Health Care system benefits insurers, not patients

Health care is an issue that concerns most people.

Whether it concerns accessing care or paying for health care services, few people are free of the anxiety that comes when they or a loved one must undergo treatment for an acute life-threatening or debilitating chronic condition.

In spite of the $4 trillion spent in 2021 on health care in the United States, the highest per capita spending in the world, U.S. life expectancy continues to languish in comparison to other industrialized countries.

So what issues demand discussion and resolution?

For many people, health insurance is tied to employment. When they take on new employment, their health insurance coverage moves as well. This creates a patchwork of coverage that is susceptible to cracks during any transition. If there is an employment gap COBRA can provide coverage, at the person's expense.

The Affordable Care Act ensures that everyone can access health insurance, with no limitations for preexisting conditions. The gig economy's growth further highlights why health insurance must not depend on traditional employment. Untethering health care from employment is essential to expanding health care security.

One solution is separating the delivery of health care service from payment of these services. Such a separation is critical to resolving a lack of access to health care services.

For most people, health care services are covered by insurance. Health insurance companies are highly profitable. In 2022, the six most-profitable health insurance companies earned more than $41 billion in profit.

The question is: Should a commodity that provides a public good like health care services be positioned to generate profits from such a public need?

One alternative is a single-payer system, much like Medicaid and Medicare. This topic is a lightning rod for controversy. Some argue that the government is ill-equipped to provide health care services for the nation. Yet, a single-payer system does not mean that the government will provide services. It would be the funnel through which health care services are paid. A single-payer system exists in 17 countries, providing models for how it can be achieved.

A second alternative is to establish and grow a network of not-for-profit health insurance companies. If health care providers work toward accepting coverage from only these entities, for-profit companies will eventually be phased out. The benefit of not-for-profit health insurance is that excess income is used for the good of its constituents, not shareholders.

Such a transition would meet resistance from the for-profit health insurance industry, which lobbies and makes campaign contributions to maintain the status quo. Nonetheless, this direction demands attention and consideration given the current state of affairs.

The disconnect among health insurance, health care providers and patients best serves the interests of health insurance companies, while placing patients and health care providers at the mercy of these companies. As middlemen, health insurance companies effectively control the flow of health care services to patients via prior authorizations. This means that health care providers are de facto working for health insurance companies, since they pay for the services provided.

There is some glimmer of hope for health care providers and patients. UnitedHealthcare's recent change in its prior authorization process is an implicit acknowledgment of this issue and a move in the right direction.

The patient must be at the center of health care for it to function in the best interest of patients, physicians and other health care professionals. In the current environment, health insurance companies are in charge. This hurts patients, as they may not get the care they need and deserve. It hurts physicians and other health care professionals, as they are forced to spend time and resources fighting for their patients, and even to get paid for their services.

When discussing U.S. health care, the services provided need to be separated from the finances to pay for them. The financial component overwhelms the service component. Until this is addressed, the current situation will continue — to the detriment of physicians, health care professionals and, most critically, patients, which we will all be at some point.

Jacobson is a professor of computer science at the University of Illinois.