American Health Care Machine and You

American Health Care Machine and You: A Call to Conscience—You Can’t Build a Ship Unless You Know It’s Supposed to Float

As a consequence of our inability to decide as a nation what a health care system should do our system was defaulted to employers as the major provider of health care insurance.  This has led to a health care insurance marketplace more overwhelming than a specialty grocery store.  Not only are there numerous products, but there are specialties within products–an unending maelstrom few can fathom, much less make informed choices.  Employers can dictate the choices for their employees, individuals in the private marketplace are lost at sea with myriad choices of cost and coverage.

The cost of an employer based system is the elephant in the room.  What is not widely discussed when there is talk of retaining the private insurance marketplace is that public dollars also pay for private insurance.  Public employers include:

  • 50 states and 5 inhabited territories—Puerto Rico, Guam, Northern Marianas, US Virgin Islands, and American Samoa
  • 39,044 general purpose local governments (municipal governments, townships governments, and county governments)
  • 50,432 special purpose local governments (special tax districts, independent school districts, and independent special school districts)

These public employers use city, county, local and state tax dollars to contract with private insurance companies for employee health care benefits. Some self-fund (act as their own insurance company by holding the money they would have paid to a private insurance company and pay their employee claims that an insurance company would have paid).  Employers who self-fund often contract with insurance companies to manage and pay claims, and monitor eligibility, benefits, authorizations and referrals.

Each of these employer public and private programs has its own program with its own staff to verify coverage, provider, co-payments, deductible, employee and dependent coverage, and so forth.  In some cases, some of these smaller groups, such as teachers, may become a subset of a larger group, such as state employees.  Benefits, however, often differ. All these thousands of layers of bureaucracies add to costs. Nearly 20% of all health care costs can be attributed to this tsunami of regulation at both the private and public levels whether federal, state, county or city.

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