The Road to Universal Coverage

Posted on | February 26, 2019 | 1 Comment

Mike Magee

New York Times columnists. Austin Frakt and Aaron Carroll, provided a genuine public service this week in offering an interactive exploration of universal health care. Readers were asked to react to the same questions presented to a bevy of health gurus.

Their 5 “Yes or No” questions were:

1. Do you support automatic enrollment in universal coverage?

2. Do you support ending employer-based private coverage?

3. Do you support replacing individually purchased private coverage, like Affordable Care Act plans or Medicare Advantage?

4. Do you support eliminating premiums and having the system financed exclusively by taxes?

5. Do you support eliminating cost sharing — meaning co-payments, coinsurance, deductibles — for everyone?

Following each vote, you are able to see the % who voted “yes” or “no”. Then there is commentary from health policy notables explaining why they voted the way they did. Spoiler alert – majorities are leaning toward big change.

The national scale is obviously tipping toward idealism and solidarity with significant push back from pragmatists/realists explaining – usually based on taxation/financing – why what logically should be done is just not politically feasible.

What is missing from the piece above, and from many others on the topic, is an obvious truism: Universality is dependent on two co-determinants – mandatory participation and transformational efficiencies.

In short, we can afford health care as a universal right for all only if we share the risk and halt profiteering collusion by the Medical-Industrial Complex.

Consider these two facts:

One in five American dollars now go to health care – we spend close to twice the amount of most other developed nations.

There are 16 health care employees for every one physician in America – and half of these 16 have absolutely no clinical purpose.

Stories of profiteering and financial abuse abound, and I review many of them in Code Blue: Inside The Medical Industrial Complex (Grove Atlantic) due out on May 7, 2019. But let me share just one recent case that illustrates the near racketeering level of absurd waste in our system as described in an investigative ProPublica piece last week.

It seems that nearly all the major health insurers have been secretly greasing the palms of the 100,000 plus U.S. local health insurance brokers to push their products on small and large employers nationwide. Secretly, the brokers have been collecting a 3 to 6% commission on every premium, which for a company of 100 people amounts to a $50,000 plus annual fee. And that’s for the regular plans. If they sell you supplemental plans (for drugs, dental, optical etc.) the commissions are richer – much richer. 40% to 50% to be exact because the benefits often go unused.

Scaling that up, BC/BS’s service of 15 million employees in 5 states generated $816 million in broker bonuses in 2017. And they and other big players like Cigna, United Healthcare and Aetna offer no apologies. To them it’s the price we pay for good, clean competition.

And then there is Morris County, New Jersey, where one fast-talking broker convinced the county’s HR people to switch coverage to Cigna and effectively concealed the administrative charges for the switch – over $800,000. The county is now suing, and consuming more local taxpayer dollars in the process.

A significant and growing contingent of consumer advocates favor big change. Why? Because they realize that crooks thrive in the cracks of complexity. Simplify is their true rallying call, and eliminating steps and “non-real” work is the surest way to finance health care for all.