From the Field

Searching for the Root of Health Care Reform

August 24th, 2009

Anyone who gives two whips about American politics has no doubt read about or witnessed the raging debate over health care reform these last few weeks. It’s recently become less of a debate and more of a cacophony of misinformation, shout-downs, and scare tactics, infuriating those who want to have a reasonable discussion on reform and enraging those that fear a Nazi-fascist-socialist-commie takeover of our health care system. Legislators are busy stoking political fires while the nuts are getting nuttier, and no one seems to remember why we’re even talking about reform in the first place.

Then I came across this clip of Anthony Weiner, a House Rep from New York, discussing health care reform on MSNBC’s Morning Joe, and for the first time in the last few weeks I thought: Okay, this dude gets it.

You should watch the embedded clip in its entirety, but for now know that Rep. Weiner is asking one of the most important questions raised in the midst of the current information war: What are the insurance companies bringing to the table? And how, exactly, are these profit-seeking insurers benefiting our health care system?

Making Money While Making Customers Miserable

It shouldn’t be a secret that insurance companies are committed to serving the interests of their shareholders. Like every other service corporation, their primary goal is to create efficiencies that maximize profits, and that’s how any well-run company should operate, right? The problem is that most of those efficiencies include routine claim denials for “pre-existing conditions” or outright coverage refusal for applicants with any kind of questionable health history. There is more incentive for an insurance company to spend their time finding ways to avoid paying your hospital bill than to spend their time finding ways to fix the system and make that hospital bill cheaper to begin with. From the company’s perspective, you’re little more than a number in a spreadsheet. You’re a low-risk asset when you’re healthy and they’re happy to take your money; get sick, though, and heaven help you because your insurance company will surely do their best to avoid helping you themselves.

That’s not to say that insurance companies are evil—their business interests are simply aligned against paying your costly hospital bills. They make money when they refuse to pay for your care (or only pay for part of it), and when Wall Street expects them to increase profits year over year, they have a financial incentive to find (or write in) holes in your coverage that keep them from having to pay out. They don’t make money when they spend $20,000 to cure your cracked ribs or successfully treat some lung disease, and the warm fuzzies they might feel for doing so won’t satisfy investors who want to see the stock price rise. But hey, that’s business!

Health Coverage For the Wealthiest Nation

There’s got to be a better way. So let’s imagine for a moment that there were another option out there that would allow individuals to buy into a plan at a rate well below current insurance plan offerings. Imagine that this plan would provide coverage for pre-existing conditions, coverage that sticks with you when you’re between jobs, and coverage that you can count on without worry of rescission when you really do end up getting sick. It’s the kind of coverage any person would want to provide for their own family, and it’s a coverage standard which we can all agree befits the wealthiest of nations. As it turns out, the President and folks in the House of Representatives agree, and that’s why they’ve proposed The Public Option.

Now, I know what you’ve probably heard: the Public Option is really code for requiring everyone to turn their medical decision-making over to some bureaucrat, or that the plan wants to kill old people outright to save the extra costs incurred as they age. Maybe you believe that we’re a country built on the infallible nature of free markets and fair competition, and that allowing the government to get into the insurance game offends your sense of capitalism and will surely destroy private insurers’ ability to earn a living. While none of those distortions are true, there are plenty of pundits and Very Serious Politicians who have spent an awful lot of tee-vee time trying to scare up opposition by pushing fabricated and frightening scenarios. Hell, some folks standing up in these town hall talks held across the country were even calling for government to “keep their hands off of Medicare”— which, you know, is an entirely government-run program.

Cutting the Bluster

So let’s bring the discourse back down to sea-level, shall we? The Public Option is just that: an option. If you totally love your current insurance plan, keep it. But why shouldn’t everyone else have the option to buy into an affordable, government-run program that can keep costs low by serving millions of participants and negotiating pricing by volume, maintain low administrative costs, and avoid the high costs of marketing and political lobbyists. The Public Option will cover you if you can’t afford private insurance or if you’ve been refused coverage for one of those infernal “pre-existing conditions.” And guess what? You can keep your current doctor, and that prized doctor-patient relationship might just improve when you don’t have a profit-motivated private insurer deciding that your doctor’s suggested treatment is too “experimental” to be covered.

Don’t worry about the government pulling the plug on Grandma, either—this plan won’t hustle the old gal into an early grave. The “death panels” craze was a hyperbolic reading of an innocuous inclusion in the House bill that suggested folks might, you know, want to write up a living will for themselves that provides instructions for care in the case that they suddenly find themselves in a vegetable state. Oh, and the private insurance industry? They’ll always have a place in the market, even if it’s just to serve those who want a “gold-plated policy” or some other nuanced insurance options. Besides, introducing downward pressure on insurance plan prices that have soared as health insurance companies consolidate and create monopoly conditions in the market can only be a good thing, right?

The bottom line is that the absurd and insane political cross-talk has undermined what is at the heart of our country’s need for reform: there are millions of un-and-under-insured Americans living in fear of getting sick every single day. There are people forgoing critical preventative care who wind up in emergency rooms and increase costs for everyone across the board. There are those who stick with jobs they hate and others who are afraid to break off and run with a brand new business idea because they can’t afford to lose their health coverage. There are untold numbers of the currently insured who will be surprised to find their private insurer won’t cover a critical piece of their care, or have their coverage rescinded at a time when they need it the most. Our system is broken, and even Public Option opponents like Joe Scarborough in the above clip are finding that insurance companies can be rather indefensible in the face of inflating coverage costs juxtaposed with healthy company profits and little to no improvement in the quality of care received.

We have an opportunity to bring some much needed change to our current health care system, and we shouldn’t let fear-mongers water down the discourse by distorting the facts and resorting to scare tactics. So let’s keep it simple: if you had the option of dumping your for-profit insurer in exchange for reliable coverage that would be there for you and your family when you need it; if we could achieve equitable health care for everyone and provide access to preventative care that greatly reduces hospital visits and cuts costs across the board; if you never had to worry about losing insurance along with your job or wonder if your child’s rare disease will be covered under your current plan; if you were offered the opportunity to have all of these things, how might you choose?

I know I’d like to at least have the option of making that choice.

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