The murder of United Healthcare CEO Brian Thompson horrified me. I didn’t know him. I first thought of his wife and young son, and the shock and sadness they and his colleagues must be feeling. At that moment, I realized that they now had to live with fear for their lives.
I’m not at all surprised that people see this differently. i have written about greed In healthcare. When I shared this news, an acquaintance smiled for a moment. some social media posts celebratedOthers, however, condemned the murder but understood the perceived motive. attack with anger To someone who represents a system that has failed them. (At least one person did through song.) Thompson became not a human being but the embodiment of a broken system.
What brought us here?
First of all, it hurts a lot. The majority of Americans report They worry that they won’t be able to pay their medical bills or that they will go bankrupt if they need care. Even if you try, you might not be able to find a primary care physician, be unable to receive treatment without complicated prior authorization, and be unable to pay for your prescriptions. Everyone I know who started working in the medical industry did so because they wanted to help others. The same goes for United, of course. And today, many people, including those who work for health insurance, are experiencing psychological harm from not being able to do that.
We must also recognize the widespread harm caused by rising health care costs. We spend twice as much as our peers and get it bad result. These presumably avoidable costs make American companies less competitive. Contributes to higher local, state, and federal taxes. and squeeze out government investment in education, housing, and more. critical condition It is necessary to create thriving communities and a productive workforce. Warren Buffett says about medical expensesThe tapeworm of America’s economic competitiveness”
No wonder people are angry. And because health insurance is the face of both rising premiums and the intrusive cost-containment efforts largely mandated, they are a prime target of that ire. But it’s not just insurance companies. Hospitals, whether for-profit or not-for-profit, are increasingly understood to be part of the problem. High bills that drive many people into debt and Widespread and deserved news coverage The result is.
These are all symptoms of a broken system.
Two underlying causes require attention.
First, health care, like much of the American economy, becoming financializedA system focused on making money. Private equity is the canary in the for-profit coal mine. moved actively For healthcare. Although most major health insurance companies, such as United Airlines, are for-profit, the degree to which they and other companies have focused on the value of their stock (as opposed to producing superior products and services) has increased in recent decades. is increasing dramatically. Although more than one-third of hospitals are for-profit, many not-for-profit hospitals are still focused on maximizing revenue and profits. One reason for this is that chief financial officers need to be concerned about corporate bond ratings. (Perhaps also because the board is dominated by bankers, not medical professionals or patients.) And the easiest way to increase profits is to become a monopoly. Now, in the medical field, Most markets are too concentrated To support meaningful competition. This applies to 90% of the hospital market, 65% of the specialist market, and 57% of the insurance company market. I am a strong believer in markets, and market failure is now prevalent in the medical industry.
Second, there is a related issue. Some people with special interests will show up, others will not. This is formally known as a “collective action problem.” To put it more colloquially, we made it happen. When we say “we,” we don’t mean patients or small businesses struggling to provide insurance to their employees. I’m talking about large organizations (companies, universities) that tried to make better deals for themselves while neglecting to look at the bigger system. In other words, we in health policy are people who have watched spending relentlessly increase without questioning our assumptions. That is myself. I wasn’t paying attention during that time. Vermont health insurance premiums have skyrocketed..
We also believe we can do better.
Recently New England Journal of Medicine Commentarymy colleagues and I argue that states are well-positioned to lead efforts to slow spending growth. We argue that medicine is like a balloon. When policymakers push for increased spending in certain areas, targeted people can easily find other ways to increase their incomes. (Especially easy if it’s a monopoly). To effectively push back, we need regulators with a clear responsibility to ensure everyone has access to affordable, high-quality care. These agencies must have the data and analytical capabilities to set spending growth targets and identify sources of wasteful spending and avoidable care. And we need the powers and policy tools to ensure spending targets are met. Provider pricing settings, Affordable standards for insurance premiumsand Mandatory improvement plan. These are tools that allow you to: If implemented effectivelythe goal is more likely to be achieved.
But to succeed, all of us who care about the future of health care—business and health care leaders, legislators, and the public—will need to come together across our divides. we need to see ourselves as admin of our community and establish a regulator that can ensure that serving the public interest is as important as financial solvency. And when health care providers, insurers, and regulators disagree, as is happening here in Vermont at this moment, we need to come together and find ways to constructively resolve the issues we face. .
Brian Thompson was an advocate of universal health coverage through private insurance. I have discussed it here, elsewhere Better policies, including effective regulation, should make that possible. Perhaps if we made quality health care affordable and accessible to everyone, fewer people would feel left out, disrespected, uncared for, and angry.
Elliott Fisher, MD, MPH, is a professor of health policy, medicine, community medicine, and family medicine at Dartmouth Institute and Geisel School of Medicine.
