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Can we regulate health insurers to do right by Americans?

Written by Diane Archer

As the debate over the future of health care in America rages on, some posit that the solution to controlling costs and guaranteeing health care to all lies with better regulating commercial health insurers. Olga Khazan writes in The Atlantic that if Congress regulated health insurers more aggressively, as European governments do, it could ensure that Americans would not get high medical bills,  How realistic is that?

Khazan suggests that Americans would be happier with commercial health insurance if they were not faced with so many surprise medical bills. And, Congress could ensure Americans never saw these bills if it regulated health care prices and had strict rules about what insurers covered, as the French and German governments do. Europeans do not get surprise medical bills.
For example, in Germany, there are different health insurers, but all doctors and hospitals take people’s health insurance, whatever it is. Most people pay nothing for their care. Supplemental insurance picks up any out-of-pocket costs. Copays are small. A tiny fraction of doctors don’t take insurance, but even they must let people know their cost in advance of treatment. No surprises.In France, there are health insurers, but all doctors are in network. Some doctors can charge above the government-negotiated rate. But, private supplemental insurance generally picks up these additional costs. Doctors’ charges must be posted publicly so you can always know what your costs will be before receiving care.

The German and French systems are not perfect, but most people think of them as being far better than the US health care system. And yet, unlike the United Kingdom or Canada, where health care is government-administered, these countries rely on private health insurers to guarantee health care to their citizens.

Do these models provide a potential path forward for Americans? Khazan argues that they would put an end to some unexpected medical bills without doing away with the health insurance people don’t seem to want to give up. But, she doesn’t explain how they would address a host of other issues we face with for-profit health insurers in the US, including cost-shifting to people in poor health and wrongful delays and denials of care.

These practices all make our system unaffordable to many people who need care and too often leave people needing costly care without the care they need. But, it is hard to see how Congress could regulate these behaviors.

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