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Nearly all other businesses reduce operating costs per transaction/customer when volume increases. Increased premiums in the face of increased sales volume calls the motive of this industry to be questionable at best. So people have had policies they were not using which means the insurance companies were collecting premiums and had little to no costs to subtract from what they collected. Healthcare in America is a disaster. We spend the most and are no where close to the most healthy. The insurance companies bear a big portion of the blame for this. As do the trial lawyers and big pharma. Capitalism is the best economic model … but sometimes “capitalism goes wild!”