The Private Health Insurance Industry is Killing the U.S. Economy

by Richard Kirsch and Rep. Jan Schakowsky

Fifteen years ago the private health insurance industry told Congress and the nation that it could fix the health care mess if government got out of the way. The insurers said that they would control costs for American families and businesses and improve the quality of care. The American people, American business and the Congress aren't about to buy that line again.

The result of leaving health care reform to the insurance industry is that health insurance premiums have gone up six times faster than wages in the past nine years. Those dollars are buying skimpier health coverage with high deductibles and caps on benefits, resulting in more and more insured people being forced into medical bankruptcy. Businesses that are struggling to meet health care costs in a global economy and dropping coverage, so much so that now 1 out of 3Americans under the age of 65 has been uninsured at some time in the past two years. Health care eats up 16% of our economy, up from 11% when the nation decided to leave the private insurance in charge.

The insurance industry and their defenders on the ideological right are resorting to the same name tired name calling that worked for them the past, "government-run" health care. It's a desperate attempt to fend off a sensible government role in making health care affordable to our families, businesses and nation. This time it won't work. The President and leadership in Congress -- and the American -- people support a two-pronged role for government. One, set rules so that the private insurance industry can't continue to put profits before our health. Two, offer a choice of private insurance or a public health insurance plan, so people aren't stuck only with private insurance.

The fact is that if private insurers controlled health care inflation as well as Medicare has over the past decade, businesses and families would see much lower premiums than they do today. Between 1997 and 2006, per enrollee spending in private insurance grew 59% faster than spending in Medicare. And Medicare has the tougher job, because it cares for the most expensive population: the elderly and those with serious disabilities.

One reason that private insurers have gotten away with skyrocketing premium increases is that they have a near monopoly across the nation. According to data from the American Medical Association, in virtually every metropolitan area in the country (96%) the insurance market is dominated by so few insurers so as to be considered "highly-concentrated." A public health insurance option coupled with a regulated private insurance market will break the stranglehold a handful of companies have on the insurance market. Most importantly, under these reforms consumers will be able to vote with their feet when their health care plan -- public or private -- doesn't work for them.

In fact, the main argument that the industry and the right has with offering the choice of a public health insurance option is that too many Americans will choose it. If private insurers are really more efficient than government, they shouldn't have any trouble competing with a public health insurance plan. It's the height of irony that the defenders of free markets are opposed to competition. But when it comes to health care, which is a public good, public insurers really are more efficient.

There is broad agreement that America's health care system does not deliver the value we need. Today, private insurers have little incentive to develop sophisticated disease management programs, since such programs may attract sicker patients into their plan. And when care improvements are achieved, private plans have no incentive to share best practices with industry competitors. A new public health insurance plan would create a mechanism for the development of innovative and transparent payment mechanisms, the expansion of quality incentives, and the adoption of evidence-based protocols. As the Veterans Health Administration and Medicare have proven capable of doing, a new public health insurance program could lead the way in advancing electronic medical records, creating incentives for greater integration of delivery systems, and establishing improved measures of quality.

The American public gets it. In a national survey of voters taken last year, four-out-of-five voters (79%) said that the insurance industry puts profits before people. A Kaiser Family Foundation poll released this week found that two-thirds (67%) of U.S. residents "strongly" or "somewhat" favor establishing a public health insurance option "similar to Medicare."

Polling by Lake Research Partners this January found that the public believes that the choice of a public health insurance option will lower costs, improve quality, and increase competition. The poll paired the strongest conservative attacks -- "rationing", "government bureaucracy", losing private health insurance and being dumped into a public plan -- against the arguments for the choice of a public health insurance plan. In every case the public favors the pro-public health insurance option, in most cases by margins of better than two-to-one. For example, 61% agree that a public health insurance plan will be better able to control costs by using its purchasing power to drive competition. Voters reject by wide margins claims that a public health insurance plan will limit access, with 66% of voters agreeing that a public health insurance plan will provide an affordable option with a wide choice of doctors.

The question before Congress is whether it will follow the will of the American people. Or, instead, bow to the private insurance industry and other interests that stand to lose if reforms are passed to really make health care more affordable. The President and Congressional leadership share a strong commitment to reforms that will guarantee good, affordable coverage for all, with a choice of private or public health insurance. We know opponents will use scare tactics across the country and a huge corporate lobbying presence inside the Beltway to block reform. Progressive leaders in Congress and Health Care for America Now will be working hard to keep the American public engaged in this fight over the next months. Our success will be the hallmark of a new era in American politics in which the public good is put ahead of corporate excess and greed.