By Brad Cotton, M.D.
Circleville (Ohio) Herald, March 13, 2019
It is true that President Obama misspoke during the crafting of the Affordable Care Act (ACA) promising that anyone who likes his or her health insurance can keep it. The truth is that, even before the ACA, no one (or almost no one) kept the same insurance year after year.
The fact is everyone loses insurance they like, constantly, and if you have employer purchased health insurance, there is very darn little of your so-called free market choice about it. You get the insurance your employer picks for you, or maybe you get to choose from two or three plans. You can bet that the choice of plans from year to year will have higher premiums, your employer will require a higher percentage of the premiums be deducted from your check, the deductibles will be higher, there will be narrower networks or restricted drug formularies forcing you to change your doctor, your hospital or your meds. I see patients daily who can’t see their new doctor, can’t afford their new meds they were herded into, or were forced into physicians, hospitals or meds they don’t like.
The insider term for this constant insurance instability is “churning,” and it is an inevitable and undesirable event as profit-based health insurers plot to keep more of your premium dollars and avoid paying for your care. Insurance companies look for the least expensive doctors, hospitals or meds while you get a new but worse deal each year. What a perverse system. We pay health insurers so that we may get health care when we need it; the insurer sees our hard-earned cash as theirs to keep and fights tooth and nail to avoid paying for your care.
If you have ever had to fight with an insurance company, you know they will fight you and your physician with denial after denial. Prior to the ACA, many health insurers spent as little as 50-60 percent of the monies they received from you on actual paying for health care. This is in industry terms called the “medical loss ratio” or MLR. The ACA requires health insurers to spend 90 percent of your premiums on actually caring for you, or refund the difference.
Churning leaves you feeling as if you had been thoroughly churned in your washing machine, pockets inside out, wallet gone and feeling as if you have been taken to the cleaners.
Our private health insurance system illustrates the aphorism that every system is perfectly designed to get the results it gets. The constant churning of your coverage, the constant instability, that feeling that you and your family are on thin ice is real and it is unsafe. The ACA was an immense regulatory attempt to force health insurers to behave responsibly by limiting an insurer’s ability to avoid covering anyone with pre-existing conditions, limiting their abilities to sell junk policies that cover nothing, or to actually dump you once you get sick. The monster of profit in healthcare can never be safely tamed and the ACA was an ineffectual attempt to do so.
For more detailed reading on the deviousness of the health insurance industry read former Cigna insider Wendell Potter’s book: “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans”. I further suggest “Trumpcare: Lies, Broken Promises, How it is Failing, and What should be Done” by physician John Geyman.
Safety lies in improved and expanded single-payer Medicare. Ask any senior how safe even currently unimproved and unexpanded traditional Medicare is. That 65th birthday is a lighthouse, guiding the way into the safe harbor of traditional Medicare. Traditional Medicare does not and has never limited physician, hospital, medications and treatment choice. Improved and expanded means we eliminate deductibles and co-pays and offer first-dollar coverage and we cover vision, dental and long-term care. We also eliminate the private Medicare Advantage plans that re-introduce all the downsides of private insurance, including churning.
Don’t be afraid of Medicare, be afraid of getting churned, your coverage constantly at risk when the health insurer’s corporate boardroom can sell your employer a cheaper or skimpier plan. When you are sick, do you go to the doctor or do you go to the banker? There are an abundance of U.S. physicians who support improved and expanded single-payer Medicare. That fact ought to tell us something.
