Op/Ed: Health insurance costs keep rising, burdening patients. Why do we put up with it?
For the life of me, I can't fathom what people like about the health care system in the USA.
Consider these statistics from the Commonwealth Fund: "By mid-2022, 43% of adults ages 19 to 64 had inadequate health insurance coverage, meaning they were uninsured at the time of the survey (9%), had coverage when surveyed but experienced a time without coverage in the past year (11%), or had continuous coverage over the past year but were under insured (23%)."
It's easy to place the blame on private health insurance companies, including my former employer, Anthem Blue Cross and Blue Shield. I spent years at Anthem answering calls from members who were justifiably upset that their health insurance policies routinely left them high and dry when it came to actually paying their medical bills. There were usually high deductibles, arbitrary exclusions and denials for preexisting conditions before the Affordable Care Act. What good is insurance if it doesn't sufficiently protect you from financial exposure?
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As much blame as the executives at private health insurance companies richly deserve, there is more blame to go around. Physician groups and hospitals often engage in very public network disputes with health insurance companies in order to raise their reimbursement rates, sometimes by large margins. Insurers are often forced to give into these demands, lest their members revolt because their preferred physician or hospital has gone out of network. This endless cycle leads to more expensive claims, higher insurance premiums and more financial exposure for the insured.
Health care providers deserve to be reimbursed fairly and consistently for their services, but a major reason the charges have become so outlandish is the uncertainty about payment. During my time at Anthem, I would also answer calls from health care providers checking each patient's eligibility and unique benefits. They also had to check with other health insurance companies and maintain contracts with those companies. When the bills aren't paid, health care providers also employ medical debt collectors to pursue bad debts. This is a tremendous amount of overhead, and we are all paying for it.
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It’s not just about high premiums and big medical bills. It’s about access to health care close to home. If you visit Exit 210 on Interstate 69 in affluent Fishers, you will see two competing hospitals within sight of one another. There is a similar phenomenon along U.S. 31 in Carmel, although the hospitals are not quite as close. IU Health and St. Vincent built those hospitals in those locations to attract the most lucrative patients, those with good private health insurance. The competition isn’t bringing prices down. Instead, we are seeing an arms race that drives prices up. This is the result of the perverse incentives that our system of private pay and private health insurance creates.
Most Americans who have health insurance get it through their employers, and I am no exception. However, employers are increasingly squeezed with skyrocketing premiums, leaving them with little choice but to decrease benefits or ask their employees to pay part or all of the premiums themselves. Any money your employer is paying for your health insurance could be redirected to a pay raise for you instead, so you’re paying for it whether you realize it or not.
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A universal, comprehensive, single-payer health insurance system is the only way to solve all of these problems. If every patient were automatically enrolled in the same health plan, and providers no longer had to chase down payments, we could eliminate a huge amount of overhead that doesn't make anyone healthier. And, if providers could no longer play different health insurance companies against each other in network disputes, then they could not force reimbursement rates higher and higher.
The rest of the industrialized world views the U.S. healthcare system as bizarre and inefficient, and the data bear that out. We Americans spend 17.8% of our gross domestic product (GDP) on health care while a single-payer country like Norway spends only 10.1% of its GDP. It doesn't matter that we have a larger population than they have because we also have a larger tax base to make up for it.
The only question that remains is, what are Americans clinging to exactly?
Daniel Dougan obtained a Master of Health Administration from Indiana University in 2014 and currently work in public health.
This article originally appeared on Indianapolis Star: Quash rising health insurance costs by moving to a universal system.
