C%20made,percent%20of%20spending%20in%202016|publisher=commonwealthfund.org|access-date=2025-11-30}}</ref>reddit.com<ref>{{cite web|title=reddit.com|url=https://www.reddit.com/r/Switzerland/comments/1gplui8/does_no_profit_for_basic_health_insurance/#:~:text=,on%20basic%20health%20insurance|publisher=reddit.com|access-date=2025-11-30}}</ref>. Historically, many U.S. Blue Cross/Blue Shield plans were non-profit member-based organizations (though some have since demutualized into for-profits). ====

In a fully non-profit insurance landscape, all profits would effectively be “seized” (i.e. retained in the non-profit trust) and redistributed to the insured population – likely in the form of lower premiums, expanded benefits, or rebates. For instance, consider that the top five insurers accrued $371 billion in profits since 2010truthout.org<ref>{{cite web|title=truthout.org|url=https://truthout.org/articles/top-5-us-health-insurers-annual-profits-jumped-230-percent-since-acas-passage/#:~:text=America%E2%80%99s%20largest%20health%20insurers%20have,medical%20claims%20from%20its%20policyholders|publisher=truthout.org|access-date=2025-11-30}}</ref>. If that sum had instead been used to reduce premiums or out-of-pocket costs, it could have substantially eased the financial burden on tens of millions of Americans. Even on a yearly basis, UnitedHealth’s $23 billion profit in 2023 could, if not taken as profit, have been used to lower premiums by an average of several hundred dollars per member (e.g. roughly $460 per person in UnitedHealth’s case). Across the industry, removing a typical profit margin of, say, 5% could similarly translate into single-digit percentage premium reductions for consumers – not a silver bullet for affordability, but a meaningful relief given current family premiums in the tens of thousands. And beyond direct premium impact, a non-profit orientation might encourage insurers to spend more on member health (care management, preventive services, etc.) rather than cost avoidance. The overall mission of insurers would shift from profit maximization to maximizing coverage and health outcomes, treating health insurance more like a public utility or service.

Of course, implementing this model would be complex. For-profit insurers would need to convert their corporate status (potentially through government action or buyouts of shareholders). There is precedent in other sectors for converting to non-profit or mutual status, but doing so at an industry-wide scale would likely require legislation. Alternatively, the government could establish a single-payer or public insurance system that displaces private insurers – which is another route to eliminating profit, though that goes even further by centralizing payer functions. Short of a single-payer overhaul, one could imagine regulating insurers like utilities, with caps on profit margins and requirements to rebate excess earnings to consumers (the ACA’s Medical Loss Ratio rule already takes a step in this direction by requiring insurers to spend at least 80–85% of premiums on medical care, capping profits/overhead at 15–20%jamanetwork.com<ref>{{cite web|title=jamanetwork.com|url=https://jamanetwork.com/channels/health-forum/fullarticle/2760129#:~:text=The%20nearly%2080%20cents%20per,entities%20who%20offer%20health%20care|publisher=jamanetwork.com|access-date=2025-11-30}}</ref>). Strengthening such regulations or converting insurers’ governance would institutionalize a consumer-first financial model.

In evaluating this idea, it’s important to weigh the potential benefits and drawbacks of a non-profit insurance industry compared to the current for-profit system. The following table summarizes some key pros and cons of each model: