Take profit out of basic health care

By Howie Wolf, M.D.
The Daily Camera (Boulder, Colo.), Feb. 10, 2015

It was refreshing to read the article in The Camera about "Changes in Colorado's health insurance market," (Daily Camera, Jan. 16) especially so because it was written by Marguerite Salazar, our state's insurance commissioner. She cited how health insurance companies can no longer charge higher premiums for women than men or deny coverage for those applicants with pre-existing conditions. In the past, companies selling health insurance weren't required to cover maternity, preventative care, and other essentials. Now they are. Besides all of that, they cannot spend more than 20 percent of premium dollars on "administrative costs." As we all know, some of those costs still include the golden parachutes given their retiring millionaire CEOs. Before these changes, more than one U.S. insurance company ran on as much as 32 percent administrative costs, meaning that the dollars they spent on actual health care were but 68 percent of premium dollars. In Marguerite Salazar's words, the carriers could make as much profit as they wanted.

Contrast those percentages with Medicare, whose administrative costs are usually 3-5 percent. In other countries where taxes are paid to run a type of national health system, insurance companies are not allowed to profit on citizens' basic health coverage.Yes, higher taxes for most European countries, Canada, Japan, and Australia, but significantly cheaper than average USA insurance premiums. Their administrative costs are also less.

Our "non-system" has improved somewhat under Obamacare. More citizens now have access to care than ever before. Medicaid is now available to 30 million more Americans, but sadly this does not mean better access to our nation's specialists and surgeons. As a family physician that sees many Medicaid patients, I have witnessed the angst of patients having to wait months just for a consultation.

An analysis by The New York Times shows that the cost of a mid-level silver insurance plan in Colorado rose 36 percent west of the Rockies while another dipped nearly 40 percent in northeast Colorado! The Affordable Care Act (ACA), or Obamacare, is still too insurer-friendly, allowing them to capture certain markets with a low, seductive price, only to be followed by rate increases after the competition has been thinned out.

Pharmaceutical company greed, too, needs to be reined in. The Prescription Drug Act of 2003 allows these companies to charge whatever they want; negotiations are not permitted. What is more remarkable is that countries who buy the same drugs from U.S. manufacturers will receive huge discounts because of the buying power of their national health systems. Our VA and Medicaid formularies are given favorable prices, but not so for the rest of Americans; not even senior citizens.

Despite the many problems with Obamacare, trying for the umpteenth time to repeal it is ludicrous. Certainly it needs fixing and should include a public option. What we need, in my view, is to take the profit out of basic health care and make improvements on what the ACA has started, eventually getting to Medicare for all. An excellent book on this subject is T. R. Reid's "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care."

Howie Wolf, M.D. has practiced in Longmont and Lafayette and now practices in Thornton. He lives in Boulder.