How Good is your Health Insurance?

by Lesley Politi on April 20, 2009

LION AND THE LAMB: How good is your health insurance?

By R.C. Braun, M.D. / Chronicle contributor

For the past 60 years access to health care through private insurance plans has been a mainstay of our society. Especially during the past 20 years the health care industry has expanded tremendously. There are many factors for this burgeoning, most notably the great advances in the science and technology of health care.

With new possibilities of care, costs have increased exponentially, and the health insurance industry has been a major player. Originally health insurance policies were almost entirely underwritten by not-for-profit organizations. Today the vast majority of health insurance plans are with for-profit companies, which means that the primary obligation is not to their enrollees, but to the investors who want to make a profit.

Today there are thousands of private insurance plans available and advertised as giving “choice” to the buyers. I am not infrequently asked for advice in purchasing a plan. But even with my medical background I cannot make sense out of the mishmash of plans. I cannot help but think that the confusion is intentional.

Today health insurance companies refer to their “loss ratio,” referring to the amount of money they lose providing health care. And the figures are astonishing — some health insurance firms use as little as 50% of their income in actually providing health care. The rest goes into high salaries for executives, advertising, and reams of paper work trying to figure out how to avoid paying for health care. Letters of “denial” are increasingly common.

Requiring health care recipients to pay large “deductibles” and “co-pays” was considered a means of limiting frivolous and nonessential care. The result has been quite the opposite — encouraging sick persons to neglect needed medical attention in the hope that the problem would go away, ultimately being both more expensive and less assured of a good outcome.

The problems of our health care have been receiving a lot of attention in the new administration and Congress. Some consider it priority No. 1. A major effort is going into promoting a dual system, giving individuals a choice between a public system, patterned after Medicare, and the private health insurance market.

It is unclear from proponents whether it is considered that such a system could solve the problems of access and cost, or whether the political strength of the health insurance industry is too strong to fight and must be accommodated. I would envision that in such a system the sickest people with the most medical expenses would gravitate to the public system, leaving the private insurance industry free to reap the harvest by insuring the more healthy.

An outcry of “socialized medicine” is often heard, ignoring the fact that already more than 50% of health care expenses in our country come through government at some level. I know of no one who advocates for our country a system such as England, where medical personnel are government employees and health care institutions are government owned.

The proposed “single-payer” health care system for our country would merely unify payment systems, and would in effect make the government the insurance carrier for all Americans. Already a majority of physicians support such a program, as well as a sizable majority of the general public. Can Congress be far behind? Let your voice be heard.


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