Why Can’t We Make Things Better in Health Care?

I have spent a lot of time around all sorts of insurance companies during the past 25 years, as an executive, entrepreneur, and contributing writer. In the health space, it is easy to hate insurance people. They receive our premium dollars, cover some of our health needs – often putting their commercial interests before those needs — and make lots and lots of money off of us.

A good case can be made that health care should be a public and not a private good. I respect that view but have never seen a well-conceived plan for how the U.S. can move from our private health insurance system to a European model where taxpayers fund a government-run health system.

Today, the odds of expecting such a plan from the bitterly divided Congress are zero. Huge compromises would be required. Further, it would take decades to effect any far-reaching transformation of health care. Such long-term planning is just not possible in Washington, and hasn’t been feasible for a long time.

Advocates of a true public health system seldom offer up approaches that explain how we’ll pay for such a system. As we’re learning, government deficits and inflation do matter. Steep cuts to defense spending are hardly a valid strategy. Big tax hikes on rich people and companies would amount to at best a down payment for a true public health system.

Plans also may include steep cuts in health prices, which admittedly are outrageous – roughly double per person here what they are in other so-called first world nations. But such plans don’t account for how private health companies would respond to price cuts, not to mention how nurses, doctors, and other front-line health professionals would react. They’re already part of the Great Resignation.

Medicare and Medicaid are certainly financed largely by the federal and state governments. But they also are largely run by private insurance companies. Why? There is no one-size fits all answer, but a major reason is that private companies manage health plans more efficiently and with better health results than do public plans.

The Veterans Administration is the closest thing the U.S. has to public health care. I think highly of the VA but its marks for customer service and health quality often fall far short of what we should expect from a public health system.

Meanwhile, health care businesses continue to feel the effects of the seemingly ingrained need in America to blame someone else whenever things go wrong.

When I see people bash health insurers, I’d like to ask them why they believe these private companies should operate with different goals than companies in other industries? Good luck trying to sell Wall Street on the need to accept lower health-care profit margins because they are in the public interest. By the way, the profit margins in Big Tech would be unthinkable in health care. But we love us our iPhones and there is no movement to shame Apple into lowering its profit margins.

So, we muddle on, unhappy and often unhealthy.