Commentary: America’s healthcare system benefits the insurance industry, not patients and doctors | Column


Could this be the year the US begins to move away from the employer-paid health insurance model?

Certainly, healthcare is an issue that concerns most people. Few people today feel the anxiety that comes when they or their loved ones have to be treated for life-threatening acute or debilitating chronic conditions, whether receiving care or paying for medical services. plug.

Despite spending $4 trillion on health care in the United States in 2021 and the highest per capita spending in the world, our country’s life expectancy continues to languish compared to other developed nations.

So what are the issues that need discussion and resolution?

For many people, health insurance is tied to employment. When you get a new job, your health insurance coverage changes. This creates a patchwork of coverage that is prone to cracking during transitions. If there is a gap in employment, COBRA will provide compensation at its own expense.

The Affordable Care Act also ensures that everyone has access to health insurance without restrictions on pre-existing medical conditions. The growth of the gig economy further highlights why health insurance should not rely on traditional employment. Decoupling health care from employment is not only a good idea, it is also essential for expanding the reach of those who receive health care coverage.

One solution is to separate the provision of medical services from the payment for these services. Such segregation is critical to addressing the lack of access to health services and highlighting such problems in our health care system.

For most people, medical services are covered by health insurance. Health insurance companies are highly profitable. In 2020, the company posted a profit of $31 billion, up more than 40% from 2019. In 2021, it made a meager profit of $19 billion. The uptrend returned in 2022, with the six most profitable health insurers earning more than $41 billion.

The question is whether commodities that provide public goods, such as health care services, should be positioned to generate profits from such public needs.

One alternative is a single payer system, much like Medicaid, Medicare, and Veterans Affairs. This topic is a controversial lightning rod. Some argue that the government is ill-equipped to provide medical services to its citizens. However, a single payer system does not mean that the government provides the service. It’s just a funnel for medical services to be paid for. Single payer systems exist in 17 countries and provide a model of how to implement it in the United States.

A second option is to establish and grow a network of non-profit health insurers. As health care providers strive to accept insurance exclusively from these groups, the for-profit corporations will eventually be phased out. The advantage of non-profit health insurance is that excess earnings are used for the benefit of the subscriber rather than the shareholders.

Given that such a transition would be met with resistance from the for-profit health insurance industry, which has been lobbying and donating to campaigns to maintain the status quo, such a solution does not have a long-term vision. represents. Nevertheless, given the current situation, this direction requires caution and consideration.

The disconnect between health plans, providers, and patients creates an equilibrium where patients and providers are at the mercy of these companies, while health insurers benefit the most. As intermediaries, health insurance companies effectively control the flow of medical services to patients through prior approval. This means that health care providers are effectively working for the health insurance company to pay for the services provided.

For healthcare workers and patients, there is a glimmer of hope. UnitedHealthcare’s recent changes to its pre-authorization process implicitly recognize this problem and represent a move in the right direction.

The center of medical care must be the patient. For medicine to function in the best interest of the patient, doctors and other medical professionals must steer the ship. In the current environment, health insurance companies are to blame. This can hurt patients because they may not receive the care they need and deserve. This is painful as it forces doctors and other health care professionals to spend time and resources fighting for their patients and even being paid for their services.

Plain and simple, the current system works in the best interest of the health insurance industry.

When discussing health care in the United States, we must separate the services provided from the finances that pay for them. The financial component overwhelms the service component. Until this issue is resolved, the current situation will continue, harming the patients that doctors, health care professionals, and most importantly, all of us will one day become.

Sheldon Jacobson is Professor of Computer Science at the University of Illinois at Urbana-Champaign. A data scientist, he uses his expertise in data-driven and risk-based decision-making to assess and inform public policy.



Source link

Leave a Reply

Your email address will not be published. Required fields are marked *