CEO murder opens door to health care reform

The aftermath from the murder of the CEO of UnitedHealthcare has been angry and ugly. Truth be told, though, the macabre event may have triggered a long overdue reassessment of the overall delivery of care in the United States, which is unsatisfactory on many counts.

The ugly dimension comes from those who express satisfaction from singling out one human being amidst a sprawling system that has run amok. The assassination of Brian Thompson by Luigi Mangione was tragic, misdirected and deranged.

The anger that has surfaced in spades should be directed at political leaders at the state and federal levels who have failed to rein in the economic and management failures of the country’s model for delivery of care.

First, let’s agree that the people working in health care perform compassionate care and medical miracles every day for families across America. (They have enabled me personally to dodge two fatal bullets — stage 4 prostate cancer six years ago and three 95%-99% blocked heart arteries this year. Stuff happens in your 80s. To say the least, big thanks to my care teams.)

That said, the non-leaders – bipartisan non-leaders – of the big insurers, of hospital systems and of our political bodies from the Oval Office on down have failed on these counts:

• Our health costs of $25,000 to $32,000 for a family of four are the leading cause of personal bankruptcy in the country.
• The uninsured rate of about 8% is unacceptable and roughly where it was in the Midwest in 2010 when the Affordable Care Act, aka Obamacare, was passed.
• The hospital industry has generally failed to adopt the lean disciplines that have transformed manufacturing across the world through the elimination of defects and waste. Infection rates at American hospitals run 4-5%. Sepsis deaths are the result. A minority of best practice hospitals run less than 1%.
• State and national governments have turned a blind eye to hospital and insurer consolidations, leading to more market power and always higher, not lower, prices. For example, the pending merger of Marshfield Clinic and Sanford Health of South Dakota is sailing through untouched by Gov. Tony Evers and Wisconsin Attorney General Josh Kaul. Antitrust enforcement is mostly non-existent.
• Soaring costs of care have not abated. Projections for 2025 are 7.5% to 8% higher costs.
• Denials of coverage by insurers run 18-19% on average and as high as 30% at United Healthcare. Twenty years ago, denials were 3% at Blue Cross Wisconsin.
• Health care reform was largely absent in the recent presidential campaigns, with President-elect Trump saying vacuously that he had “options for a plan” and Kamala Harris doubling down on Obamacare, the “unaffordable” care act that did little to control costs.
• Some business leaders of medium-size corporations are bailing out of their own health plans. Frustrated with the soaring costs, often double digit, they are defaulting to a newly authorized model called ICHRAs (Independent Coverage Health Reimbursement Arrangement). They tell their employees to go to the Obamacare exchanges to buy coverage for themselves and their families and then reimburse them for the premiums. The companies are getting out of the health care game.
• Many large providers own their customers, the insurers. It’s pure collusion.

The upside of the invective flowing from the assassination is that it may have triggered an overdue national discussion on the sorry state of the economics of U.S. health care, as highlighted above. Fortunately, some fairly obvious, but not fully appreciated macro-solutions have surfaced in the last couple of years:

More Government Oversight – Because the industry – it is an industry at almost 20% of our economy – has become so consolidated by monster corporations that it begs for Teddy Roosevelt-style trust-busting and regulation of prices, quality and mergers. Wisconsin pioneered regulation of the monopolistic energy sector a hundred years ago through a public service commission (PSC).

We are an appropriate state to launch a PSC for health care. That would spell the end of steep, automatic annual price increases without public oversight.

Medicare Advantage For All – American elders have voted with their feet, switching from straight Medicare payments to Medicare Advantage that enables choice and competition among plans offered by insurance companies. More than half of Medicare eligibles have done so.

ICHRAs Also Favor Competition – Employees can choose from various plans on the ACA exchanges to suit the needs of their households. People like choice; they like competition.

Medicare Advantage is an improved vehicle for Medicare, the best managed form of national care. It should attract Democrats like Sen. Bernie Sanders, a tireless advocate for Medicare For All, which has gone nowhere, and Republicans who favor choice and competition.

Consumers have shown the way to common ground for a national plan. Some Republican business people have given up on their unaffordable plans, defaulting to Obamacare exchanges. It’s time for political leaders of both parties to follow their leads.