U.S. health system must serve patients, physicians first
Could this be the year America starts to shift away from the employer-sponsored health insurance model? Health care is an issue that concerns most people. Few are free of the anxiety that comes when they or a loved one must undergo treatment for an acute life-threatening or debilitating chronic condition.
In spite of the $4 trillion spent in 2021 on health care in the United States, life expectancy in our nation continues to languish compared with other industrialized countries.
For many people, health insurance is tied to their employment. This creates a patchwork of coverage that is susceptible to cracks. If there is a gap in employment, COBRA is available to provide coverage, at the person’s own expense.
The growth of the gig economy further highlights why health insurance must not depend on traditional employment. Untethering health care from employment is essential to expanding the footprint of people with health care security.
One solution is separating the delivery of health care service from the payment of these services. For most people, health care services are covered by insurance. In 2020, health insurers generated $31 billion in profit, an increase of more than 40% from 2019. In 2021, they earned a paltry $19 billion. The upward trend returned in 2022, with the six most profitable companies earning more than $41 billion in profit. Should a commodity that provides a public good be positioned to generate profits from it?
One alternative is a singlepayer system, much like Medicaid, Medicare and Veterans Affairs. This is a lightning rod for controversy. Some argue that the government is ill-equipped to provide health care services for the nation. Yet, a single-payer system does not mean that the government will provide services. It will only be the funnel through which health care services are paid.
A second alternative is a network of not-for-profit health insurance companies. If health care providers work toward accepting coverage from only these entities, for-profit companies will be phased out. The benefit of this is that any excess income is used for the good of constituents, not shareholders.
Such a transition would be met with resistance by the forprofit health insurance industry,. Nonetheless, this direction demands attention and consideration given the state of affairs.
The disconnect among health insurance, health care providers and patients places patients and providers at the mercy of health insurers. These companies control the flow of health care services to patients via prior authorizations. Health care providers are de facto working for health insurance companies, since they pay for the services provided.
There is some hope. UnitedHealthcare’s change in its prior authorization process is an acknowledgment of this issue and a move in the right direction.
The patient must be at the center of health care, and health care professionals must be steering the ship. In the current environment, health insurance companies are in charge. This hurts patients, as they may not get the care they need and deserve. It hurts health care professionals, as they are forced to spend time and resources fighting for their patients and even to get paid.
The current system is functioning in the best interests of the health insurance industry.
Health services need to be separated from the finances to pay for them. The financial component is overwhelming the service component. Until this is addressed, the current situation will continue — to the detriment of health care professionals and, most critically, patients, which we will all be at some point.