Health care is not a television. Among other things, you have little clue what you are buying, both because private insurers hide critical information and because private insurers are constantly changing the terms of your coverage, including their network doctors. Worst of all, if a private insurer is delivering a defective array of goods and services–e.g., failing to provide access to good care–you won’t get your money back; and, if you are healthy and don’t use a lot of health care, you might never know that you paid the insurer for junk coverage.
Private health insurers do not operate like retailers of consumer goods. There is no evidence that private health insurers provide value, either good quality or fair prices. They are simply payers. Even if it turns out that they pay for your defective knee prosthesis, private insurers will not compensate you or call to account the manufacturer of that defective knee. Private insurers generally won’t even report the defective product.
Public insurance, like traditional Medicare, works differently. You know exactly what you are buying–coverage from virtually any doctor or hospital anywhere in America. Coverage that does not profit from denying care. Coverage that is designed to ensure you get the care you need. Coverage without surprise bills. With traditional Medicare, public insurance, the government provides some oversight of the health care delivery system that is far better than the virtually non-existent oversight private insurance offers.
Medicare penalizes health care providers for certain “never-events,” events that happen as a result of your receiving care that should not happen. For example, it penalizes a hospital if it readmits you within 30-days of discharge, in certain situations in which readmissions should never have happened. In many cases, readmissions are evidence that the hospital discharged patients prematurely.
These “never-event” readmissions happen all too often. Jordan Rau reports for Kaiser Health News that Medicare has just fined half of all hospitals for an excessive number of readmissions. These readmissions happened pre-novel coronavirus. [NB: Medicare is likely to adopt a more lenient policy towards hospitals during the pandemic.]
Medicare can tailor penalties. Critical access hospitals–hospitals providing the only inpatient care in an area–are exempted from penalties. Hospitals that care primarily for psychiatric patients, children or veterans or that offer rehabilitation services or long-term care, are also exempted.
In a world without traditional Medicare, government-administered public insurance, it’s not clear that there would be any checks on health care providers to promote value. States could take this work on, but most do not have the will, the skill or the resources. In a world without traditional Medicare, with only private health insurance, it is hard to imagine that we would have health insurance that delivered the care we needed at a price we could afford.
Here’s more from Just Care:
- Don’t let the hospital keep you in bed if you’re able to walk
- Hospital care: Three major inequities
- Big non-profit hospitals put revenue ahead of social mission
- Plan ahead for a hospital visit: Talk to the people you love about these seven important items
- Seven things to do before you or someone you love leaves the hospital
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