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Surgeon General Misses the Diagnosis: Terminally Ill Insurance Structure

Saddled with a massive bill for an emergency room visit, a former US Surgeon General (under Trump) calls for tweaks to our market-model skin-in-the-game insurance. Sadly, he misses the diagnosis: our insurance morass is moribund, can’t be saved. Only a complete reboot can achieve universal protection. That’s what a Surgeon General should be fighting for.

May 22, 2024

I’m a Former Surgeon General and I Couldn’t Believe My $10k Medical Bill
MEDPAGE TODAY
May 17, 2024
By Jerome Adams, MD, MPH

While attending a conference in Arizona in January, I embarked on a popular hike up the renowned Camelback Mountain. Unfortunately, mirroring the experiences of many who preceded me, I underestimated the effects of the dry desert air and midday temperature. I consequently found myself dizzy and dehydrated, necessitating an emergency department visit. 6 weeks later, I received medical charges approaching $10,000. Despite my insurance company negotiating it down to $4,800, the onus of the entire amount still fell on me due to my high-deductible health plan (HDHP).

 The ordeal underscores a harsh reality: Millions of Americans face unforeseen out-of-pocket expenses, but few can shoulder such a burden.

Surprise medical bills, such as the one I received, often stem from patients unwittingly receiving care from out-of-network providers, resulting in substantially higher costs that insurance fails to cover.

Despite healthcare purportedly operating as a free market, I was not furnished with the requisite information to make an informed decision regarding my purchase. Moreover, I was not apprised of the cost of my care until 6 weeks later!

The proliferation of HDHPs, encompassing almost 60% of individuals with employer-provided health insurance post-ACA, compounds the issue.

To address the scourge of surprise and exorbitant medical bills and ameliorate the healthcare system for all Americans, I proffer several recommendations:

  1. Enhance transparency in healthcare pricing
  2. Institute arbitration for billing disputes
  3. Advocate for consumer protections
  4. Support legislative efforts to address surprise medical bills
  5. Foster collaboration between providers and insurers
  6. Improve HDHPs

My advocacy transcends personal interests; it serves as a clarion call for healthcare reform, ensuring that everyone can access necessary care without fear of financial ruin.

Published comment by Don McCanne: Although we desperately need reform, Dr. Adams’ recommendations would have a negligible impact on our system. With a well designed single payer system – an improved version of Medicare provided for everyone – we could provide accessible, affordable, equitable, high quality health care for all. The single payer model removes billions of dollars in administrative waste. It allows free choice of health care providers without the need for cost sharing barriers. It is affordable for all because it is funded through progressive taxes. All would pay less than they are currently paying under the current system, except for the very wealthy who would pay more but not so much that it would have any negative impact upon their lifestyles. (Keep in mind that the wealth of society is a product of the individual workers and the resources of nature and that the wealthy use capitalistic tools to segregate that wealth to their own ends. Returning some of that wealth in the form of health care for all should achieve the altruistic goal of health justice for all.)

 

HJM Comment by: Don McCanne

We can thank Jerome Adams for providing us a fine example of one of the reasons why we have such an expensive health care system that ranks so poorly (U.S. spends the most but ranks last amongst 11 modern nations, per the Commonwealth Fund). This reason here is that our political leaders frequently resort to garbage policy science when we know what policy would actually bring us a vastly superior system. Of course, that’s single payer.

When you see how our former Surgeon General was stung by our current system, and then he makes recommendations that are sort of an offshoot of market economics that he says would “ameliorate the healthcare system for all Americans,” you know that he has not learned anything. The market concepts he supports have kept us as the most expensive and poorest performing system of wealthier nations.

In contrast, single payer policies would accomplish the goals of universality, affordability, equity, accessibility, freedom of choice, prevention of medical debt and other features that people are looking for in health care today. This is evident around the world. Many economists have explained how a great excess of wealth is accumulating at the top, and the tax system can be used to lower health care costs for the rest of us, notably without threatening the extreme affluence of the wealthy.

But we, the people, have to do it. We have to elect legislators and government politicians who demonstrate to us that they do understand policy, rejecting policies that are for the billionaires with a few crumbs for the masses, but rather advancing policies for all of the people, so that we all have a right to housing, food, education, retirement, and, yes, health care.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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