As an HR professional with 20+ years of experience, including benefits management, I’m perplexed when I hear from proponents for a government run or “Medicare for all” type health care system. Currently, over 178 million Americans receive health coverage through their employer. This is 18x the amount of people who receive coverage through Medicare, Medicaid and the Exchanges of the Affordable Care Act (ACA) combined.
Providing access and affordable health insurance to all Americans has already proven to be challenging for the government. To add, individuals who have health coverage through government programs like Medicare, Medicaid and the ACA Exchanges have to navigate bureaucratic systems. Individuals with Federal coverage have a limited pool of medical providers who will accept their insurance and are forced to adjust to escalating costs of care. Without a Federal subsidy or discount, government health care plans are already unaffordable for the masses. With skyrocketing deductibles before an insurance carrier pays any claims, it’s a scary undertaking and individuals have no ability to influence pricing factors that may leave them deciding between rent, food, or health insurance.
Then there is Medicaid, which is reserved typically for our poorest most vulnerable citizens. Medicaid’s eligibility requirements and coverage options vary from state to state, which can be confusing for individuals shopping for insurance. Historically, Medicaid has a much more effective track record than Medicare of controlling costs but this comes at a price. Eligible individuals must find a health care provider who accepts Medicaid, which is a limited group of practitioners. In addition, Medicaid doesn’t cover all prescription drugs. Since Medicaid varies by state, each state can choose which medications they will and will not cover. For patients with a prescription for a drug not on the approved list they will have to pay for the medication out of pocket, ask their doctor for a generic alternative or have the pharmacist submit a special request on their behalf. This process could discourage some from access to care.
To further add to the conundrum, fraud exists at all levels in healthcare; however, government programs are challenged with a higher level of fraud and improper payments. These types of fraud contribute to increasing costs. Pricing transparency doesn’t exist on a consistent scale. This model favors the insurance carrier, not the consumer. It can be frustrating as a consumer of healthcare trying to understand why an MRI at one center in the same zip code costs 4 x as much at another. In my opinion, a fruitful path to real reform should include clear concise costs for all aspects of patient care – cost, quality, readmission scores, within any network.
Employer plans are much more successful in stabilizing costs and are flexible to meet the health needs of employees and their dependents. This will not be possible if everyone is in a government insurance plan. Health care shouldn’t be a one size fits all approach. After all, every individual is unique and will have different health care needs. As it relates to costs, employers have consultants to help mitigate increasing health care fees and have leverage in buying power since the largest purchasers of health care is the employer-sponsored system. Data shows that employer-sponsored plans have been rising more slowly compared to government programs. There are also financial incentives under employer-sponsored plans, such as tax-free payments towards health care. In addition, employers offer tax saving programs like Health Savings Accounts, or Flexible Spending Accounts, which employers and employees can contribute to for medical-related expenses. All in all, employers are doing something right because surveys indicate that employees like and are satisfied with their health benefits.
So, again I ask, what’s all the hubbub about Medicare for all/government health care? Medicare for all isn’t going to solve our problems. I’d urge law makers to think of the bigger picture. Many modifications can be made in the health care space without scrapping tax benefits, resources, and rate stabilization that employees receive in the employer-sponsored system.