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Insurers don't like to 'share'

Dr. Susanne King

Saturday, May 24

The current mantra of those who support our private insurance model for health care is "shared responsibility." Their goal is to ratchet up the amount that individuals will have to pay for medical costs, by buying insurance policies that have higher deductibles, larger co-payments, and higher costs for prescription drugs. What "shared responsibility" is about is maintaining insurance company profits.

Under pressure from Wall Street for disappointing earnings during the first quarter of 2008, CEOs from the two largest health insurance plans, United Health Group and Wellpoint, told investors last week that they would "continue to protect their (profit) margins" and "not sacrifice profitability for membership" i.e., they aren't going to hold down premium increases to keep members on their rolls. Wellpoint's CEO, Angela Braly, also said that her company's market power would give it the ability to lean hard on its network doctors to accept lower reimbursements. What she didn't add was that her predecessor, retired CEO Larry Glasscock, left Wellpoint in 2007 with a $23.9 million farewell package. The private insurance model benefits neither patients nor doctors.

The truth is that when we examine who ultimately pays for health care, it is neither employers nor the government, but the individual. Employed individuals are paying for employer-sponsored health insurance plans rather than getting wage increases.


Employees pay out-of pocket expenses for their share of premiums and health care costs that aren't covered by insurance. And employed individuals also pay taxes to the government. We, as working people, provide the financial support for our current private insurance-based system.

Meanwhile, insurance companies aren't working for us. They are busy working for their investors, and distributing our hard-earned dollars to them, as well as stoking the fortunes of their CEOs, like Wellpoint's retired CEO Glasscock.

If we had a single-payer health care system, a national health insurance system that covered everyone and was administered by the government, there would truly be shared responsibility. The system would be funded by a modest tax on earnings, which would be an affordable, progressive tax. National health insurance would be real insurance, in which everyone is covered and the risk is distributed across the entire group, rather than the cherry-picking of healthy, working individuals that now occurs with private insurance. Everyone would have access to medical care. Coverage would be comprehensive, and would include medical care, dental care, mental health care, medications, and long term care. Patients could choose their own doctors and hospitals. There would be no co-payments or deductibles, and no denials or hidden costs when a patient needed his insurance.

Polls show that the majority of people support national health insurance. The obstacle to health care reform is corporate special interests that profit from the current health care system, and their tenacious grip on the political process, through their lobbying efforts and political donations. This leads some to say that significant health care reform, like replacing our private health insurance system with national single-payer health insurance, is not politically feasible.

But there is a growing grassroots movement for single payer health care. More and more doctors are joining the organization Physicians for a National Health Program (www.pnhp). There is legislation at the federal level for a national health insurance program, HR 676, currently sponsored by 90 legislators, including Rep. John Olver and seven other representatives from Massachusetts.

Recently, in his New York Times column, Thomas Friedman wrote this about his mother and her perseverance. Every time life knocked her down, she got up, dusted herself off, and kept marching forward, motivated by the saying that pessimists are usually right, optimists are usually wrong, but most great changes were made by optimists. Health care reform activists are optimistic and marching forward; please join us to reform the health care system.

Susanne L. King, M.D., is a Lenox practitioner.

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