Affordable Healthcare: How to make it work

I live in Florida. As I read the newspaper today, I was appalled to see that Florida Tea Party members were testifying before the state legislature encouraging them…no insisting…that they flaunt the Federal Affordable Care Act insisting that it is illegal in spite of the Supreme Court decision to the contrary.

Then I read a new issue of FierceHealthPayer, an industry newsletter for Healthcare Plan Executives. This issue had two separate articles and a commentary that made me wonder how we will possibly get to affordable healthcare in this country.

The first article reported that the American Medical Association (AMA) has reviewed health plans across the country and opined that 70% of commercial insurance markets are anti-competitive. This means that in 70% of the locales in this country, the vast majority of the health insurance is provided by one company. One of the primary arguments of the insurance industry and their Congressional supporters against a single payer national health plan is that competition is necessary in order to achieve quality and control costs. If that is so, we will not get to affordable care or adequate quality given this current anti-competitive situation.

The second article discusses the trend toward self-insurance on the part of large employers. There has been a steady increase since 2006 in the number of large employers who are managing administrative costs and avoiding variable state laws by self-insuring. In 2011, approximately 60% of workers were covered in a self-insurance program run by an employer. Small employers generally do not have this option. The risk of self-insuring for a small group is much greater than the outrageous cost of group coverage through one of the major insurance companies. Self-insurance often tries to control costs by limiting benefits.

The final item that grabbed my attention is a commentary in this same newsletter. The editor reported on the confused state of smoking cessation coverage among private insurers. She pointed out the requirement in the Affordable Care Act for such coverage and the indications by surveyed insurers that they do include smoking cessation coverage.

Yet when Georgetown researchers studied 39 health plans, they found that none of them took all of these vitally important steps: clearly stated that tobacco cessation treatment is covered; provided coverage for individual, group and phone counseling and tobacco cessation medication; provided treatments with no cost-sharing for members; and provided access to treatment without members having to meet prerequisites.

Read more: Why wouldn’t insurers cover smoking cessation? – FierceHealthPayer

These are the factors that are most likely to result in successfully quitting the use of tobacco products. You would think that insurers would want to have this particular benefit in their plans and that it be used. After all, the direct medical costs and productivity losses caused by smoking-related illnesses each year is almost $200 million.

The juxtaposition of these four items today reminds me of my personal conclusion…we need a single-payer national healthcare system if we are ever going to get our costs under control and provide quality healthcare services to most U.S. residents. Just by removing the 22% growth in earnings posted by the five major insurers in 2010, we might get a start on controlling some of the costs involved. Standard benefits across the country would make the system easier and more consistent for employers with workers in multiple states. And real implementation of preventive measures like smoking cessation would make all of us healthier.

And now I will wait for the comments….

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