While listening to the promises to repeal Obamcare during the Republican National Convention, I was reminded of what those of us in the health insurance industry said when our friends in Congress were able to block passage of President Clinton's health care reform legislation 18 years ago.
Like the politicians in Tampa, we insisted then that a big government program not only wasn't needed, but would be harmful -- that what the government really needed to do was get out of the way and let the free market work.
Insurance company spokesmen like me assured the public that our then-novel managed care plans, coupled with the invisible hand of the market, would do the trick. Leave it to us, we said, and we'll get medical costs under control and enroll every American in a good HMO.
The proponents of a pure free-market health care system hope that Americans have amnesia and can be persuaded to blame President Obama for the problems that grew almost immeasurably worse between the demise of the Clinton plan and the passage of the Affordable Care Act. They want us to believe, despite overwhelming evidence to the contrary, that health insurers and the largely unfettered, loosely regulated marketplace can somehow turn things around. And that we should reward insurers for their failure by turning the Medicare program over to them.
In many respects, the free market approach to health care has indeed been just what the doctor ordered, although not for patients. We spend twice as much on health care per person as western European countries do on average. Yet, according to the Commonwealth Fund, 81 million Americans are now either uninsured or underinsured -- far more than during the Clinton administration. And with just a few exceptions, we rank well below almost every other developed country in measures of health outcomes, such as longevity and infant mortality.
There is fresh evidence almost every week that our uniquely American free market health care system continues to fail us.
Last week, in a piece about hospitals buying physician practices, the Wall Street Journal reported that patients are getting bills for doctor visits that are much higher than they were before their doctor's medical group became part of a hospital system. Hospitals are charging more for physician services they now own just because, well, they can, thanks to the free market.
The story quoted insurance executives saying that one of the reasons insurers are raising premiums is because they're having to pay more for physician and outpatient services as a result of this trend. And because insurers have moved millions of us into high-deductible plans, we're having to pay more out of our own pockets, too. So we're getting hit where it really hurts -- our pocketbooks -- twice.
Another reason for skyrocketing premiums: hospitals are also merging with each other to have more clout at the negotiating table with insurers. According to the health care consulting firm Irving Levin Associations, there were 86 hospital mergers or acquisitions last year. That's compared to 75 in 2010 and 51 in 2009.
Those mergers and acquisitions not only have been enabled by our free market approach to health care, they've been necessitated by it. The consolidation among hospitals is accelerating because of the even more rapid consolidation in the insurance industry. The two biggest health insurers, UnitedHealthcare and WellPoint, are giants because of their numerous acquisitions over the past several years. As a result of this consolidation, almost every metropolitan area in the country is now dominated by just one or two big insurers.
It has become a kind of arms race between hospital systems and insurers, and there are no signs that it will end anytime soon.
There was other fresh evidence last week that patients do not benefit from these trends. In a study published in Health Affairs, researchers reported that Americans younger than 65 (and not yet eligible for our single-payer Medicare program) are more likely to die because of a lack of timely access to affordable, effective care than people in the same age group in the single payer systems in France, Germany and the United Kingdom. For men, the preventable death rate was 69 per 100,000 in the United States versus 53 in the U.K., 50 in Germany and 37 in France. American women fared a little better but not much. Especially disheartening was the fact that we are falling further behind those countries every year.
Bottom line for us: we're paying more and more for health care but continuing to trail the rest of the developed world in access to quality, affordable care.
In a recent post on the Forbes website, free-market advocate Sally Pipes of the Pacific Research Institute bemoaned the fact that "the dream of single-payer health care in America just won't die." This despite a decades-long campaign by insurers and their allies to equate single-payer systems like those in Canada and Europe with socialism and big government. Considering the many failures of the U.S. health care system, it is more appropriate to wonder why the dream of a free-market health care system just won't die.
Follow Wendell Potter on Twitter: www.twitter.com/wendellpotter
I propose an alternative that enhances the ACA with a hybrid system where basic care and a focus on health & wellness are part of a public program with no need for insurance, while extensions to that are available in the private sector. For more on this view, see http://www.mhealthtalk.com/2012/08/hybrid-model/.”
It's obvious people are sicker today and require more medical care then ever. Health Care is serving itself!
I believe it is a right not a privilege.
A patient's financial situation shouldn't be a factor in whether or not they get treatment and whether or not they live or die.
Patients with pre-existing conditions should be treated the same as those without.
Health Care is not a choice for most people.
Patients shouldn't have to bankrupt themselves in order to receive treatment.
People need to take responsibility for health choices they make and be encouraged to make healthier choices.
Patients should be able to get the treatment their doctor recommends without interference by an insurance company concerned about maintaining a profit instead of the patient's well being.
Free market approaches don't acheive any of the things that I find important.
The rest of the industrialized world has decided that HC is a right for their citizens. These countries don't spend anywhere near what we do on HC. Even the countries that use private insurance carrriers, like Japan, control the prices that providers can charge. That means they don't use a free market approach.
I would like to know why the proponents of a free market system for Health Care feel they way they do.
What are your guiding principles? Is there any common ground between what I believe and what you believe? Is it OK to let people die without treatment based on income,credit rating or health condition? I just want to know what you consider important.
CHECK YOUR MATH. Here is the most current information, published 7/23/12, on Canada from the PHAC (Public Health Agency of Canada). Even in the age group with the highest incidence rate, the infection rate is .86%.
The incidence of pertussis is highest in infants and children, and decreases sharply in those older than 14 years. Average incidence rates from 2005 to 2009 were 86 cases per 100,000 population among infants less than 1 year of age (average of 310 cases per year), 33 cases per 100,000 in children 1 to 4 years (459 cases per year), and 16 cases per 100,000 in children 5 to 9 years (290 cases per year).
From 2001 to the present, incidence has generally decreased down to 1.96 cases per 100,000 in 2011.
Check any of the countries with universal health care and compare those while you're at it.....