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The economic crisis that began in the United States in 2008 and its impact in Brazil starting in 2014 preceded the health crisis triggered by the COVID-19 pandemic. Considering these three time intervals, this article analyzes the susceptibility of health plan and insurance companies to economic cycles of recession in Brazil and the United States. There is evidence of a relationship between periods of economic crisis and retraction of actions and services in national health systems. However, both the United States and Brazil showed a growth in the number of health and insurance plans. The vectors driving the expansion of the private market in both countries have similarities and singularities. The "Obamacare" marks the beginning of the inclusion of population segments in the coverage of programs that use private care schemes, funded with government resources. In Brazil, despite negative general economic indices and reduction in the public health budget, health plan companies increased revenues and profits, even in the context of the pandemic and the growing economic crisis in the country. Business strategies to attract foreign investors were combined with actions to obtain credits from public institutions and increase tax deductions and exemptions, preserving financial gains. A comparison between the impacts of the financial crisis on the Brazilian and American private health markets allowed us to identify the weaknesses of our universal public system absorbed by market rationality.