It’s Still All About Money

It’s Still All About Money


Leonard Zwelling

         As if anyone at MD Anderson needed to be reminded of the
primacy of money in any discussion about health care, Reed Abelson wrote a
piece in the NY Times on August 13
that reports how this fact is undermining any benefits derived from ObamaCare.

         To summarize, few people buying insurance care about access to
a specific doctor or a care network, and for sure quality of care delivery is
not in play. What matters to most people, especially those using the ObamaCare
health exchanges, is the cost of the coverage. Between half and two-thirds of
those employing the exchanges are choosing either the cheapest or next to
cheapest plans available regardless of whether the plans guarantee access to current
care networks or doctors. This is particularly true of the well people upon
whom the cost-containment strategy of ObamaCare is based. The idea was to get
everyone in one pool or another, especially the well. Get them all to pay in
with only the sick pulling money out  (the medical loss ratio) and the system would
work. Too bad. The sick either have Medicare, Medicaid, or more often
employer-based coverage, and the well buy the cheapest coverage they can, if
they buy any at all. 

         This could easily lead to a death spiral with those
extracting the most from the system paying the least (but not enough to defray
the cost to the insurers, thus the recent rash of carriers pulling out of
ObamaCare markets, and the well not carrying the load of paying in while taking
nothing out. Nice plan. Bad execution.

         So what are the insurance companies doing?

         First, they are raising their premiums IF they are still in
the exchanges for many are getting out as the business model for them is
unsustainable. It should come as no surprise that 30 million of the uninsured did not become insured as was the goal when ObamaCare was passed in 2010. Even the
expectation of 20 million registered by now is actually closer to 10 million and some of
them had had insurance before ObamaCare and for one reason or another availed
themselves of the exchanges’ cheaper variant.

         It really is time to start over when it comes to reforming
health care in America.

         First, is it a right or a privilege?

         Second, Medicare for all or free market solution? (Think
hard before you answer that one.)

         Third, run the numbers. What would cost the least over all.
Not who would pay the least, what would cost the country the least?

         Then everyone currently in the health care game will need to reassess his or her expectations
about getting rich in the health care-industrial complex.

may well be gone as any more than processors of claims to a single-payer system.

         Doctors may not make over $250,000 per year unless they are
in the concierge or cash business (plastic surgery or psychiatry), which really
cannot be outlawed but due to out-of-pocket cost will have limited subscribers
among today’s patients.

         Hospitals will have to learn to manage costs and patients
efficiently and not ask the clinical side of the house to pay for research or

         Patients will have to become wise consumers, ask questions
and behave like they actually care about their health (eliminate smoking, eating junk
food, drugs, promiscuity, the usual stuff your mother told you to avoid).

         I know, I know, I’m a dreamer. You got that right! But I was
the guy waving his hands in 2009 while I was on Capitol Hill asking my
Republican staff colleagues if they even wanted to discuss a single payer
system and getting stuff thrown at him.

         The United States can really do this, but it will take
leadership from both the legislative and executive branches. Ha! Like I said,
I’m a dreamer.

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