Choice Among Private Insurance Options Isn’t Real Choice

November 27, 2024

The State of Health Insurance Coverage in the U.S.

Findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey
November 21, 2024
By Sara R. Collins & Avni Gupta

Survey Highlights

More than half (56%) of U.S. working age adults were insured all year with coverage adequate to ensure affordable access to care.  But there are soft spots requiring policy attention: 9 percent of adults were uninsured, 12 percent had a gap in coverage over the past year, and 23 percent were underinsured, meaning they had coverage for a full year that didn’t provide them with affordable access to health care.

Among adults who were insured all year but underinsured, 66 percent had coverage through an employer, 16 percent were enrolled in Medicaid or Medicare, and 14 percent had a plan purchased in the marketplaces or the individual market.

Nearly three of five (57%) underinsured adults said they avoided getting needed health care because of its cost. 44 percent said they had medical or dental debt they were paying off over time.

Delaying health care has health consequences: two of five (41%) working-age adults who reported a cost-related delay in their care said a health problem had worsened because of it.

Nearly half of adults (48%) with medical debt are paying off $2000 or more; half of those with debt said it stemmed from a hospital stay.

 

Comment by: Don McCanne

When we discuss the problems with financing our health care system, many in the policy or political communities brag about the advances we’ve made through insurance coverage. But these increases have largely been through private insurer models that hamper access: There has been a sharp increase in the numbers of individuals in Medicare Advantage plans, which typically offer narrow provide networks while vastly overcharging the government through diagnostic upcoding and risk selection. States rely widely on private Medicaid intermediaries, which have significant provider network issues. Employer-sponsored private plans increasingly shift direct costs to employees through higher premiums, greater deductibles and copayments, and more aggressive prior authorization. Similarly in ACA marketplace plans. Thus, increased reliance on private plans is really an expansion of the problems that are peculiar to the private insurance industry, as revealed in the newest Commonwealth Fund Health Insurance Survey.

Promoters of these plans say that they are giving us freedom of choice by placing health insurance coverage in the marketplace, which touts competition as being an important mechanism for controlling costs. But look more carefully at the choices we supposedly have. Insurance category is dictated: Medicare by age or disability, Medicaid by poverty, employer sponsored plans by your job, or ACA plans or individual private market plans merely because no other choice is available. Many retirement plans mandate Medicare Advantage, and dropping physician payments in traditional Medicare undermine that option. Most of all, we have no choice about the higher non-clinical spending required by superfluous private insurance intermediaries, via profits, cumbersome administration, and administrative tasks forced on providers.

Besides, what choice do we really want? Don’t we really want free choice of physicians, hospitals, and other medical services – that would be available through an equitably funded, universal, public, single payer program, a program that belongs to all of us rather than just to the millionaires and billionaires, a program where all of our health care dollars are spent just on health care? I don’t think we really want a choice of private plans that are designed specifically to use what should be our health care dollars to create greater wealth for the intermediaries that find innovative ways of diverting our funds away from health care?

Look at the choice we made through the recent election. We elected a president who is choosing administrative personnel who intend to eliminate our traditional government Medicare program that is free of private carriers, and replace it with a universal private Medicare Advantage program which has already been demonstrated to divert hundreds of billions in health care dollars to their private industry. Furthermore, our president-elect has brought in the richest man in the nation who intends to manipulate our government in a manner that will make him the world’s first trillionaire. Is that the choice that we want? giving our health care dollars and other funds to the wealthiest individuals in our nation, while leaving out many of those with genuine health care needs that are inaccessible to them under our current system so reliant on private insurers?

Let’s give everyone the freedom of choice in selecting the health care that they need and want instead of having false choice of which intermediary is going to take much of our health care dollars away and leave too many of us without the health care that we need.

What is our choice to be? Profits over patients? Billionaires over health care budgets? Or patients over our own health care system that is designed to take care of everyone? It doesn’t seem like that is a very difficult choice.