I would suggest that the interests of the insured do not coincide with the interests of either the health insurance companies or employers. Very rarely does an employee have a choice of insurers from his employer. The employer is most frequently limited to offering the insurance provider with which it can negotiate the lowest rates, not the best coverage. The smaller the employer the less leverage it has when negotiating. The primary interest of the employer is cost management and stability.
Health insurance providers are among the most profitable companies in America. Their primary interest is getting the highest premiums for the lowest outlay to healthcare providers.
Effective and sustainable systems require balancing the interests of the participants. In this case, the insured, healthcare providers, insurance providers, and employers. Our current system does not do that. The insured gets shortchanged, healthcare providers distort their services to meet the arbitrary rules of insurance providers, while employers have been forced into an ever increasing spiral of higher costs — and the health insurance providers get fatter and fatter and are able to pay multi-million dollar salaries to their CEOs while stacking the economic and legal deck in their favor by corrupting our legislators through enormous lobbying budgets.
The results of this grossly unbalanced system are ever increasing healthcare costs and declining standards of care relative to the rest of the developed nations. Medicare-for-All is not the answer. The disruption it would cause would be untenable. I believe the answer is to balance the current system by:
- Moving the regulation of health insurance from from the state to federal level. The average American no longer lives his whole life in the state where he was born. Moving from one state to another can be a health insurance nightmare, especially for those with preexisting conditions — while the jumble of regulations among the different states makes coherent management of health insurance costs impossible.
- Removing the burden of providing (and in many cases, administering) employee health coverage from the employer and replacing it with a reasonable per employee tax that will be guaranteed stable for a fixed period.
- Taxing employees a reasonable amount roughly equivalent to their current contribution to employer-paid coverage. Guarantee the stability of that amount for a fixed period.
- From the pool of money from items 2 and 3, above, fairly distributing the opportunity to provide basic coverage, for individuals and families, to participating insurance providers at predetermined rates. Move the processing of healthcare claims to a centralized and common organization such a the current Medicare claims facilities or a consortium of the participating insurance providers.
- Allowing covered individuals and families to purchase additional coverage from insurance providers. If a provider does not wish to provide that additional coverage, the basic coverage would be transferred to a provider who will.
- Repealing the lobbyist inspired limitations on government negotiation of drug prices with pharmaceutical companies.
- Allowing the government to negotiate standard service rates with healthcare providers commensurate with the cost of delivery and a reasonable profit.
This is a first pass at talking points, not a finished plan. It is roughly based upon the way health insurance operates very successfully in Switzerland. As a pattern, it could be tailored to fairly balance the interests. of the insured, healthcare providers, insurance providers, and employers. It is unlikely to be popular with Big Pharma, healthcare insurance companies, and a substantial number of specialist MDs as they they are the groups that profit the most from the status quo. What is certain is that there is a finite limit to how long the current system can be sustained — and that the alternative solutions will be even less palatable.