A lesson from a classic
In the 1843 Charles Dickens classic "A Christmas Carol," Jacob Marley comes back to warn his former business partner Ebenezer Scrooge that serving humankind was his business; not business for business's sake. The U.S. health insurance industry seems to have forgotten this important lesson. Since their entry into the marketplace in the mid-1800s, the industry has moved from being more than a simple insurer of coverage. Today, these economic behemoths are the centerpiece of the system that is supposed to provide health security to most Americans. They are beginning to fail in this important task. They are a component of a overall health-care delivery system that is broken and, far too often, does not live up to its potential.
Are insurance companies the only one to blame? Of course not. But their business practices are a major part of the problem. Much of what is proposed in health-care reform is the result of an industry that has not addressed the need to have a system with everyone in and no one out; a system where avoiding providing the needed service to many drives the business model; and a system that pays for the volume of services delivered and not the quality of them. In a truly competitive world, they would go out of business because someone else would serve their customers cheaper, faster and with better customer service. Because insurance companies are essentially monopolies, this does not happen.
Health insurance companies are the target of public ire because everyone knows they are the one group with the capacity to make the most dramatic changes to the fragmented system as we know it today and have not done so. They control more than premium costs. They control costs through provider payments; they control access to care through the decisions they make on which practitioners to include on their provider panels; they make coverage decisions through the design of benefits; and impact quality through payment and other program strategies.
As a product in the marketplace, health insurance costs too much and is becoming increasingly undependable. It seems like the business of insurance has overtaken the reason for providing it: health security. They are certainly not the only problem in the health care delivery system, but they are a major component that needs fixing.