John Marty wants to make Minnesota a leader in real single payer health care. In a new book, Healing Health Care (free, available on-line), he outlines many of the problems with our current, insurance-controlled health care system and proposes an alternative, the Minnesota Health Plan.
Overall, our health care costs too much. The insurance company model of paying for health care keeps those costs up. Marty writes:
“We spend much more on health care than any other nation— about twice as much as other industrialized nations. In 2012, people in the U.S. paid an average of $8,745 per person. Germany was about half that at $4,811 per person; Canada was $4,602; France was $4,288; and Japan was $3,649. In fact, the second most expensive country in the world was Norway at $6,140— fully $2,600 per person less than the US pays!”
We, the consumers, are the ones paying for inflated health care prices through our insurance premiums.
The high cost of health care is not the only problem with the insurance industry system of health care. While the Affordable Care Act tried to limit some insurance industry abuses, many companies find loopholes and bend the law as far as far as it will go.
For example, insurance companies are now forbidden by law from refusing coverage to people with pre-existing conditions. Some, however, are cherry-picking customer/patients without actually breaking the law.
Here’s how it works. Many insurance companies list some essential generic drugs as non-preferred, making them more expensive for consumers. Non-preferred status means a higher co-pay.
If you have diabetes or high blood pressure or epilepsy, you need certain drugs on an on-going basis. In general, the population of people with these conditions is also a higher-cost population for insurers. When an insurance company classifies the essential, generic drugs to treat your disease as ‘non-preferred,’ you will likely choose a different company. That means the first insurance company neatly avoids covering people with your condition, without actually breaking the law by refusing coverage for people with a pre-existing condition.
Then there’s the in-network/out-of-network rip-off.
Say you’re admitted to an in-network (covered by your insurance company) hospital for an approved surgical procedure. You have checked to make sure that you have an in-network surgeon, and that your procedure is approved. But the anesthesiologist – a doctor whose name you don’t even know and who may not be assigned until the morning of the surgery — is out of network. You are stuck with a huge bill for his services.
Or maybe you have a medical emergency and go to an in-network hospital emergency room. Your care should be covered, right? But emergency room care is delivered by whatever physicians the hospital has on duty, and sometimes the physician who treats you is out-of-network. Do you want to stop treatment for your heart attack / broken leg / pneumonia to check on the network status of all the physicians in the ER?
These are just a few of the egregious abuses regularly perpetrated by insurance companies. It’s business, you see. Business means making profits, the biggest possible profits, regardless of who gets hurt.
Marty proposes a new, single-payer model for Minnesota. He says we can do it under the “innovation waiver” provisions of the Affordable Care Act, beginning in 2017. For more about the Minnesota Health Plan he proposes, read Healing Health Care. Or stay tuned to this blog – I’ll have more to say in future posts.