The End of Health Insurance
The recent killing of a health insurance CEO is sad, and provides an opportunity for our upcoming government.
“Deny” was written on a bullet, and the widow said there had been threats about a lack of coverage. The likely motive is not hard to guess. You probably know a few people who have suffered money or health as a result of flaws of the U.S. health insurance industry. Many people die preventable deaths from our healthcare system. There are plenty of studies showing that most of our health outcomes are worse than other developed nations.
Most doctors don’t know much about insurance, because they don’t deal with the business end of their clinic or hospital, but I do. I’m a family doctor who runs medical, dental, and pharmacy (and previously mental health) for tens of thousands of people who bounce between no insurance, Medicaid/Medicare, and private insurance like United Healthcare. I do keynotes on healthcare improvement. With that background, here are some thoughts:.
The Problem:
- Government programs work best! If you are lucky enough to have Medicaid, Medicare, Tricare, or VA, you can navigate healthcare much easier than the other options. These programs cover almost 36% of the population. I know you think these programs have flaws, but there are way less problems than with private insurances. If you make too much for Medicaid, I suggest you take a “Medicaid vacation” from work to lower your income for a while, then reapply.
- If you are the 49% of the country who has private insurance through your employer, you may have noticed that your premiums keep going up, the employer covered portions keep going down, deductibles/ copays/ coinsurances keep going up, panels of available providers keep decreasing (making continuity of care almost impossible), and pricing of anything from meds to Xrays is incomprehensible. You just pray you don’t get sick, because if you do, you are going to have to pay cash for most of it anyway.
- Another 6% of the population buy private insurance themselves, because they don’t have an employer who offers health insurance. This is the realm of the Obamacare marketplace exchange plans, which have high deductibles and let you see almost no doctors. I know these provider panels are limited because I have tried to get my own clinic on the “marketplace” panels and all local insurance companies (including United Healthcare) denied me, saying “by invitation only”. That’s right: they deny doctors as much as patients! I recently became a patient myself, with a chronic condition, and have been ping ponging around this category of self employed marketplace nomads, floored how anyone navigates it.
- That leaves 8% of the population who is uninsured, which is people who make too much for Medicaid but can’t afford the Obamacare games, people who don’t want to pay for employer based health insurance which costs half their paycheck and covers nothing, people who choose to go naked because the math just doesn’t make sense, or those who are undocumented and can’t work. Most of these 8% use the ER for even simple problems, which your taxes pay for.
The Mandate
- Democrats didn’t fix it. Obama’s expansion of Medicaid eligibility was great, but his marketplace thing doesn’t work. Plus, there was not much change in private insurance, whic is 55% of the population, so the UHCs of the world have continued to increase costs and decrease coverage. Maybe they can’t deny selling someone coverage based on preexisting conditions, but they sure can deny paying for coverage in a hundred other ways.
- Republicans now have an opportunity. With full control of the government, there is no one to blame. Do they know how to fix it? I’m a private businessman like Trump and Musk, but I don’t sell luxury lodging and cars like them, I provide social services to poor people, using government money. And based on that, I can say that healthcare is one place where capitalism is not king. Profit maximization has not caused health maximization. Now is the time to get rid of private health insurance. Just leave Medicaid, Medicare and the VA, and put most of the country into Medicaid. It need not be free for all; one can easily require an annual AGI based contribution from the 1040. Nevermind the improved healthcare endpoints, the cost savings and efficiencies realized would be enough to make any businessperson turned politician happy.
The shooter studied his target so that he had perfect timing. He also studied the industry so he had perfect timing. Now is the time to talk about health insurance reform!
