Comment by Don McCanne
Although
a majority of Americans favor a national health program, many in the
policy and political communities express a preference for incrementally
building on the existing multi-payer system, as modified by the
Affordable Care Act (ACA). Although 64 percent of our heath system is
already funded through our taxes, our government gives control of much
of our total spending to the private sector, such as the private
insurance companies. Thus the private sector is the source of much of
the incremental changes that are taking place. Now that Fidelity
Investments is entering the scene, what incremental change are they
offering that will benefit patients?
a majority of Americans favor a national health program, many in the
policy and political communities express a preference for incrementally
building on the existing multi-payer system, as modified by the
Affordable Care Act (ACA). Although 64 percent of our heath system is
already funded through our taxes, our government gives control of much
of our total spending to the private sector, such as the private
insurance companies. Thus the private sector is the source of much of
the incremental changes that are taking place. Now that Fidelity
Investments is entering the scene, what incremental change are they
offering that will benefit patients?
* They
are introducing Fidelity Health Marketplace - similar to the government
insurance exchanges under ACA except that they are privately owned and
operated. Since they are targeted at small businesses, they are an
additional intermediary that increases administrative complexity and
expenses. That adds to the cost of the insurance, so that does not
benefit the patient.
are introducing Fidelity Health Marketplace - similar to the government
insurance exchanges under ACA except that they are privately owned and
operated. Since they are targeted at small businesses, they are an
additional intermediary that increases administrative complexity and
expenses. That adds to the cost of the insurance, so that does not
benefit the patient.
* The plans will be
purchased with a defined contribution from the employer. Because the
contribution is fixed, more of the premium costs are shifted to the
employee, especially over time. Either the employee must contribute more
to the premium, or choose a plan with fewer benefits, which then
increases financial exposure in the event of medical need. That does not
benefit the patient.
purchased with a defined contribution from the employer. Because the
contribution is fixed, more of the premium costs are shifted to the
employee, especially over time. Either the employee must contribute more
to the premium, or choose a plan with fewer benefits, which then
increases financial exposure in the event of medical need. That does not
benefit the patient.
* Fidelity already
offers health savings accounts - savings accounts that are linked with
high deductible health plans and can be used to pay the deductibles and
other cost sharing. Since high deductible plans have lower premiums
which are less likely to exceed the defined contribution, Fidelity will
no doubt heavily market the plans which are linked to their own health
savings accounts. Since employers would use the Fidelity Marketplace to
reduce their own health benefit spending, by offering a defined
contribution, it is likely that employees will have difficulties keeping
their health savings accounts funded. Higher deductibles linked to an
empty savings accounts certainly does not benefit the patient.
offers health savings accounts - savings accounts that are linked with
high deductible health plans and can be used to pay the deductibles and
other cost sharing. Since high deductible plans have lower premiums
which are less likely to exceed the defined contribution, Fidelity will
no doubt heavily market the plans which are linked to their own health
savings accounts. Since employers would use the Fidelity Marketplace to
reduce their own health benefit spending, by offering a defined
contribution, it is likely that employees will have difficulties keeping
their health savings accounts funded. Higher deductibles linked to an
empty savings accounts certainly does not benefit the patient.
*
If an employee or family member has an expensive chronic disorder then
a more comprehensive plan should be selected to mitigate the higher
costs. But with the smaller defined contribution, the portion of the
premium that the employee must pay is significantly greater, and often
unaffordable. That does not benefit the patient.
If an employee or family member has an expensive chronic disorder then
a more comprehensive plan should be selected to mitigate the higher
costs. But with the smaller defined contribution, the portion of the
premium that the employee must pay is significantly greater, and often
unaffordable. That does not benefit the patient.
Private
sector solutions in health care financing, including insurers and other
fiscal intermediaries, are designed primarily to benefit the industry,
usually at a cost to the patient, though often opaque and thus
deceptive. Public sector solutions, such as Medicare and Medicaid, are
designed to benefit the patient. But even there the private sector has
moved in with their private Medicare Advantage plans and their private
Medicaid managed care programs, to the detriment of patients and
taxpayers.
sector solutions in health care financing, including insurers and other
fiscal intermediaries, are designed primarily to benefit the industry,
usually at a cost to the patient, though often opaque and thus
deceptive. Public sector solutions, such as Medicare and Medicaid, are
designed to benefit the patient. But even there the private sector has
moved in with their private Medicare Advantage plans and their private
Medicaid managed care programs, to the detriment of patients and
taxpayers.
How much more of this private
incremental invasion of our already dysfunctional health care financing
system can we take? The next time you hear a politician say that we need
to build on the system we have through incremental steps, do not remain
silent. Say something. Yell, if necessary. Scream, if that’s what it
takes. But do not let them con us out of the national health program
that a clear majority of us want.
incremental invasion of our already dysfunctional health care financing
system can we take? The next time you hear a politician say that we need
to build on the system we have through incremental steps, do not remain
silent. Say something. Yell, if necessary. Scream, if that’s what it
takes. But do not let them con us out of the national health program
that a clear majority of us want.
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