The new federal health care reform’s goal is to create a situation where all Americans will have health insurance, a goal that I support 100%. One of the problems that the regulations actually create is the simple fact they further empower the health insurance companies, not patients. We all have found out that much of our healthcare is controlled by the insurance company, not our doctors and not what might be best for us patients. All too often the insurance companies decision to cover a drug or treatment is driven by their profit motivation, not what is best for the patient.
The reality is that neither the doctor nor the patient has any bargaining power with the insurance carriers. The majority of our insurance comes either from our employer or from a federal program. Neither the doctor nor the patient has any ability to influence in the contract negotiations with the insurance carrier.
Doctors, like employees and government beneficiaries are offered one choice, either take it or leave it. If a doctor does not take the insurance carrier’s offer, they will no longer be able to treat their patients. Doctors and patients cannot afford to walk away, thus the entire contract is dictated by the carrier no matter how inequitable the deal.
According to the New York State Department of Health as of 2009 nearly 80%of all enrollees in commercial managed care programs are in only six health insurance behemoths: GHI-HIP, Empire, MVP/Preferred Care, Oxford, Excellus/Univera and CDPHP. On Long Island, where I work, 66% of the market is controlled by Emblem and WellPoint.
According to a report from the organization, Health Care for America Now, the profits from the 10 largest publicly traded insurance companies rose 428%from 2000 to 2007! In 2009 the United Hospital Fund reported profits just in New York State of nearly $1 billion, a 25% increase over 2008.
Now, think to the many times you have waited and waited for pre-authorizations for a treatment or a drug. Delays and rejections are an all too common. How often has your trusted doctor informed you that they will no longer take your insurance, in some cases they decide not to take any insurance? If you find yourself in need of any mental support, not uncommon in cancer survivors, you will be shocked how few therapists take any insurance. This situation and others like it just demonstrates how the consumer patient bears the brunt of this lopsided market. The insurance carriers are making too much money at the expense of our health and our life!
There has to be solutions. Perhaps allowing doctors to ban together as collective bargaining units to counter the ability of insurance companies to dictate reimbursement rates would provide a partial solution. Perhaps limiting the profits of these companies by controlling their premiums like we do with our utilities is another plan. I am sure there are many other good solutions which our legislators can develop. I do know that things cannot continue as they have been going.
Joel T. Nowak, M.A., M.S.W.