The health insurance industry is "closest to the parasitic relationship imposed by the Mafia," with companies "raking in hefty profits and bloating cost, without providing any benefit at all," Jonathan Kellerman, a clinical professor of pediatrics and psychology at the University of Southern California Keck School of Medicine and a novelist, writes in a Wall Street Journal opinion piece. According to Kellerman, in any industry, the "middleman interposed between seller and buyer raises the price of a given service or product," and, although some "intermediaries justify this by providing benefits" or physical facilities, health insurers "provide nothing other than an ambiguous, shifty notion of 'protection.'"

The health insurance business model "is unique in that profits depend upon goods and services not being provided," he writes, adding that, as a result, the "consequences of any insurance-based health care model" will "be progressively draconian rationing using denial of authorization and steadily rising copayments" for consumers and "massive paperwork and other bureaucratic hurdles, and steadily diminishing fee-recovery," for health care providers. Kellerman writes that, although most health care reform efforts "emphasize the need to get more people insured," such an approach makes health insurance an "important commodity," rather than a "service delivered by doctor to patient."

He adds that "perhaps the solution" to increased health care costs, bureaucracy and "diminishing levels of service" is "a radically different approach: fewer people insured." In the event that "substantial numbers of health care providers shook off the insurance monkey on their back" and the "supply of providers was substantially increased by opening more medical schools," a "more honest, cost-effective system benefiting everyone" except health insurers would result, according to Kellerman (Kellerman, Wall Street Journal, 4/14).
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