For-profit insurance model can't be fixed

By Jonathan D. Walker, M.D.
The (Fort Wayne, Ind.) Journal Gazette, August 16, 2017

Over the past few months, Congress has been unable to replace the Affordable Care Act (ACA, or Obamacare). The blame is usually placed on superficial things, like Republicans who failed to vote along party lines.

But the real problem is that the ACA started out as a conservative plan to maintain the free market in health care; it is hard to make it more conservative without disrupting safety nets that Americans have come to appreciate – such as the rule against excluding those with pre-existing conditions.

The first version of the law actually originated in the 1990s in response to reforms proposed by the Clinton administration. Then, as the ACA evolved, it was heavily influenced by the for-profit insurance industry. In fact, back in 2009 – before the ACA was passed – Business Week published an article titled: “The insurance companies have already won.” In other words, whatever form the law was going to take, the basic structure was exactly what those companies wanted.

This is very important to understand. From the very beginning, the ACA was accused of being a government takeover of health care, but in a very real sense it was a corporate takeover of a government's attempt to expand insurance coverage.

And that is a problem. Those companies have a fiduciary responsibility to place their shareholders over the needs of patients. Former WellPoint CEO Angela Braly said it best when speaking to stock analysts in 2008: “We will not sacrifice profitability for membership.”

But we need to ask ourselves whether we want that business model to remain in control of our health care dollars. The debate over replacing the ACA with the measures proposed in Congress is not really a debate at all – they all perpetuate the for-profit model of insurance, a model that gives us a very complicated and expensive health care system that siphons money away from actual patient care.

The real debate is whether we want to continue with what we have – and all the copays, deductibles and network restrictions – or whether we want to talk about expanding the insurance program that we all pay for but that most of us are forbidden to have: Medicare. Medicare manages to cover the oldest and sickest and poorest of us at much less cost than expensive for-profit insurance companies do, and it doesn't have to pay for things like executive salaries, advertising and underwriting.

Medicare does have problems, and a lot of those stem from the fact that we don't pay attention to how lobbyists have controlled the program. A well-known example is how Congress passed a law that forbids Medicare from bargaining over drug prices.

Despite that, economists have shown that by eliminating all the needless bureaucratic waste and complexity in our current system, and by paying for Medicare with an equitable and fair tax program, over 95 percent of Americans would actually save money on what they are paying for health insurance. And American companies would be freed of the burden of shopping and paying for expensive insurance plans their employees aren't happy with. That money could go toward raises rather than premiums.

But that concept is invariably pushed off the table by our current representatives. An example is how a true “public option” (the ability to have Medicare rather than something from Aetna or Anthem) was eliminated from the ACA, even though polls suggest that over 60 percent of Americans favor access to basic government-sponsored insurance.

Take a minute to explore the subject for yourself. Go to the Physicians for a National Health Program website ( and look at the FAQ sections; it only takes a few minutes to get a brief overview. You may realize why all the attempts to replace the ACA have failed and why they had to be created behind closed doors with very little public input – they all would have made things worse.

Perhaps it is time to ask our politicians to at least consider the idea of basic coverage for all through an expanded and improved Medicare.

Dr. Jonathan Walker is a retinal surgeon and assistant clinical professor with the Indiana University School of Medicine in Fort Wayne.