Most Americans are familiar with the inadequacies of health care insurance: it is expensive, not transparent, with costs and claim denials the crux of complaints.
The original purpose of health care in this country was to pay for catastrophic and unpredictable events. We’ve rotated way off that axis with disease and chronic illness treatments resulting in expensive claims that fall outside high-cost insurance premiums.
Medical doctor and ethicist Saum Sutaria reframes the modern purpose of coverage this way: “Health care insurance is a discount card.” His description, as dissatisfying as it may feel, is realistic.
One point highlighting the absurd state of U.S. health care insurance is our two-tiered system – some insurers are nonprofit companies and others are profit-driven.The separate market styles impact everything from decisions about claims, in-network and out of network choices, medical resources and, importantly, costs.
At a time when health insurance companies are so unpopular, you would think there would be public agitation for congressional hearings on why we have for-profit companies frequently denying the health care claims of their customers. It is a conflict of interest or, at least, priorities. Many questions emerge, but finding someone willing to explain our bifurcated system is challenging.
Despite dozens of requests to insurance companies, state insurance commissioners and national insurance associations, only one person would go on the record with me about the issue.
Allison K. Hoffman, professor of medical ethics and health policy at the University of Pennsylvania Carey Law School, is that expert. She said profit and non-profit tiers exist because we don’t have a universal health care system; that policy terms vary based on the type of coverage, and most people have coverage chosen by their employers.
In short, workers and their families get what they get until the insured turn 65 years old.
Hoffman notes Americans do make an essential choice about coverage when they are eligible for Medicare. But she cautions that “consumers should think through their specific needs” when choosing between traditional Medicare (more provider choice and less use review) and Medicare Advantage (lower cost sharing and sometimes extra benefits).
Ironically, Medicare and the Affordable Care Act insurance exchanges (aimed at shrinking the volume of uninsured) are two programs that offer choice and are government-administered, while universal health care is a political non-starter.
Will health care insurance even surface as a critical concern – including a dive into why we have for-profit health care insurance companies – for federal policymakers in this political cycle? It could happen if voters exert pressure on Congress, stressing this issue increasingly frustrates and negatively affects all Americans.
There must be a better way forward for the future of health care in the U.S.