How can you help our hospitals and health care providers (and yourself)?
First, learn how private health insurance, pharmacy benefits management companies and some providers collude to divert large amounts of your premium and tax money away from the health care you’ve already paid for. Learn how they create unnecessary complexity, confusion and cost barriers for you and unjustifiable profits for themselves.
If you have a medical emergency, will you have the insurance policy and network allowing the care you need? Will you receive a surprise bill? Will your plan cover the drug or procedure your doctor recommended? Will your preauthorization or claim be denied?
Insurance agents deserve pay and praise for helping us navigate a complex, confusing and costly health care system. But why have a complex, confusing and costly health care system in the first place? We don’t have to.
Here are wasteful elements of corporate-run (private) insurance we need to reject:
1. Medicare “Advantage" plans: All private insurances “cherry-pick” and “lemon-drop.” You tend to be picked if you are healthy and wealthy and dropped (via narrow networks and drug formularies) if you are unhealthy and unwealthy. Such adverse selection adds byzantine complexity and cost. Administrative overhead for Medicare “Advantage” is 10% versus 3% for public-run traditional Medicare. The overhead for other forms of private health insurance is 10-30% when providers’ offices are included. No organization or business can sustain a 10-30% administrative overhead.
2. Part D and other corporate-run drug plans: Most (seven of eight) prescribed medicines are generic and cost only pennies per pill. Pharmacies work under pharmacy benefits manager gag rules preventing them from telling you what your prescription could cost without insurance. Your copay is likely to be more than the amount your generic prescription would cost without insurance. You can probably save money by shopping pharmacies without mentioning insurance and delaying Part D until you need a brand-name drug.
3. Employer-based self-insurances (administrative service contracts): ASCs administer employer health care funds without significant accountability to anyone — your employer, insurance commissioners, you or the public. ASC opacity invites abuse of your health and money.
As you’ve seen during this pandemic, we all suffer or face risk when others don’t get the care they need. A virus can decimate a church, factory or neighborhood. Fear of cost prevents people with chronic illnesses (diabetes, hypertension, etc.) from getting the care they need. Neglected illnesses decimate families and neighborhoods.
We know how to enact laws that ensure everyone the necessities they cannot provide well for themselves: fire protection, police protection, affordable education, roads, bridges and potable water. According to a 2017 RAND Corp. study, Oregon can have health care for all Oregonians at no greater price than we collectively now pay in premiums, taxes and out-of-pocket (for a system that leaves a third of us without good health care).
According to a 2019 Elway Institute study, three of every four Oregonians, rural and urban, favor universal health care. If you dread what will happen to your family’s health care if any member dies or loses a spouse or a job, you will welcome health care no longer tied to a job, age, spouse, ZIP code or income level.
Please contact your state legislators to ensure Oregon’s SB 770 Task Force carries out its work mandated by the 2019 Legislature — to design a system that brings illness-related suffering, death and cost under control.
Urge Sen. Wyden and Rep. Schrader to support true universal health care at the national level and thank Sen. Merkley and Rep. DeFazio, who are already on board.
Mike Huntington, MD, is a retired radiation oncologist and vice chair of Mid-Valley Health Care Advocates. For more information on the topics discussed in the column, see mvhca.org.
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