Robert Stone
The Journal Gazette (Fort Wayne, IN)
January 5, 2009
The largest gorilla recorded weighed 600 pounds and lived in a zoo. In the wild they don’t get that big. An 800-pound gorilla exists only in our imaginations.
When debating how to fix our ailing health care system, someone always says, “There’s an 800-pound gorilla in the room, and it’s the insurance industry. No matter how we want to reform health care, they are so powerful they are going to call the shots.”
Let’s examine the industry today. The big five health insurers remain huge, but they are beginning to stumble. While the overall stock market fell 40 percent as of last week, heavyweights such as Anthem/WellPoint, United Health and Humana have seen their stock prices plunge 60 percent — $82 billion of value, gone.
We shouldn’t be surprised these companies are in trouble. Insurance, after all, is part of the badly hit financial services sector. And while in 2005 financial firms accounted for 38 percent of total U.S. corporate profits, today many of these former darlings of Wall Street are bankrupt or part of the bailout.
The health insurance industry is deeply enmeshed in finance. Take WellPoint, for example. Last year the company’s executives wanted to incorporate as a bank in Utah so they could directly manage the health savings accounts of wealthy individuals nationwide. They resented the fact that other banks were collecting fees on such accounts. WellPoint also wanted the government to insure its depositors through the FDIC, i.e., it wanted to socialize the risks of its banking venture, but privatize the profits.
Why Utah? Because Utah has some of the loosest banking regulations. State regulators balked at first, arguing that WellPoint looked like an insurance company, not a bank. But WellPoint persevered and succeeded in getting the rules bent to become reclassified as a financial company.
Poor regulation has contributed to the overall financial crisis, no doubt.
In the case of the health insurance industry’s predicament, at least two other forces are undermining its viability: the steadily declining numbers of people in employer-sponsored health plans and skyrocketing costs.
Private health insurance, with its rising premiums, co-pays, deductibles, exclusions and so on, is becoming increasingly unaffordable for individuals, families and businesses. The private model of financing care is no longer sustainable; it is dying. It is more like a dinosaur stumbling toward a tar pit than a mighty gorilla.
We can no longer afford to have these for-profit companies dominate our health care system. They are the problem, and retaining their inefficient, greedy business practices should not be part of the solution.
Instead, we should turn to the “other 800-pound gorilla” in the room — the elegantly simple solution staring us in the face: Medicare for all. Medicare is the universal government financed (“single-payer”) health care system we have already for everyone age 65 and older. We have more than 40 years’ experience with it. Simply replace for-profit insurance with Medicare for everyone.
This makes so much sense that those who want to protect the for-profit insurance industry don’t want to talk about it. When they do, they demonize it and call it “socialized medicine.” Do you think Medicare is socialized medicine?
We can deal with the dying health insurance industry compassionately. People working in the industry will need to be retrained. There is plenty of work to be done. We can retrain them to help care for the 46 million Americans who are currently denied care. And under this plan, displaced workers won’t lose their insurance.
As for the insurance company CEOs with their multimillion-dollar salaries — we may just have to let them fend for themselves.
Robert Stone , M.D., practices emergency medicine in Bloomington. He is director of Hoosiers for a Commonsense Health Plan and a member of Physicians for a National Health Program. He wrote this for Indiana newspapers.