Wendell Potter, a former health insurance executive at Cigna, knows first-hand how poorly corporate health insurers ensure that Americans get the care they need. They create all kinds of obstacles to care and coverage. In an interview with Philadelphia Magazine, Potter explains why corporate health insurers are to blame for our failure to contain the spread of the novel coronavirus; we need guaranteed universal health care to contain it.
In the US, we have more than 30 million people who are uninsured. We also have nearly 50 million people who are underinsured; they have health insurance, but it is inadequate to enable them to get the care they need. Understandably, millions of Americans are not willing to take the risk that they will be able to afford the care they receive when they go to the hospital or the doctor’s office. As a result, many Americans are not seeking treatment for COVID-19.
Canada has a government-administered universal health care system and a lower death rate from Covid-19 than the US. In Canada, there are no out-of-pocket costs for this care. Having universal coverage is critical to contain the spread of the coronavirus.
In addition to universal coverage, you need a strong public health infrastructure and smart leadership. The UK has a system of government-administered universal care, but it has a higher COVID-19 death rate than the US. Prime Minister Boris Johnson was too slow in locking down the country, too slow in providing personal protective gear to health care workers and too slow in ensuring mass testing.
Health care should be free at the point of service. Other wealthy countries do not charge their residents for care at the point of service. They simply tax their residents on a sliding scale for their coverage. In the US, the average out-of-pocket cost of COVID-19 treatment is somewhere between $9,000 and $20,000 for people with insurance. We ration care based on the ability to pay.
The US also ties health insurance to employment. As a result, most of the 43 million people who have lost their jobs as a result of the pandemic were forced to find new coverage. We now know that at least 5.4 million of them could not. Many older adults are skipping needed care for fear of contracting the virus if they go to the doctor or the hospital. Some are dying. Their deaths are preventable.
Federal law has no teeth when it comes to ensuring that people get needed care because we rely so heavily on private health insurers for people’s care. The recently passed CARES Act requires that COVID-19 testing be free in most instances. But, the federal government is hard-pressed to enforce the law and there are lots of grey areas. Some people who have negative test results are getting big bills. And, out-of-pocket costs for COVID-19 tests are all over the map.
Meanwhile, health insurers are profiting nicely. United Healthcare earned $5 billion in profits in the first quarter of 2020, up 3 percent. Insurers are collecting premiums, but not paying out as many claims as usual because people are not going to the doctor or hospital for checkups and elective procedures.
Congress is not likely to pass legislation that guarantees government-administered health care for all any time soon, even if a Democratic president is elected and we have a Democratic Congress. That said, Democratic voters favor Medicare for All. The tide is turning. Potter says that it is becoming more difficult for health insurers to stop federal reforms that diminish their power.
Here’s more from Just Care:
- Seven reasons commercial insurance cannot meet our health care needs
- Eve’s story: Commercial health insurance, inhumane choices
- Hospital rates out of control with private health insurance
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Coronavirus: Older adults take full advantage of Medicare telehealth benefit