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Subpar Consumer Experiences with Health Insurance

June 27, 2023

Summary: Surprise, surprise – our fragmented, profit-driven, gap-permeated health insurance “system” leads to terrible consumer experiences accessing health care. It’s time, finally, to adopt a simple, efficient and generous solution – single payer.

Survey of Consumer Experiences with Health Insurance
June 15, 2023
By Karen Pollitz, et al.

Key Findings

*  Most insured adults give their health insurance positive ratings, though people in poorer health tend to give lower ratings. … 84% of people who describe their physical health status as at least “good” rate insurance positively, compared to 68% of people in “fair” or “poor” health.

*  Despite rating their insurance positively, most insured adults report experiencing problems using their health coverage; people in poorer health are more likely to report problems. A majority of insured adults (58%) say they have experienced a problem using their health insurance in the past 12 months – such as denied claims, provider network problems, and pre-authorization problems.

*  Nearly half of insured adults who had insurance problems were unable to satisfactorily resolve them, with some reporting serious consequences.

*  Among those with the greatest mental health needs, many adults across insurance types find their coverage lacking and report forgoing needed care. Among insured adults who report being in “fair” or “poor” mental health, four in ten (43%) say there was a time in the past year when they did not get mental health services or medication they thought they needed …

*  Affordability of premiums and out-of-pocket costs are a concern, particularly for those with private health coverage, and for some, contributed to not getting care.

*  Insured adults overwhelmingly support public policies to make insurance simpler to understand and to help them avoid or resolve insurance problems.

Adults with Medicare are the most positive in their overall ratings with nine in ten (91%) rating their coverage positively, including half who say it is “excellent.”

Marketplace enrollees, regardless of health status, are the most likely to rate their insurance negatively.

Over the years, Congress has enacted a number of measures to make health insurance more understandable and easier to navigate, and to hold health insurers and public programs accountable for the coverage they promise. Alone, these measures are unlikely to eliminate all the problems people encounter with health insurance, especially those related to affordability, but they may help to reduce somewhat the dizzying complexity of health insurance in the U.S. And they may inform oversight so that regulators can better monitor how well insurance works when people need to use it. At the same time, stronger oversight and accountability could entail more administrative costs – a trade-off we did not probe in this survey.

Comment by: Don McCanne & Jim Kahn

This comprehensive survey should be read in its entirety to understand the startling inadequacy of US health insurance under our complex combination of public and private plans and no insurance at all. Despite its failings, it is the most expensive health system of all nations.

One of the major deficiencies in our system is the very high administrative costs which waste funds that could be filling the voids in care, so it is ironic that Congress responds to the recognized problems with even more administrative burdens. Which “may help to reduce somewhat the dizzying complexity of health insurance in the US” … wow, how low can we set expectations?

Viewing the report, much of the problem lies with the tools used by the private insurance industry, but when you think about that, it is not too difficult to understand why. Private insurance is designed primarily to make generous profit for the owners – the billionaire shareholders whose goal is further wealth accumulation. On the other hand, truly public insurance is owned by the people of the nation and is designed specifically to deliver health care to those who need it.

When you read the findings, it’s obvious that all we would have to do to correct the deficiencies is to make the entire insurance program public. The simplest, most efficient, most effective, and most equitable way would be to enact and implement a single payer (an improved Medicare for All) that includes everyone, a single payer that we, the people, own. The problems listed in the Key Findings above would melt away.

But this does mean that elected leaders would have to put in place policies that serve the people rather than the private insurers and their investors. This last point we must tackle seriously now. Really! Access to health care is at stake, as the report vividly describes.

About the Commentator, Jim Kahn

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Jim (James G.) Kahn, MD, MPH (editor) is an Emeritus Professor of Health Policy, Epidemiology, and Global Health at the University of California, San Francisco. His work focuses on the cost and effectiveness of prevention and treatment interventions in low and middle income countries, and on single payer economics in the U.S. He has studied, advocated, and educated on single payer since the 1994 campaign for Prop 186 in California, including two years as chair of Physicians for a National Health Program California.

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