Nobody’s defending the entire system. And nobody’s claiming the insurers couldn’t become more efficient.
The debate we’ve seemed to localize on is if we are better off WITH the insurer as the intermediary, or not (single payer). The jury is way out on this one; some countries with excellent universal care systems use them (Switzerland, Netherlands) while other countries with excellent universal care systems have gotten rid of them.
In order to answer that question, it would be necessary to dig into the data a lot deeper than we tend to do. % of GDP spent on health care is a crude metric.
But my view is that we’re better off with the insurers in the middle than not, for several reasons. ONE is that this is their business that they are experts in, and the government is not expert in it. TWO is the fraud issue, which is related to ONE. THREE is that if there’s an error in pricing risk, the insurer is exposed to those cost overruns, not the taxpayer.
I could go on, but that’s my take.