Posted on May 26, 2008

Geyman's Do not resuscitate the insurance industry


The Most Basic Question in the Health Care Reform ‘Debate’

Posted by John P. Geyman, M.D.
Professor Emeritus of Family Medicine
University of Washington

Inaugural posting
May 23, 2008

Adapted from my book Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It (2008), with permission of the Publisher, Common Courage Press

The most basic question underlying the so-called debate over reform of U.S. health care is being dodged by most participants, policymakers, and politicians. As health care costs spiral out of control and exclude more and more millions of Americans from even the most rudimentary health care services, what debate we have deals with incremental tweaks as delusional and false hopes of reform. The air is filled with claims and hopes for a long and growing list of ‘reforms’ — for starters, these include employer and individual mandates, expanding prevention programs, chronic disease management, pay-for-performance, state high-risk pools, association health plans, information technology, tax credits/vouchers, and more. Within this cacophony of noise, the big issue is being missed.

What then is the big question? It is whether or not we should continue with private multi-payer financing of health care. Although private health insurance served the public interest in its earlier years, those times have long since passed. The industry has been transformed over the last 50 years to a largely investor-owned industry within which profits to shareholders and CEOs trump service to patients and the public.

The industry’s track record speaks for itself. It is on a death march. The costs of insurance premiums alone have become unaffordable for tens of millions of Americans, and are increasing several times faster than costs-of-living and median family incomes. Insurance covers less and less of total health care costs. Access to affordable health care has become a major concern affecting all middle-class Americans, with no relief on the horizon. Private insurers go to great lengths to avoid coverage of sick individuals and even high-risk groups. As the employer-based market shrinks, they seek out new lucrative markets in generously subsidized public markets, especially Medicare and Medicaid, for revenue growth. This industry is unsustainable, as some insiders are starting to fear. Even Wall Street analysts are beginning to see dark clouds on the industry’s horizon.

The industry’s 60-year report card is in, and it has failed the public interest. It is now time to require an efficient, equitable, and sustainable financing system that can enable universal coverage of all Americans for necessary health care by spreading risk across our entire population. Subsequent commentaries will focus on the many ways in which private health insurance cannot meet that challenge.

“Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It” by John Geyman, Common Courage Press:


By Don McCanne, MD

Today, Memorial Day, we commemorate the U.S. men and women who perished while in military service for our country. Somehow it doesn’t seem right that this day has become associated with hazardous sporting events, travel with excess fuel consumption, picnics with the requisite beer, and a surge in slaughter on our highways. It seems much more appropriate to contemplate what our men and women were fighting for. After all, they did give their lives for us.

They were defending America. They were defending a nation that has learned to balance our freedom to achieve our personal goals through individual liberty, with our sense of community through social solidarity in making this a better nation for all of us.

The balance between individual freedom and social solidarity is a dynamic. Our policies can be used to improve both sides of that balance, or they can be used create an inappropriate imbalance, often resulting in impairment of both sides. We don’t always get it right.

The nation understands that there is something wrong with the provision of one of our most fundamental needs - health care. On this Memorial Day we should commemorate those who gave to our nation all that they possibly could. We can make our own humble contribution by resolving to do all that we can to make this a better nation. Making our health care system work for all of us would provide the balance we are seeking by using solidarity to enhance the role of the individual through better health.

John Geyman’s new book could not be more timely. There is a surge in activity to move forward with political solutions to our health care crisis. There is a loud call to end the policy debate and move forward with UNITY behind models that build on private insurance plans. But Geyman shows us that private plans are rapidly deteriorating in their ability to provide the health care needs of the individual and in their ability to provide affordable, comprehensive health care financing for the nation. Instead of improving both sides of the balance, health plans are weighting down the scales and causing both sides to crash.

This weekend is the beginning of John Geyman’s blog series on why private health insurance cannot meet our challenge. It is crucial that we understand the fundamentals. Without further dialogue on policy, the momentum for UNITY will move forward with the private plan model and crush our scales of reform. Geyman shows us that the private plan pathway can only lead to greater physical suffering and financial hardship. We can improve both health care for individuals and health care financing for the nation through a single payer national health program, but first we must pass the hurdle of the obsolete, dysfunctional model of private health plans.

In addition to his blog, John Geyman’s book, “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It,” will soon be available. It will be of great importance in our advocacy work with the new administration and Congress. Everyone should have a copy. It can be pre-ordered now at the Common Courage Press website, and is very inexpensive with the publisher’s discount. Even though delivery will not be until this summer, I emphatically recommend that you order it now while you are thinking about it. At least, check out the website at this link: