Why Do We Need a Health Insurance Industry?
As the country contemplates a major reform and restructuring of the way we run our national health care system (if it can even be called that), it needs to be pointed out that the mammoth health insurance industry is nothing but a parasite on that system.
Health insurance companies add zero value to the delivery of health care. Indeed, they are a significant cost factor that sucks up, according to some estimates such as one by the organization Physicians for a National Health Program, as much as 31 percent of every dollar spent on medical services (a percentage that has been rising steadily year after year).
Insurance companies are damaging in more ways than simply cost, though.
They also actively interfere in the delivery of quality medical care, as anyone who has had to battle with some “nurse” on the phone at an insurance company to get required pre-authorization for needed procedure can attest. Just recently, the editor of a local weekly alternative paper in Philadelphia, Brian Hinkey, the victim of a near fatal hit-and-run accident last year who spent several days in a coma, and has been working hard to regain the use of all his limbs and faculties, reported in an opinion piece in the Philadelphia Inquirer on how his insurer after a few successful weeks of in-hospital rehab, denied him coverage for six critical weeks for out-patient rehab services, though every specialist on head injuries knows that early, consistent therapy is crucial to recovery of lost brain function.
This kind of human abuse is standard operating procedure for companies whose bottom lines are fattened the more services they can deny to insured clients. My own father, once doomed by a metastasized cancer following prostate surgery, was saved by a procedure offered by a physician in Atlanta that his Blue Cross plan in Connecticut refused to pay for. He had to finance the expensive treatment himself.
Now these medical system parasites are suddenly running scared, because it is clear that if everyone in America is to be guaranteed health insurance coverage—a promised goal of the new administration of President Barack Obama, and, according to polls, the desire of a large majority of the American people—they are going to stand exposed as a costly impediment to achieving that goal.
Insurance companies have managed to stay profitable and at least somewhat affordable to the private employers and workers who, together, have to pay for them, by denying care not just to policy holders, who are denied certain tests and treatments but especially to those who have known ailments, who are simply denied coverage altogether.
For decades, people with “pre-existing conditions” have been either barred from coverage, or have had to sign waivers that excluded them from getting coverage for treatment of those pre-existing conditions. In the worst case, which is all too common, people have ended up dying because they couldn’t get treatment for common and easily treated ailments like high blood pressure or diabetes.
Now we hear that two big insurance trade groups, the Blue Cross and Blue Shield Association and America’s Health Insurance Plans, have offered to "phase out the practice of varying premiums based on health status in the individual market" in the event that all Americans are required to obtain health insurance.
Well sure they’re doing that. If they didn’t, the government would force them to! The insurance industry, in saying that it would not price sick people out of coverage in a nationally-mandated health insurance scheme, is merely recognizing the political firestorm that would arise if it were not to do that, and were to force the sick and inform onto some government insurance plan, subsidized by taxpayers, while they just cherry-picked the healthy population, as they’ve been doing now for decades.
The whole point is that if everyone is included in the insurance pool, instead of only the healthy population, then the overall cost of being chronically or critically ill to the individual is spread over the whole of society. Premiums get adjusted accordingly.
Medicare is the model. Here we already have a government plan that covers every single elderly and disabled person.
If we were to simply extend Medicare to cover everyone in America, we would essentially have the Canadian model of health care (which, it should be pointed out, costs half what we pay in America for health care when private insurance and government programs are added together). As with current Medicare, the government would pay for treatment, with private doctors and hospitals providing the care, and with the government negotiating the permissible charges. That, in a nutshell, is what “single-payer” means—the government is the single payer for all health care. It doesn’t mean, as the right-wing critics claim in their scaremongering propaganda, that people would be forced to use certain doctors and certain hospitals. Far from it. That’s what private HMOs do.
Medicare is efficient (only 3.6% of Medicare’s budget goes to administrative costs, compared to 31% for health care delivered through private insurance plans), its clients like it, and doctors and hospitals accept it.
We should not be tricked by this seeming sudden appearance of decency on the part of these corporate parasites. There is simply no valid reason for preserving the private insurance industry’s role in any health care reform plan that is aimed at giving everyone access to health care in America. The Obama administration needs to jettison its “free market” fetish when it comes to health care. The financing of health care for all Americans can all be handled much better by the government. Medicare has proven this. Other countries—Britain, Australia, France, Canada, Taiwan and most other modern nations have proven this.
Leave the insurance industry to handle our car insurance and our life insurance. It has no more place in the delivery of health care than do tapeworms in the digestive process of our bowels.
DAVE LINDORFF is a Philadelphia-based journalist and columnist. His latest book is “The Case for Impeachment” (St. Martin’s Press, 2006 and now available in paperback). He can be reached at firstname.lastname@example.org