Thursday, June 04, 2009

Health care reform: Public option mandatory; single payer ideal

I confess: I was not an early supporter of a public option for health insurance. This is because I believed that our existing system could be reshaped to work for the good with some reforms, some regulations, and some transparency.

In my defense, I have worked in employee benefits for nearly 30 years, and have some working knowledge of the types of reforms that could actually work. But they won’t. The reason is simple enough: the culture of the insurance industry works against the good of the insured and toward the good of the company’s shareholders.

Health insurance cannot be a for-profit enterprise. Period. It must be a not-for-profit enterprise, and that means all facets: pharmacy, hospital, diagnostic, imaging, etc. As soon as profits are the primary motivator, patients become the problem. When patients become the problem, attention is only paid to ways to make them less of a problem, either by cutting back what is insured, how much is insured, or by raising their rates to unaffordable extremes. Right now, all three of these options are in play.

This is truly critical. A recent study indicates that 19 percent of companies want to stop offering insurance over the next 3-5 years. If they do, we will be at the precipice of a complete collapse of our economy as health care costs continue to take a larger bite out of our income.

Yet, Aetna has no concern for this. They serve only one master, the bottom line. This is at the heart of why markets are ineffective and inefficient ways to keep health care costs down. There is a fundamental conflict between the need to serve a profit on every quarterly statement and the requirement to provide benefits to the policyholders who pay the premiums that pay the claims and the profit.

This is a crisis that won’t be eased by tweaking a badly-broken and dysfunctional system. The entire system that must be reshaped into a single payer system and coverage for all. It is a system that must put health at the front of all considerations rather than profits.

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