“Industry rule number four-thousand-and-eighty: Record company people are shady.”
---A Tribe Called Quest
One of the most frustrating parts of being a Primary Care Physician in the U.S. is not being able to get necessary care for your patients because they cannot afford it. Last week I had to watch a 55-year-old woman with uncontrolled blood pressure and rapidly progressing kidney disease walk out of my office with only half of the medications she needed to control the blood pressure and stabilize her renal function. The medications were too expensive, she couldn’t afford adequate insurance coverage, and 22 months after being laid off from her job as a middle school teacher, was still looking for work. Later that morning I sighed helplessly as a 45-year-old diabetic patient told me he had to choose between buying his insulin and paying his rent. I knew if I were in his position, I’d be forced into the same decision.
The thing is, these patients both had health insurance. Such scenarios are unfortunately not unusual. A 2007 survey by the Commonwealth Fund found that even among Americans who were insured all year, 16 percent reported being unable to pay their medical bills, 15 percent had been called by a collection agency about medical bills, 10 percent changed their way of life to pay medical bills and 10 percent were paying off medical bills over time. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. And yet sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.
Even with health insurance, the out-of-pocket costs for health care are becoming prohibitive. In 2011, health insurance premiums averaged $5,429 for individuals and $15,073 for families, 113 percent higher than in 2001 (four times the overall rate of inflation). Meanwhile, covered services have shrunk dramatically, and co-pays have risen. Over that same period, Medicare premiums have hardly risen at all, and out-of-pocket expenses have remained the same. On average, employees pay 18 percent of premiums for individual coverage and 28 percent for family coverage.
U.S. employers are increasingly using high-deductible health plans to shift a greater share of medical expenses to workers. In 2011, 32 percent of companies with 500 or more employees offered high deductible plans, up from 23 percent in 2010. As a result, the average deductible nearly doubled between 2003 and 2010, to $1025 for an individual and $1975 for a family plan.
High deductibles lead to the postponement of needed medical care, which is precisely what they’re designed to do. Moreover, they lead to bankruptcy. Every day, 3,700 American families file for bankruptcy caused by illness and medical bills. These are middle class families. Roughly 60 percent of them have a college education, and the same percentage had private health insurance when they got sick.
Perhaps the economic downturn is partly to blame. With the economy struggling so mightily, conventional wisdom might suggest we are all feeling the pinch. But the five largest health insurance companies -- WellPoint, UnitedHealth, Aetna, Humana, and Cigna -- which, combine to cover 100 million Americans, are doing just fine. Between April and June 2011, they earned over $3.3 billion in profits, up 13 percent from their 2nd quarter profits in 2010, which, incidentally, was their most profitable year ever.
It’s no surprise these enormous earnings are not going towards improving access to health care for the families they cover. Instead, they go towards protecting the narrow self-interests of their stockholders, board members, and top executives. WellPoint alone spent $67 million on lobbying over the last 3 years and paid their CEO, Angela Braly, $13 million in 2010. They also spent $21.6 billion dollars of patient premiums to buy back its own stock from 2003 through 2010, pushing the price of the stock options their executives and board members own still higher. The transfer of wealth from individuals and employers to the Wall Street elite is staggering.
The profit in the health insurance industry is the single greatest barrier to building an efficient, sustainable system of health care in this country. These companies are morally bankrupt parasites that threaten to financially bankrupt our health care system. Congress has not shown the ability to help us. The political process is so poisoned by the money at stake, it has become a largely empty and cynical exercise in propaganda.
If you consider yourself a socially responsible individual -- or, to be more provocative, if you have a conscience -- you would divest of any holdings in for profit health insurance companies from your personal portfolio. You would encourage your pension plan, your union, your church, your city council, your friends and neighbors, and your university endowment to do the same. Perhaps the only way to rein in health insurance companies is if their stock prices fall and their influence erodes.
The actions of this industry are indefensible. Their business model is to profit by finding ways to avoid caring for sick people in their time of greatest need. I’ve trained my entire adult life to do just the opposite, and I’m tired of seeing my patients needlessly suffer.