Private Insurers Aim for Profit, Not Care
Is It Time for Universal Health Care?
Not Before Private Health Insurance Makes a Money Grab
by Tanya Feke, MD
America Ranks Last
A harrowing report was put out by the Commonwealth Fund in 2014. Out of 11 industrialized countries, the United States came in dead last for its health care system. It was not one issue that led to its embarrassingly low ranking. America placed 5th for quality care, 9th for access to care, and 11th in each of three categories: efficiency, equity, and “healthy lives”. Healthy lives takes into account infant mortality, preventable deaths, and overall life expectancy for people at age 60.
What do those other countries have that we don’t?
Universal health care.
If you think much has changed in the grand scheme since 2014, you are a bit naive. The Affordable Care Act, aka Obamacare, may have increased access to care for millions of Americans. It may have prevented insurers from price-hiking people with pre-existing conditions. It may have required insurance companies to cover basic preventive health services. It may have expanded Medicaid programs in 32 states. It may have add years to the life of the Medicare Trust Fund too. Still, it did not do everything it set out to do.
Though many people have better coverage than they had before Obamacare came to pass, others are paying more for it in unfair ways. Insurance premiums are rising at astronomical rates. If you have access to health insurance but still cannot afford it, The Commonwealth Fund is going to ding you for it.
The ACA (Obamacare) – Insurance Companies Win
With the American Health Care Act passing the U.S. House of Representatives in May, many people are left wondering what to expect from our health care system if it also passes in the Senate. Will Democrats and Republicans come together to make a more viable plan? A more workable plan?
No matter how you look at it, Americans are left at the mercy of private insurance companies. If the Affordable Care Act remains the law of the land, private insurers will continue to price hike premiums for people on ACA plans. With more sick people to cover, their profit margins are at risk.
The ACHA (Trumpcare) – Insurance Companies Win
If the American Health Care Act had gotten enough votes to pass the House and *gulp* the Senate, the insurers STILL would have had the upper hand. They would be allowed to increase rates for people with pre-existing conditions. They could charge seniors, regardless of their health status, five times as much as they would for younger beneficiaries (currently they can only charge three times as much). Not only that but they could manipulate their plans so that they would not reimburse for preventive care. Worse, they could intentionally leave off specific treatments so that individuals with certain chronic medical conditions would not sign-up one of their plans in the first place. Without viable coverage options, where would these people turn?
The Congressional Budget Office reported that 14 million people would lose their health coverage by 2018 and 24 million by 2026 if the ACHA came to pass. Premiums would also increase under the ACHA, at least through 2020. After that, premiums would be expected to decrease but not across the board. The age-related ruling could make premiums unaffordable for seniors until they finally became eligible for Medicare.
The Health Insurance Drive for Profits
If private insurance companies cared about your health, they would charge a fair rate based on where you lived in the country (some states have lower average incomes) and cover the medical care you needed, including preventive screening. After all, if you stop disease in its tracks early, you do not have to pay the long-term costs of managing a chronic illness.
That, my friend, is how you save healthcare dollars.
Instead, all the insurers focus on is short-term profit.
Let’s take a look at how much a CEO earned at one of the big five insurance companies in 2015.
– Aetna, Mark Bertolini: $17.3 million
– Anthem, Joseph Swedish: $13.6 million
– Cigna, David Cordani: $17.3 million
– Humana, Bruce Broussard: $10.3 million
– UnitedHealth, Stephen Hemsley: $14.5 million
How much money did each company have to make to pay out such exorbitant salaries? Surely, there must have been some profit! Yet the private insurers claim they are losing money under the Affordable Care Act. This is their argument for driving up premiums at least.
Making Big Insurance Even Bigger
Insurance companies have also tried to merge forces, Aetna with Humana and Anthem with Cigna, to further increase their profit margins, though they would not be so bold as to tell you so. Their official claim is that merging would help them to consolidate their resources so that they could offer lower cost care.
The U.S. Justice department saw things differently. They saw these mergers as direct opposition to anti-trust laws and blocked both acquisitions.
Evidence shows that these mergers would have resulted in higher prices, not lower. The companies would create monopolies in certain areas of the country. No longer having to compete against each other for national accounts, the private insurers are the ones who would decide how much they could charge. The diminished competition would lead to higher prices for doctors, hospitals, and most importantly, your pocket.
A Whistleblower Suit Against Big Insurance
Private insurers may not be able to merge, but they will find other ways to make a money grab. Just ask whistleblower Benjamin Poehling. He filed a suit against UnitedHealth Group Inc. in 2011.
As a former UnitedHealth executive, he reported that the insurance company overcharged the federal government potentially billions of dollars for care provided through their Medicare Advantage plans. He relays that they manipulated risk adjustment scores for their beneficiaries so that it appeared they were getting more care than they actually were. The files were finally released to the public in February 2017.
(No) Mercy of Private Insurers
My point in all this? The AHCA still has to pass the Senate before it becomes the law of the land. No matter which law prevails, the ACA or AHCA, private insurers will find some way to use it to their advantage and turn a profit.
As long as they hold those reigns, actual patient care will come second place to dollars and cents.
Without change, our American health system will continue to rank low compared to other industrialized nations. If we are trying to make America great again, we need healthy citizens to get us there.
This begs the question: Can we revamp our current healthcare system to decrease the power of the almighty insurance company? Or is it time for the United States to turn to a single payer system, i.e. universal healthcare?
Let the debate begin.