56°
UMass Boston's independent, student-run newspaper

The Mass Media

The Mass Media

The Mass Media

The Hidden Cost of Private Sector Healthcare

There’s been a lot of talk nationally about the evils of government-run health-care.  “We don’t want faceless government bureaucrats getting in the way of doctors.”  Many right-wing politicians like George Bush and op-ed writers like Michelle Malkin have used, if not that exact sentence, then words to that effect.  These are short, pithy slogans, but they don’t tell what government-run health-care does. On the other side, ask a Canadian, a Brit, an Israeli, or a Czech.  Most love their single-payer government-run health-care.  There are occasional waits for non-emergency care but generally their medical needs are fully covered. Most Americans have no experience with government-run health insurance.  They just know what they have through their current provider, so perhaps you might like a short tour through a couple of programs: one is current private insurance while the other is a government-run system.  Both are in the United States. Private insurers, like Aetna, Cigna or Blue Cross, have the right to refuse coverage to you in most states if you have any pre-existing condition, even dandruff or acne – Massachusetts is an exception.  If they find that you have a pre-existing condition that you did not list on your application, then they can cancel your policy with no notice and no possibility of appeal.  Any procedure beyond basic visits to your primary care doctor must first be recommended by your physician and then referred back to your insurance company.  If your insurer claims that the procedure is not medically necessary or that there is a less expensive procedure that you should try first then they have the right to override your doctor.  The insurance company actually pays people to deny necessary claims in order to improve the company’s profitability.  Ask local webcomic creator Randy Milholland.  He asked his readers to send him money so he could quit his day job.  That’s what he used to do for work. That sounds a lot like faceless bureaucrats getting in the way of your doctor. Most private health insurance companies are for-profit entities that pay dividends to their shareholders.  The private sector tends to pay better than public sector so salaries are higher.  Premiums have risen two to three times as fast as the rate of inflation for nearly two decades, as have most co-pays.  As of last year, prescription drug co-pays that were $5 in the mid-to-late 1990s are generally $15-20 now.  Not only are your premiums higher, so are your out-of-pocket expenses. Most of these companies have been running profit margins of 20%.  This doesn’t include the cost of running the business, the cost your doctor has to pay to administrative employees who need to know how to handle up to two hundred different insurers, or the time your doctor has to spend filling out extra paperwork and calling your insurer to yes, get something covered that you really need. How much extra are you paying for what you really need?  Are all of these costs truly necessary? There are several public health insurance plans in the US, like Medicare and MassHealth.  I have relatives on Medicare.  I have had MassHealth.  Like with most private insurers, you have to choose a primary care doctor.  After that, well, you and your doctor do what is medically necessary for you.  The government does not actually deny anything; they want to make sure you stay alive and healthy.  Administrative costs are minimal.  Even co-pays are low.  No MassHealth recipient pays more than $3 for a co-pay, and that’s for a three month prescription.  Medicare Part D – well, that’s another column. This does not sound like faceless bureaucrats getting in the way of your doctor.  Or stealing your wallet. According to 60 Minutes, Medicare has some truly egregious fraud – in the billions of dollars per year.  Even so, even with the high cost of fraud and the higher costs of taking the highest-risk patients that private insurers refuse to cover, public insurance has been demonstrably more cost-effective in the US and worldwide.  There are no profits to pay, minimal overhead, and most of all no paying people to deny you necessary care. Ask a Canadian or a Brit about their national health plans, then ask if they’d want to give them up.  Ask somebody on MassHealth if they would rather be on Harvard Pilgrim or Blue Cross.  Ask a senior if they want to get rid of Medicare and go back to Cigna or Aetna.  So let me ask you: which plan would you prefer?  This isn’t everything.  Still, socialized medicine works very well – when we give it a chance.