By Johnathon Ross, M.D., M.P.H.
Toledo (Ohio) Blade, December 23, 2018
The ProMedica vs. Aetna tiff is just one more piece of evidence condemning the profit motive in health care (āāProMedica doctors say Aetna pays lower rates,ā Dec. 8). Imagine two pirates with knives fighting over our money while tied to us at our wrists. Yep, we have skin in the game. Except it isnāt a game and we know who will get skinned.
Americans have an almost religious belief that market forces can solve any problem. Narrow physician networks are at the heart of the ProMedica vs. Aetna dispute. Narrow networks are supposed to create competition that will control costs and improve quality. Instead, they create out of network price gouging by providers.
This is not the first bad idea promoted by the acolytes of market forces in health care. We have tried privatization of Medicare through competing Medicare Advantage plans, privatization of Medicaid by competing HMOs, privatizing facilities like nursing homes, home care, hospices and dialysis. We have tried insurance reforms such as marketplace exchanges like those of Obamacare, the federal employee health benefit system, high-risk pools to reduce insurer risk, and expanding insurance markets across state lines. We have tried putting providers and patients at risk through HMOs, PPOs, ACOs, capitation, health savings accounts, high deductible health plans, bundled payments, pay for performance, narrow networks, and the Holy Grail for doctors ā malpractice reforms. All have failed to control costs, improve outcomes, or expand access.
Most economists agree that health care is not a commodity like a can of soup. The information needed to make health decisions is often uncertain and expensive to obtain and for the most serious and expensive conditions, you buy or die. Most people only want the health care that they need. For example, if open heart surgery was on sale, would you have two?
Health care is a basic human need and should be a human right, especially in a rich country like ours. Winston Churchill is rumored to have said āYou can always count on Americans to do the right thing, after they have exhausted all the other possibilities.ā I suspect we are there.
The right thing is a national health insurance program. Multiple studies, including four new ones this past year, show that an improved expanded Medicare for all would cover everyone with no copays or deductibles with complete choice of provider and still save money ā a lot of it! There are bills in front of the Ohio and U.S. legislatures to create an improved and expanded version of Medicare for all. It will save lives and save money. We need the political will to move forward and do the right thing.
Dr. Ross is a member of the Toledo Lucas County Board of Health.