Take health insurance off employers’ backs — they’ll gladly give up the tax credit

Sept. 13--Lori Shandro Oüten is one of five Treasure Valley experts the Idaho Statesman's Business Insider magazine asked to describe how to repair our broken health-insurance system.

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Lori Shandro Oüten is on the front line of the health insurance crisis. A former certified public accountant, she opened The Shandro Group, a small independent insurance agency, in 2005.

Oüten works with individuals who need to buy insurance on Your Health Idaho, the Idaho exchange. She also works with small-business owners who want to provide insurance for their employees.

Both of her client bases are stressed and stretched, she says. With mounting questions and concerns about Congress' inability to follow through on promises to repair or replace the Affordable Care Act, it's likely to get worse. In July, the four companies on the Idaho exchange proposed rate increases as much as 68 percent come January.

"This past Jan. 1, I wrote about 15 new policies for small employers who didn't offer it before, because all of their employees were in individual plans, but the premiums went up 30 percent," she says. "It's going to be worse this Jan. 1. The [Idaho] Department of Insurance told the companies to file their rates as though they were not going to get cost-share reduction monies that are part of the law."

Q: How would you fix the Affordable Care Act?

Assuming the cost of health care isn't going to change? Well, there should be transparency in understanding where the real problems lie and in understanding what the real cost factors are.

If you took into account what our country already spends, what state and federal governments spend, what companies spend on the HR departments you need to figure out how to do it all, and the lost tax revenue from companies deducting what they pay for benefits, if you took all of that into account, we could afford to give everybody access to coverage.

Is that single payer?

Not really. That's a little bit how they do it in Germany, which is a multipayer system, and it's how it works with ACA if you get a tax credit.

If we could broaden that idea and re-evaluate and redistribute the money we're already spending, we could provide everyone with a stipend and let them buy their own plan. It [the stipend] is based on the cost of the silver [midlevel] plan, but you can choose to buy a bronze [low-end] or gold [high-end] plan.

It's so wrong that the people I work with either can't afford the coverage, or they can't afford to use it when they need to. It's embarrassing that our country can't figure this out.

Why do you think that would work?

Most employers that I work with would rather not have to deal with providing health care. They'd rather run their tech company or printing business and buy new equipment. They don't want the deduction. They want someone else to provide that, and no one is.

Even if you had your open enrollment period and the employer brought in a consultant to help people make choices, that would be so much cheaper and more effective than the employer saying, "I'm going to choose these plans and spend all this money on it," and they're not even sure it's what their employees want.

I wonder, if everyone had health care and didn't have to stress about it, how much bigger would the [gross domestic product] be? What if the average citizen didn't ... have to plan their lives around jobs because they provide benefits? What if they were free to start the company they always wanted instead of working for someone just for the benefits?

What's the bottom line?

We have to reduce health care costs. Insurance companies can't control the cost of health care, and no one is trying to do anything about it.

And I don't know what the incentive is for health care providers to govern themselves.

When has any pharmaceutical company or medical devices company said, "You know what? I don't need to make this much. Let's find a way to change things so we don't have to charge so much."

Physicians should be paid for maintaining someone's health, not for every service they provide.

People think hospitals are nonprofit. Wouldn't it be great if their way of reinvesting in the community could also reduce costs? Instead, they put the profits into facilities, property, landscaping and sound systems in surgery suites. They should figure out what they really need to provide the best health care and use their profits to subsidize the cost.

Dana Oland: 208-377-6442, @IDS_DanaOland

The views of all five experts will appear Sept. 20 in the print edition of Business Insider. The other four:

-- Dr. Ted Epperly, CEO of Family Medicine Residency of Idaho, argues that it is time to go to single-payer health insurance.

-- Charlene Maher, CEO of Blue Cross of Idaho, thinks regulation by Idaho instead of the federal government would solve health insurance woes.

-- John Rusche, a Democratic former state legislator and a physician, says everyone must participate in health insurance, and insurers deserve more certainty.

-- Dean Cameron, director of the Idaho Department of Insurance director, urges a return to pre-Obamacare plans and less federal regulation.

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