It’s no doubt that the health care conundrum our nation is facing is fraught with high-risk hypotheses and their unpalatable consequences. Complicating this further is the business-minded nature of many lobbyists and policy-makers influencing our government’s decisions, including President Trump’s. This is particularly timely given the recent executive orders Mr. Trump has unilaterally implemented that both sides of the aisle are concerned about. As a physician with a top priority of patient care, it behooves me to remind Mr. Trump and his entourage that the reason for health care legislation is to prevent, diagnose, and treat illnesses rather than turning better profits.
With many financially interested parties in our health care industry, there are certainly biases and conflicts of interest that exist. Health insurance companies collectively fill the role of negotiating pricing between the businesses and the patients at the expense of premiums, deductibles, and co-pays. If given the option of which patients to insure, they’re incentivized to maximize profits and minimize expenditures as much as possible.
Put another way, what advice would you give to someone who sells something essential to everyone? It seems logical, as many industries have done, to sell direct-to-consumer. This allows for the cheapest pricing and makes it available to the widest number of people. To be more explicit, it removes “the middleman” who was profiting off of the downstream customer. We’re not talking about bread here though. Add to this the ethics of selling a product that allows customers to live longer, healthier lives. Our health insurance industry makes large profits by commoditizing access to health care.
Proposed as a business model that results in a more expensive product due to multiple middlemen making money at various stages versus a simplistic direct-to-consumer model that results in that product being sold at a lower cost to consumers with higher profits for the seller, it becomes clear that industry’s goal is increasing profits, not helping Americans.
Furthermore, the ultimate payer who makes up for what profit-hungry insurance companies are unable or unwilling to pay is our nation’s government while “the middlemen” come out on top with enormous profits. Our government and our patients pay one of the largest percentages of GDP in the whole world just to seemingly enhance profits of the insurance industry. If we ignore lobbyists and politicians with conflicts of interest, would anyone argue with a system that makes the same health care more available to patients at lower costs and results in the government saving money?
Conversely, one could argue that with one or few payers providing insurance, Americans may be subject to whatever that payer decides it will fund for its customers, just like now. However, the checks and balances provided by elected representatives in the United States government should theoretically be better suited to provide what many consider to be a human right to its people than a for-profit company. Especially with the idea of an Obamacare repeal looming overhead, without mandates to insure everyone, a company has no incentive to insure a patient they know will be more expensive, but who arguably needs access to health care more than healthier non-users these companies see as profit-boosters.
By eliminating the middlemen of private insurance companies, we could actually redirect profits toward making health care cheaper for Americans and reduce our debt caused by health care spending. Although not always evident in President Trump’s statements, I would like to think our nation’s leadership has more of a moral obligation to care for our country’s people than a for-profit company.
An expanded government option made available to every American would certainly keep the private industry in check. Instead of competing to maximize profits at the expense of patients, such a government option would likely reset what the private sector is competing for. If health care outcomes are starting to be considered in the reimbursement of providers, those permitting access to care should take responsibility by increasing eligibility and access to insurance.
After all, when you are in the business of helping people, whether you are a doctor or an insurance executive, it is imperative to have the same moral obligation to “do no harm,” as the Hippocratic Oath states.
Mark P. Abrams is a cardiology fellow.
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