Private plans haven't delivered the cure
The Orange County Register
April 10, 2005
Private plans haven’t delivered the cure
By Don R. McCanne, M.D.
Bruce Bodaken, CEO of Blue Shield of California, warns that, unless we reduce health-care costs and provide coverage for the uninsured, we will likely turn to a government-run single-payer system [“’Vicious cycle’ of care,” Business, March 30].
That raises two questions. Why hasn’t Bodaken’s own industry been able to solve the problems during the past half-century that it has had control of health care spending? And what is there about a single-payer system that would cause policy-makers to turn to that option?
Private health plans should be providing us with higher quality at lower cost. But by most measures, we are receiving relatively mediocre care that is rife with error and wasteful excesses, while many are not receiving even the most basic essential services. And over 90 percent of Americans agree that health care costs are out of control. Since private plans are failing us on cost and quality issues, are there any other reasons to keep them in charge?
Do private plans avoid the inherent waste of government bureaucracies?Unfortunately, private plans actually consume a far greater percentage of health care dollars in administrative costs than do public programs such as Medicare. And worse, our fragmented system of funding care places a tremendous,wasteful administrative burden on the providers of health care.
Bodaken exemplifies this inefficiency in admitting that he can’t figure out the benefits of his own personal health plan provided by his own company. Do private plans provide us with choice? The American Medical Association just released a report confirming, by Justice Department standards, that 93 percent of HMO/PPO markets are “highly concentrated.” So much for true market choice of health plans. Besides, the choice we really want is choice of our own physicians and hospitals. Most private plans limit our choice and assess severe financial penalties for failing to use their preselected choices.
If we leave the plans in place, what options do we have? Everyone agrees that the status quo will never do since costs are skyrocketing, access is diminishing and quality is not improving.
Should we relax regulatory oversight, allowing the markets to work more effectively? We know that the plans invariably attempt to sell to the healthy and avoid the sick. That might be appropriate for the marketplace, but it shifts the burden of risk from the plans to the taxpayers.
Should we instead increase regulatory oversight? Requiring that plans jointly guarantee affordable coverage for everyone would create a de facto single-payer system since the plans then would provide primarily only the administrative services that we actually do need for health care financing.
The $1.9 trillion that our nation is already spending on health care is more than enough to pay for comprehensive health care services for everyone. But there is an urgent need for us to demand much more accountability for our health care spending. Just don’t expect it to come from the health plans.
http://www.ocregister.com/ocr/2005/04/10/sections/commentary/READER%20REBUTTALS/article_474432.php