By Rob Stone, M.D.
The Herald-Times (Bloomington, Ind.), July 14, 2015
Do you look forward to calling your health insurance company with a problem?
Happy to call Anthem to have them explain a bill?
Do you think it will be even easier to get satisfaction when Anthem merges with Cigna?
The health insurance industry already consolidated from hundreds of companies in the 1970s to being dominated by just five huge companies by the time the Affordable Care Act passed in 2010.
Now, in the wake of the recent Supreme Court decision upholding the ACA, out of those Big 5, Humana and Aetna along with Anthem/Cigna are merging to create the Big 3.
We should be alarmed. When companies get this big, its not good for us little people. The ACA didnt start this problem. Neither can it fix it.
Medicare, one of our nation’s most popular social programs, turns 50 on July 30. As noted in a July 3 New York Times editorial, in 1965 when Medicare was enacted, advocates of Medicare, which today covers 46 million Americans over the age of 65 and 9 million younger disabled people, expected that it would expand to cover virtually all Americans.
Although polls between 1999 and 2009 showed consistent majorities in favor of expanding Medicare to people between the ages of 55 and 64 to cover more of the uninsured, it never happened.
Medicare already takes care of the most complex and expensive patients in our system, and does it well.
Medicare only spends about 2 percent on administration and overhead. In other words, it’s very frugal versus private insurance, whose overhead and profits amount to 12 to 25 percent.
As the giant health insurers consolidate, they will not be looking for ways to pay for more beneficial services.
They will be introducing more “innovations” that prevent patients from getting the care that they need.
That’s the way that the marketplace for health insurance works.
Medicare doesn’t work that way.
In traditional Medicare, you have free choice of doctors and hospitals. At the same time, payments are based on legitimate costs and fair margins.
Medicare (and Medicaid) are the victims of skyrocketing health costs, not the cause. Despite the ACA’s expansion of coverage, about 27 million people will remain uninsured in 2025 (Congressional Budget Office).
The complexity of this highly fragmented system of paying for health care is unique to the United States and results in high costs and inequities that leave tens of millions underinsured and tens of millions more with no insurance at all.
Based on international comparisons, our healthcare quality is mediocre and our healthcare costs are by far the highest of all nations. Politicians may say “we have the best healthcare in the world,” but that doesn’t make it true.
Five years ago, Congress could have and should have extended Medicare to cover all Americans. Instead, it passed the complex ACA, which keeps the wasteful and bureaucratic insurance industry in charge.
It’s not too late to take the next step – Medicare for all.
Dr. Rob Stone of Bloomington is director of Hoosiers for a Commonsense Health Plan.