Why would it matter to them whether they pay out for hospitalisation, or pay out for flu shots? The payouts don't matter. We saw that with the banking crisis. They're covered by bigger insurers who are covered by government bailouts because they're too big to fail. All that matters is that premiums keep coming in.

Insurance companies can write off excess payments anyway. Those making the decisions undoubtedly have hedged portfolios, so if the company they're working for goes under it doesn't matter as long as other companies in their portfolio benefit. Many will even take out short positions on their own failing company and profit from its demise.

Gone are the days when CEOs actually cared if their particular company's on-book expenditures matched its income.