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Shape Up or Ship Out!



We are coming to the end of the first year of the Affordable Care Act (ACA).  Although the ACA ushered in an era of improvements, we still have a long way to go.   Devin Miller, Washington correspondent for the American Academy of Pediatrics, optimistically reports that more children that ever are currently insured, thanks to the ACA, Medicaid, and the Children’s Health Insurance Program. 1 He reports a 25% reduction in the number of uninsured Americans, which should be great news.    My question is, what does “being insured” mean?  In my experience, the new Covered California plans generally have a large deductibles, sizable co-pays, restrictive formularies accompanied by many exclusions.  If you can still go bankrupt from medical bills while insured, how much good has this done?   We are happy that many more people have insurance now, but that needs to translate into good medical care for policy-holders.  If the insurance industry does not step up and become a good partner in the health care system, in my opinion, this legislation is sunk.
Now that everyone at or above a specific income level is obliged to pay for health insurance (or pay a fine), the insurance industry has been considerably strengthened.   Those of us who qualify for private insurance have placed our health in the hands of enormous corporations whose primary goal is to make money for themselves and their shareholders.  In 2013 Joseph Swedish, CEO of Wellpoint (AKA Anthem) “earned” $17,000,000.  That’s right--8 figures.  This was topped only by Mark Bertolini of Aetna who raked in a sound $30,700,000.  That translates into $90,029 per day, or about $11,254 an hour, assuming an 8- hour workday. To further extrapolate, that comes to $188 a minute, or slightly over $3 per second.  If insurance companies are allowed to raise premiums, increase co-payments, deny coverage, fail to provide adequate networks of providers, and underpay the workforce of physicians and healthcare providers, the ACA is going to fall apart.  The conservatives that hate “Obamacare” will joined by the liberals who hate the insurance industry’s greedy profiteering and the law will be so unpopular there will be a groundswell of opposition.  
The insurance industry has a choice to make in 2015:  They can choose to a good job for their patients and for medical care providers by promoting good, comprehensive health care, or they can continue to overcharge, deny care, hassle patients and chisel and grind the doctors.  They can choose to be good partners to those of us that are in the trenches actually doing the work, or they can continue to hassle and underpay us.  In its heart of heart, the insurance industry knows that it provides no true or meaningful service.  It is an expensive, expendable intermediary, and many argue that it should be disposed of altogether.  MediCare operates well without Anthem; Medicaid runs smoothly without United HealthCare.  The VA system runs just fine without Blue Cross or Blue Shield.  The entire country of England operates without Aetna.  Canada does just fine without HeathNet.  
I challenge the insurance industry to step up and become good partners before it is too late.  I ask the insurance industry to make the following commitments:   
1.  No one in an administrative position will ever, ever make more than one of the physicians working in the system.
2.  Spend the majority of premiums you collect paying for medical care.  MediCare spends 2% on administration, --surely a private company can do better than any government-run organization?
3.  Answer your phones within 5 minutes, and put someone on the line that can actually address my needs when I call.
4.  Change your disclaimer to state:  Clarification of benefits IS an authorization of payment; rest assured that we will take care of you
4.  Pay claims without hassling patients or providers.  
5.   Beef up your outreach and preventative medical endeavors.  
6.  Do what it takes to help our country achieve a sensible, caring, comprehensive health care system---or get out!  Remember, we don’t really need you at all!

  1. Washington Report, AAP News, Volume 35; number12; Dec 12014

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