Noah Smith really, really does not understand how health insurance works or that insurance is a tug-of-war between providers and insurers. He sees insurers as a blameless mediators caught between costs and providers, principally because they do not make much obvious profit. In reality, they are a source of inflationary pressure in a continual arms race between how much money required insurance drives up de facto costs, how much providers attempt to grab, and how much they are bilked and can bilk.

It’s a multi-layered fraud combined with financial conflict and beset with huge inflationary pressures, mostly caused by insurance itself.

In other words, they are all villains and none are blameless. I’d say providers and insurance companies are about 40/40 villain, with other 20% being various other health care parasites.

The entire US medical system is a scam and insurance companies are no less evil and no less crooked than any other component.