In examining Question 4, we are being asked to give guidance on a fundamental question in health care and wellness. What we need is a sensible integrated system of privately delivered public-funded care. There is no question that if we pooled all of the premium dollars currently expended, we could provide world-class care for all. This has been true for more than 20 years.
There will be a bumpy road, but it’s one we must take if we want to be well and be competitive in the decades ahead. We cannot wait for the federal government, or other states, as some suggest. Leadership guidance is needed, and it starts with “yes” on Question 4.
The private insurance industry really developed out of policy decisions in the Eisenhower years, and the delivery of care privately, through largely private insurance methods, has become our norm.
According to The New England Journal of Medicine, which looked at data from 1999, approximately 30 percent of U.S. health care expenditures were related to administration; that’s an extraordinary amount of money. Further down the food chain, the accounting departments of hospitals and other care practices are full of smart people trying to make a broken system work for another day.
Universal Health Care in Massachusetts is unique in the country, and when I compare it with care delivery models in other states where friends and family live, it holds up very well. It is the model for the Affordable Care Act and is essentially the form of care and coverage that Richard Nixon proposed to Ted Kennedy. Kennedy declined 30 years ago, saying that the dependence on private insurance would drive up costs unnecessarily. Prescient, no?
As an employer, every year at this time we hold our breath, waiting to see what new and tangled permutations of insurance administration will be brought forward, and at what cost. Benefits are chipped away, costs shifted, exclusions nuanced ever more finely. Now some carriers charge an additional premium for the larger and better-equipped hospitals. At my company, we have offered wholly or partly paid health insurance for 39 years, and it is a scramble every year.
This year, for the first time, the annual premiums at Wright Builders will top $200,000. To put a finer point on it, the staff and company are paying between $5 and $6 per hour worked for health coverage. And every month, nearly $5,000 of those premiums are being used by private insurers for their administrative and profit purposes, not for care delivery. An employee benefit that should be a source of reassurance and comfort within an organization becomes a template for anxiety around quality and availability of care.
The national movement to reduce and constrict coverages, notably by repealing Obamacare, is taking the country in a profoundly wrong direction, one that makes us less well and less competitive in world markets. It targets people who have medical conditions and who are less affluent, by intent. It’s bad for all of us.
Personally, I would prefer my elected representatives to be writing legislation, having hearings and doing that collective work, and having professional health policy councils making level-of-coverage decisions, rather than relying on actuaries in for-profit insurance entities. I believe our government system is the best the world has ever known, and it’s one that can and should rise to this task.
Specifically, wait times for care have nothing to do with the payment arrangements. Wait times for care now are in part driven by location, income and health status, and lack of planning and coordination within the industry.
I am a Medicare consumer, and Medicare rates are income-based, which is appropriate. I also have to buy the gap insurance, and some of these programs, along with prescription coverages, are a whole other tangle. Medicare for All is a rallying cry, and a helpful one, but I think when we look at this, we need to understand that Medicare suffers from political parsing that needs to be corrected.
For example, the Bush-Era Part D prescription arrangements codified an expensive and non-competitive procurement arrangement; they are not in the patients’ best interest. Currently, the only way to have full medical coverage under Medicare is to buy supplemental plans. Single-payer initiatives will not cause this — the current system is organized that way and should be re-examined.
Spotty and expensive care delivery, in a mash-up of private insurance coverages, and exclusions, have many social and financial consequences in health status, wellness, infant mortality, addiction, school achievement gaps, family stability and job performance.
Health care costs are a top cause of personal bankruptcy in our country. The notion that having multiple private insurance carriers gives us “choices” among different plans does not pan out because of the opaque and complex plan descriptions and pages of fine print.
It’s time to support Question 4, helping to provide elected representatives with the guidance and courage needed to do this challenging but necessary work.
Jonathan A. Wright of Northampton is founder and senior adviser at Wright Builders in Northampton, a published poet and author, and consults and presents on sustainability. His third book, “The Makers Journey: Stories from the Living Building Experience,” is due out in 2019 from Ecotone Publishing.