Healthcare is in the news a lot lately. Here are summaries of 3 recent articles along with my comments:
1. Health insurers use cash and gifts to sway which benefits employers choose
Link: https://www.propublica.org/article/health-insurance-brokers-cost-commissions-bonuses
Summary: Health insurance companies give out lucrative commissions and bonuses for influencing brokers who set up coverage plans. These incentives are not illegal, but they may distort benefits packages offered to employees. Critics condemn both the insurance companies and the brokers for conflicts of interest and jacked up costs.
Comment: I agree that this is a vivid example of healthcare dollars being spent on something other than health. I disagree that insurance companies and brokers are the villains. Rather, insurance companies are merely competing by the rules in their tough market. And brokers are performing the necessary service of cutting through our chaotic and fragmented healthcare system – so complicated that even big employers need their expert help. The fragmented system is the root of the problem, not the insurers or brokers per se. Six big insurers cover half of all U.S. employees, and 852 smaller insurers cover the rest. This fragmentation creates needless complexity, adds administrative expense, and doesn’t make us one bit healthier. Kinda makes you see the rationale for moving toward a single payer on the Medicare or Medicaid model.
2. Health care and insurance industries mobilize to kill ‘Medicare for all’
Link: https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html
Summary: The powerful Federation of American Hospitals, health insurance association, and PhRMA have banded together in a coalition to launch a pre-emptive public relations campaign against single-payer healthcare. The single-payer approach would have the most direct impact on the health insurance industry. The coalition, benignly called Partnership for America’s Healthcare Future, opposes single-payer in all its forms, “whether you call it Medicare for all, Medicare buy-in, single payer or a public option.”
Comment: This reminds me of the “Red scare” tactic that the AMA used to defeat President Truman’s national health insurance plan in 1949, and the “Harry and Louise” ad campaign used against Hillary Clinton’s healthcare plan in 1993. (See “Healthcare Reform Successes and Failures”) In the next section, below, I acknowledge the very real challenge of managing the potential disruption that healthcare reform would bring to so many stakeholders. It is not only the insurers who perceive a threat, but all other components as well, which now comprise 1/6 of the entire U.S. economy.
3. Democratic Party’s ideas on healthcare are wrong
Summary: Politics and foreign affairs commentator Fareed Zakaria sees a stampede of Democratic Presidential candidates toward single-payer Medicare-for-all. He agrees with the goal of universal healthcare on moral grounds. But he criticizes the Democrats’ frenzy as impractical and politically impossible. First, Democrats have not explained how to pay for the $3 trillion yearly cost. Second, they have ignored the economic disruptions that would result from moving to single-payer. Third, they have overlooked successful public-private health insurance system such as Switzerland’s.
Comment: Though I am usually fan of Dr. Zakaria, I disagree with his points in this case. Regarding cost, theoretically there should be little difference between the $10,000 per capita Americans currently pay, in the form of premiums, copays, deductibles, Medicare taxes, and garnished wages (to pay employer’s share of premiums), and the equivalent amount they would pay in Medicare-for-all taxes. Regarding disruption, I agree a real challenge, but one that could be addressed by gradual implementation over a term of 5 years or longer. This would allow commercial insurance company employees, for example, to gradually migrate over to Medicare claims processing or to switch to other fields. Regarding Switzerland, Dr. Zakaria is correct that its regulated insurance system standardizes “essential benefits” and achieves universal access through an “individual mandate.” But I am skeptical that the Swiss model could be successfully scaled to the 858 separate U.S. insurers and to our population of 320 million (compared with 23 Swiss insurers for their population of 8.5 million). Nor could an Americanized Swiss-style insurance system – still fragmented and unwieldy – succeed in unrigging the exorbitant prices baked into the U.S. system. Obamacare did adopt an approach resembling the Swiss model as a first step toward universal coverage. But now I think that the full ethical, economic, and political clout of a unitary U.S. government-backed finance system – representing the people and their common good – will be needed to accomplish the goals of cost control along with truly universal coverage.
Conclusion: Healthcare reform is in the news and in the air. Reform will be a big project requiring everyone to sacrifice and accept change. Can we all come together to debate thoughtfully, or will we circle our wagons to protect our narrow interests?
Now, take action. . .
Image Credit:
Title: Newspaper vendor opposite London Paddington Station
By: KF
Rights: This work has been released into the public domain by its author, KF at English Wikipedia.
URL: https://commons.wikimedia.org/wiki/File:Newspaper_vendor.jpg#filelinks
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