Health insurance companies take your premiums, invest them, and do their very best to avoid paying for your care.
Michael C. Huntington M.D. July 30, 2020
Published in the Corvallis (Oregon) Gazette-Times July 12, 2020
Private health insurance, pharmacy benefits management companies (PBMs) collude.
They divert large amounts of your premium and tax money away from the health care you’ve already paid for. Learn how they create unnecessary complexity, confusion, and cost barriers for you and unjustifiable profits for themselves.
Will you receive a surprise bill?
If you have a medical emergency will you have the insurance policy and network allowing the care you need? Will your plan cover the drug or procedure your doctor recommends? Will your preauthorization or claim be denied?
Why have a complex, confusing, and costly health care system?
Insurance agents deserve pay and praise for helping us navigate a complex, confusing, and costly health care system. But why have a complex, confusing, and costly health care system in the first place? We don’t have to.
Here are wasteful elements of corporate-run (private) insurance we need to reject: See videos here.
1. Medicare “Advantage" and supplemental plans:
All private insurances “cherry-pick” and “lemon-drop”. You tend to be “picked” if you are healthy and wealthy and “dropped” (via narrow networks and drug formularies) if you are unhealthy and unwealthy. Such adverse selection adds byzantine complexity and cost. Administrative overhead for Medicare “Advantage” is 10% versus 3% for publicly-run Traditional Medicare. The overhead for other forms of “private” health insurance is 10-30% when providers’ offices are included.
2. Part D and other corporate-run drug plans:
Most (7 of 8) prescribed medicines are generic and cost only pennies per pill. Pharmacies work under PBM gag rules preventing them from telling insured clients that prescriptions might cost less without insurance. The price of generics without insurance may be less than half of the listed copay. You can probably save money by shopping pharmacies without mentioning insurance and delaying Part D until you need a brand-name drug.
3. Employer-based self-insurance (Administrative Service Contract):
ASCs administer employer health care funds without significant accountability to anyone: your employer, insurance commissioners, you, or the public. ASC opacity invites abuse of your health and money.
We all suffer or face risk when others don’t get the care they need.
As you’ve seen during this pandemic, The virus can decimate a church, a factory, and a neighborhood. Likewise, even if more ordinary times, fear of cost can decimate families and neighborhoods. People with chronic illnesses (diabetes, hypertension, etc.) don’t get the care they need and die.
We enact laws that ensure everyone the necessities they cannot provide well for themselves:
We make laws concerning fire protection, police protection, affordable education, roads, bridges, and potable water. According to a 2017 RAND study, Oregon can have health care for all Oregonians at no greater cost than we collectively now pay in premiums, taxes, and out-of-pocket, all for a system that leaves a third of us without good health care.
3 of every 4 Oregonians, rural and urban, favor universal health care according to a 2019 Elway Institute study.
If you dread what could happen to your family’s health care and finances if any member dies or loses a spouse or a job, you will welcome health care no longer tied to a job, age, spouse, zip code, or income level.
Ensure Oregon’s SB 770 Task Force carries out its work mandated by the 2019 Legislature
Please contact your state legislators to —to design the universal health care system we all need.
Urge Senators Wyden and Rep. Schrader to support true universal health care.
Thank Sen. Merkley and Rep. DeFazio who are already on board.
An excellent series of videos that deals with these topics in more depth can be found on the Mid-Valley Health Care Advocates website (mvhca.org).