By Jack Cumming
To tell the truth, I thought of calling this confession “Too Close for Comfort,” but more importantly, it’s personal. In the early 1980s, I was the executive in charge of Equitable Life’s individual health insurance business. Before Equitable was demutualized and sold to a French company, AXA, Equitable was a major American insurance business run for the benefit of its customers.
Too Close for Comfort
My position then was dramatically similar to Brian Thompson’s for UnitedHealthcare. Mr. Thompson was the executive assassinated recently on a New York street two blocks from where I had worked. To my mind, that’s “too close for comfort.” It’s tempting to think, “There but for the grace of God go I.”
Although Mr. Thompson’s death is still under investigation, it appears that it was a political killing directed at the health insurance industry. Mr. Thompson’s vulnerability was that he held a job closely resembling the responsibility that I had so many years ago.
Of course, there are big differences that can provide food for thought. To begin with, the news tells us that Mr. Thompson was paid $10 million a year, while I was paid $120,000. That would be roughly $460,000 in 2024. Continuous inflation is our national policy.
Also, UnitedHealthcare is a for-profit company, while Equitable Life was then a mutual company, managed for the benefit of its customers. UnitedHealthcare is based in Minnesota, while Equitable Life was located near the assassination site in New York City.
Politicking Vs. Principled
There are also similarities. Politicians tinkered with health care legislation in 1980, and they continue to tinker today, pandering to widespread popular dissatisfaction. The principles for health care reform were the same then as they are now. Perhaps, if we could agree on principles, we could find a uniquely American path toward an effective, just system as a paradigm for the world.
1. Universality
The first principle is that health care should be universal, with everyone having the same access. That’s where pandering and tinkering begin. Of course, some say, “‘Universal’ shouldn’t include those illegally in the country,” and what about tourists? Those are popular political questions; science, in contrast, tells us that disease is globally contagious.
In the U.S., Social Security universally includes everyone from birth to postmortem. The means to accomplish universal inclusion is at hand through the FICA tax system, with tourists potentially assessed a visitors’ fee. That’s not complicated. The mechanism is already in place.
2. Shifted Burden
A second principle might be to shift responsibility for assuring which health care services are needed and warranted from patients to providers. After all, how can a patient be expected to know whether a treatment or medication is effective and/or fairly priced? The patient shouldn’t be responsible for judging pricing equity during a medical crisis or at any time. Patients aren’t the experts. Health care providers are.
That principle is also realizable. Make providers responsible for getting paid from the system. That system can be a government monopoly, as in some countries, or a mixed system, as Medicare is now. The patient needs only to show up and be treated. The patient should not be expected to be at risk. Treatment should be a privilege, though hypochondriacs who abuse the system could lose that privilege. Health care is a privilege more than a right.
3. Economic Accountability
The third principle is that the number, structure, and compensation of providers should be determined by supply and demand criteria at an executive level — whether governmental or private — and be economically comparable to benefits and rewards provided by employment in other industries. The cost of health care in the United States is way out of line with that in other countries — perhaps due to the inherent corruption of American lobbying — and that does not need to be the case.
4. Comprehensiveness
The fourth principle is that health care should be comprehensive. The United States has multiple systems, ranging from the Veterans Administration to Medicaid, but none of them is either universal or comprehensive. Medicaid provides long-term care as a last resort after nearly all individual resources have been exhausted. Hospital emergency rooms also provide universal care to all comers but, again, only under circumstances of duress. Playing with deductibles, co-pays, and what’s covered has become a political game played by Congress.
It’s simply not that difficult to create a practical system that is all-encompassing and provides people of all circumstances with the minimal health care needed for a healthy existence. As a glaring inequity, people who have children with birth defects carry an extraordinary burden for which enlightened social policy could provide relief. We have the intelligence within our midst to do much better than what we now have.
5. Both Local and Global
The fifth principle is more of an observation. Almost all health care is delivered locally where patients are located. Yet, the health care infrastructure and system are politically determined largely at the national level, which has disadvantaged rural areas. Paradoxically, not only is health care local, but it is also global since every human being on Earth faces similar challenges.
The practical takeaway from that observation is that we should cooperate globally to address health care while also allowing local people to ensure that they have the health care to meet their needs. Global means that health care should be available wherever one travels in our increasingly mobile global society. Nancy Pelosi should have the same care at hand in France as she has at home in San Francisco. That is, after all, a principle.
6. Prenatal to Postmortem
That brings us to the sixth and last principle, at least for this article. One’s well-being and health condition is personal, absent a mass disaster. Why, then, are employers involved in meeting their employees’ health needs beyond occupational health maladies? That makes no sense.
The World War II wage controls that created this anomaly ended with the termination of the Wage Stabilization Board in February 1947. Now, nearly 78 years later, many Americans are unwillingly tied to an employment situation by their dependence on employer-provided health care.
Labor unions, too, tie their members’ choices to Taft-Harley plans. Americans deserve to have freedom of employment. The absence of universal, portable health care creates an unnecessary complication in business-labor relations. Therefore, the principle is to have health care stay with the individual from prenatal to postmortem.
Political Failure
Americans are right to be dissatisfied with their health care. The political class — politicians and their government relations funders — has failed the general welfare by elevating party factionalism above deliberative action for the common good. Even the U.S. Supreme Court, the ultimate guardian of our heritage, has failed us with the Citizens United decision, which gave license to special interests to corrupt what should be nonpartisan deliberation.
Nowhere is this corrupting force more evident than in discussions of health care. The failure is evident in the comparison of America’s cost burden with that of all other nations. The elevation of politics above nation is evident in the quest for a popular object for blame, ranging from insurers to pharma, even as the bulk of health care costs go to physicians and hospitals. You can’t address a cost challenge without looking at the major contributors to the cost imbalance.
Senior living advocacy is part of the problem, while it could be part of the solution. LeadingAge, for instance, is qualified as a public benefit 501(c)(3) instead of as a 501(c)(6) lobbying organization. Recently, though, it dismissed financial risk as de minimis instead of helping to put in place protections for senior living residents comparable to those of insurance policyholders and bank depositors. That is a sad commentary on our times.
navigating health care in the US is a nightmare especially for anyone who is ill and trying to be their own advocate. It is heartbreaking to see the waste of $$, overpaid executives and the lack of accountability with “deny, defer, depose” being the order of the day for many who cannot fight for themselves Wondering where AARP is in all of this, as your ideas seem doable and positive, but not without the right lobbying on many levels.
First with respect to AARP. They make most of their money from companies selling products and services to older people so I am not sure you should expect much help there.
Second, the system is a mess. No doubt, part of the problem is waste and overpaid executives. But much bigger is that every health system out there is terrified of being sued and for good reason. This means massive numbers of extra tests, procedures and so on.
Mostly the problem is that as these systems get bigger they exist to serve and protect the system, then people come later. It is a system that needs a complete overhaul and that seems unlikely to happen.