Insurance companies take a large risk that their income from premiums will exceed the amount they pay out to doctors, hospitals, and other medical providers for their services. They lower their risks by denying coverage as often as possible.
In most of the civilized world, healthcare systems provide coverage for whatever the doctor orders. In many countries, there is no charge for healthcare at the point of use or minimal copays. Our Medicare plan for older Americans
is remarkably similar to what is available for everyone in most counties.
It
is common knowledge that the healthcare system in the U.S. is broken. OECD
ranks us last in healthcare availability and outcomes.[i] Millions
of people can’t afford medical care
except in emergency rooms. Millions of people can’t afford health insurance.
Our life expectancy is 76.4 years compared to 80.4 years for OECD countries.
Our infant mortality ranks thirty-third out of thirty-eight countries. We have
the highest levels of diabetes. We spend twice as much on healthcare than any
other OECD country and have worse results. There is plenty of blame to go
around. Prescription drugs are expensive, and hospitals are costly and getting more
expensive as hedge funds buy them up and reduce staff and departments to
increase profits. Too often the U.S. healthcare system isn’t so much about
healthcare as it is about profit. So let’s shoot the CEOs?
Brian
Thompson, the CEO of UnitedHealthcare, was shot in the back while walking to an
investor information meeting. The assailant evidently believed that shooting a
CEO would improve healthcare. It won’t. The assailant has two degrees from an
Ivy League school and comes from an upper-middle-class prominent family, who
went missing for a month before the shooting. He should know better. Shooting
someone isn’t an acceptable way to express anger. It is not justifiable under
any circumstance. It never was. But that was then and this is now.
A
study by the University of
Chicago indicated that only seventy-eight percent of those surveyed blamed the
assailant totally. Sixty-nine percent said that denial of coverage by insurance
companies was to blame, and seventy-six percent blamed the general inequality
of wealth or income. Axios reported that in a survey of one thousand voters, seventeen percent said that the killing of Brian Thompson was acceptable or
somewhat acceptable. Shockingly, forty-one percent of those 18-29 said it was
at least somewhat acceptable.
The
assailant, Luigi Mangione, received loud applause when he was mentioned on TV.
Axios said that the public's veneration of Mangione “Revealed a deep distrust
of the health insurance industry and its treatment of patients in need of
critical care.”[ii]
The
day after the killing, Andrew Witty, the CEO of the parent company of
UnitedHealthcare, wrote an opinion piece in the New York Times in which he said
that he and his colleagues were trying to make sense of, “The unconscionable
act and the vitriol that has been directed at our colleagues.”[iii] Yes,
the deliberate and planned shooting was an unforgivable act. The vitriol should
not be unexpected.
Mr. Witty went on
to note that, “No one would design a system like the one we have. And no one
did. It’s a patchwork built over decades.” He is right. It is a system that
doesn’t work, it shouldn’t work and shouldn’t exist. Nothing changes without
change. A highly educated friend of mine recently wrote to me, “I knew the U.S.
healthcare for us old folks was broken but since coming here (nursing home) I
realize how very bad it is.”
Mr. Witty was correct, the system is broken. You can’t expect different results if you keep on doing the same thing over and over again. Change requires change.
But will we make the needed changes? We just elected a president who has appointed people to responsible positions who want to do away with the parts of the system that work. They have convinced a large segment of the country that easily available and affordable healthcare is a bad thing. They want to tear apart Medicare and Medicaid which provides basic coverage for millions and millions of older people and low-income people. They don’t see good healthcare as a basic human right. They are wrong.
So what would be a good start to improving the healthcare of Americans? What would be a good start to make our healthcare as good as that of other nations? We could start by agreeing that everyone should have good healthcare. The rub is that it is hard to get people to agree on the definition of good healthcare. Then we could try to agree that everyone should have affordable access to good healthcare.
If
we could agree on those two things it would open the floodgates of strategic
options related to how we pay for healthcare, how we provide it, and how we use
the system. My thought is that we try to
determine how we will pay for healthcare before we redesign the system.
Everyone agrees that healthcare is expensive, but it doesn’t have to be so
much. Hospital services, for example, have risen 269% since the year 2000.[ii]
That suggests that some of the costs are increasing because the for-profit
hospitals feel that they can raise the prices with impunity.
The
price of drugs in the U.S. is extremely costly compared to the rest of the
world. For example, the cost of the new drug for weight loss, Ozempic, is $936
in the U.S. It is $93 in the UK and $83 in France.[iii]
Most users don’t pay full price if they have insurance. Other countries
negotiate prices directly with manufacturers or have national groups that
determine the price. The manufacturers tell us they could not afford to develop
new drugs if prices were constrained, but they do it for other nations. The U.S.
and Australia are the only two countries that allow drug manufacturers to
advertise. Eli Lilly spends $1.0 billion on advertising each year and Pfizer
averages $3.7 billion for advertising. They spent $9.3 billion and $10.7 billion
respectively for research. Simply outlawing pharmaceutical advertising would
save the system billions of dollars. Allowing negotiation for prices would
reduce the cost of drugs by more than a third. Outlawing for-profit hospitals
could lower those costs by at least half. A single-payor funding plan would
eliminate billions of dollars that flow into insurance company profit
streams. The point is that affordable healthcare for all citizens will require a massive disruption of the
current system.
If
we designed a system that wasn’t a patchwork of random methods and regulations
we might do away with healthcare for profit. We might find ways to reduce by
half the cost of healthcare if more people were healthier because they can
afford preventive care. We might find ways to reduce our child mortality rates
and increase our life expectancy. We might be able to provide prenatal care to
all who need it. We might reduce the number of people who don’t seek medical
care because of the cost. Killing CEOs won’t change the system. What will
change the system is a nation of people who believe that good affordable
healthcare is a human right.
Imagine a nation whose people’s
health is as good as the rest of the world. We could be that nation someday.
[i] The Organization for Economic Cooperation and Development is an
international organization that provides economic information from one hundred
countries.
[ii] Axios, 12/27/2024
[iii]Andrew Witty, New York Times, 12/13/2024
[1] Nonpartisan research
organization at the University of Chicago
[1] Bureau of Labor Statistics,
2024
[1] Shawn Radcliff, Heartline,
7/31/202 13
