Can Americans end our abusive relationship with private health insurance?

Americans do not like their private health insurance. It didn’t take the inflamed online rhetoric after the murder of United Healthcare CEO Brian Thompson to make that point clear. According to a recent Gallup poll, only 30 percent of Americans have a favorable view of the private health insurance industry.

Americans have good reasons to feel that way. For starters, it costs so much to get covered. The average American pays thousands of dollars for private health insurance — most of it in wages they never actually see. In 2019, average American workers forked over 18 percent of their total compensation to help employers purchase health insurance on their behalf.

At the same time, Americans are finding out that their problems don’t end with getting an insurance policy. Rather, that is just the start of a whole new set of issues. Despite the gazillions we spend on private health insurance, individuals are picking up more and more of the tab each year.

The current arrangement, where we pay increasing deductibles and face rising caps on out-of-pocket expenses, even has a new name: “co-insurance.” This term — a piece of double-speak only Orwell could love — suggests not that your policy is covering less, but rather that you are just getting the opportunity to “share” more of the bill. Too bad we don’t get to share any of the industry’s $25 billion in annual profits.

Driving these hefty margins are increasingly shameless methods of profit-maximization. The insurance industry practice of questioning the necessity of expensive medical services was once, at least arguably, based on legitimate disagreements about cost-effectiveness. Not anymore. Now insurers cynically deploy artificial intelligence to systematically thwart legitimate claims from being paid. Moreover, these companies intentionally make the appeal process so complicated that they count on us to simply roll over and give up.

Despite this mistreatment, Americans mostly act like there is no way out. We stay in jobs we otherwise would quit, just to keep an ever-shrinking benefit. We pay more and more for even the most routine care, dreading the day we might incur a major medical expense. Even those of us with “good insurance” fear we are one serious illness from needing to set up a GoFundMe page to pay for care.

We are like someone in an abusive relationship who cannot see what is plain to all of our friends — we need to move on.

What we mainly fear is that “breaking up” with the current private insurance model would be even worse. That a change would lead to decreased access and faceless bureaucrats coming between us and the healthcare we need (as if that is not happening now). We hear tales — mostly from the same industry doing the abusing — about how much worse it will be if we leave. Never mind that Americans who get health insurance administered through government agencies feel quite positive about their arrangements.

To be fair, insurance companies did not create the underlying problem in American healthcare —the fact that it is so expensive. Hospitals, doctors, the pharmaceutical industry, medical device makers and compliant elected officials open to lobbying from special interests must take the blame for that. Private insurance companies have merely found a way to profit from the situation. But it should be noted that when it comes to administering health benefits, government plans do it more transparently, more efficiently and for less money than private industry.

There are some recent signs that the battered American public might finally be thinking more seriously about packing its metaphorical bags. Over 60 percent of Americans now feel that government needs to ensure that Americans have health care coverage — a huge increase from even a few years ago. Could the vision of a country where most people actually get their health insurance through that government be far behind?

Transitioning away from a private health insurance system that is primarily employer-based does not require abolishing the system altogether. A first step would be to offer all Americans — not just those over 65 — the opportunity to get Medicare benefits through a so-called “public option,” in which they are given the choice of being covered by a government entity. Later, our country could have the much more fraught discussion about extending these benefits to all Americans through public funding. People could still opt to buy private insurance — as 60 percent of Canadians do — if they want it, and employers could still offer the benefit either as primary coverage or as a perk.

Change is hard. Even a bad relationship has the advantage of being a known quantity. And we all know there are no perfect relationships — or healthcare utopias — out there. But we need to think hard about whether we are going to keep taking abuse or start looking for something better, something healthier.

When it comes to our troubled relationship with private health insurance, it is past time that we look in the mirror and ask ourselves — what are we holding on to, anyway?

David Oxman is a physician and associate professor of medicine at Sidney Kimmel Medical College in Philadelphia.

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