By Jerry Bartone
The article “It’s Time to Rethink Insurance” by senior fellows at the Hoover Institute makes many valid points, but fails to address the big picture.
A hip replacement in the United States costs around $130,000, while the same procedure costs around $30,000 in other developed countries. We have the highest health care costs in the world because the U.S. health care system is like a giant, 24-sided Rubik’s cube, composed of a complex group of players with competing interests.
While employers strive to reduce costs, employees want the best benefits. While insurers work to control costs by limiting provider networks, patients want choices of providers. While doctors want to provide the very best treatment, insurers and regulators are increasing their administrative burdens. While stockholders of insurance companies push for higher profits, patients and employers actively seek lower costs. Our fragmented system is fertile ground for the underground economy of fraud and kickbacks from such players as pharmaceutical companies and medical device manufacturers.
There is no one answer, but there are fundamental changes that can create the most positive impact. The first step should be to learn from the best. Some of the very best models in the world are located here in the United States: the Mayo and Cleveland clinics.
The senior fellows at the Hoover Institute argue that higher deductibles will make consumers wiser shoppers. But many people are poor advocates for their care. Low-income people, faced with the choice of a $40 deductible for an X-ray or putting food on the table, will choose food. Many people will choose cable TV and a smart phone over necessary health care. When a significant portion of the population delays preventive and routine care, costs rise for everyone. Free or very low-cost health care, especially preventative care, can result in an overall healthier population and a significant reduction in costs for everyone.
I often hear the argument that increased competition among insurers would lower costs. Like the airline industry, the insurance industry would be more efficient with consolidation, not added competition. The mental health clinic at Community Concern does business with 58 health care plans. There is ample competition. We have exceeded the tipping point where the cost of contracting and paneling providers, collecting from patients and adjudicating claims exceeds the savings from competition.
We have seen with the Affordable Care Act that when you move one or two sides of this Rubik’s cube, the results are a multitude of unintended consequences. Let’s reform by learning from some of the best health care models in the world, which happen to be right in our own backyard.
Jerry Bartone is the executive director at Community Concern of WNY.