Managed Competition: Let the Patient Beware


In an average year, one dollar out of every 10 I bring home goes for health insurance. My premium went up 10 percent in January and an additional 19 percent this week. On top of that, I pay the first $1,000 plus half of the next $4,000 for any actual healthcare. In spite of its enormous premiums, my insurance company is now in receivership. As a 52-year-old cancer survivor, I may not find another one if it folds.

In short, I’m one of the millions of Americans who are praying that Hillary comes up with something good. The rumors say she’s going to come up with — something political.

If you’ve been watching the trial balloons float by, you know that the choice is between two systems called single-payer and managed competition. In a single-payer system the government becomes the health insurer for everyone. You don’t pay premiums, you just pay taxes. You go to whatever doctor or hospital you like; the government pays the bill and negotiates with doctors, hospitals, and drug companies to keep rates reasonable. You pay only for services not covered, such as elective plastic surgery.

Canada and many European countries have had single-payer systems for years. They also have longer life expectancies than ours, lower infant mortality, and 25 percent lower costs. If our healthcare costs were like theirs, we would save $160 billion a year — $640 per capita-10 times the job stimulation package the Republican senators just insisted we couldn’t afford.

The other choice, managed competition, doesn’t yet exist anywhere in the world. The rumors say that you or your employer will join a “health allegiance,” an organized group of people who share an insurance plan — like today’s health maintenance organizations. If you are working, you pay premiums into the plan. If you are elderly or unemployed, the government pays, and you get basic coverage. You can join an alliance with more expensive doctors and hospitals and broader coverage if you can afford it. You can choose alliances, but once you’re in one, it dictates which doctors and hospitals you use and which services are covered.

The big political difference between these plans is that in managed competition, insurance companies are still in on the deal. There will be a double layer of bureaucracy, first the insurance companies, then the government regulating costs and operating Medicare.

The rumors say that Hillary and Bill are going for managed competition because managed competition will unleash the power of the market to keep costs down. Canny consumers will shop among alliances and find the one that offers the best service at the lowest price. If you believe that, you’ll believe anything.

If the market worked that way, it would have done so with our present competitive system. What the market has produced, and what managed competition will perpetuate, is a cruel, bloated system that caters to the rich, neglects the poor, and accumulates layers of administrators whose outrageous compensation comes right out of our pockets.

The highest-paid executive in America is Thomas Frist of the Hospital Corporation of America, who earned $127 million last year. Albert A. Cardone, the CEO of New York’s Blue Cross and Blue Shield, is paid a mere $600,000, but his customers’ premiums pay for his chauffeur-driven Lincoln Town Car and the cellular phone in the boat at his vacation home in Florida.

That’s why my insurance premium rises 30 percent a year and why 37 million people can’t afford health insurance. And that’s why Hillary and Bill are going for managed competition — because these big players have millions of dollars with which to lie to us (they like to make up stories about long lines in doctors’ offices in Canada), to bribe politicians, and to kick up an unholy fuss against any change that threatens their lifestyle.

The reasons to favor managed competition are: 1) You love your insurance company; 2) you think the government might be up to enforcing some rules, but not up to actually managing anything; 3) you believe that rich people should have better health care than poor people; 4) you think health care is something you can and should shop for like cars or soap.

You should favor a single-payer system if: 1) You care more about the health of people than the wealth of insurance companies; 2) you think the government of the United States ought to be able to administer something as well as the governments of Canada or Germany; 3) you believe that health-care ought not to be distributed according to income; 4) you think healthcare, like schools, soldiers, fire trucks, and roads, is something to be publicly provided, not marketed.

Whatever you think, now’s the time to sound off. The compromising Clintons and the spineless Congress will not go against the vested health care interests unless the public kicks up an unholier fuss than the insurance companies do. Write to Hillary Rodham Clinton (Presidential Task Force on National Health, The White House, Washington, D.C. 20500), or write to your Congressional Representatives and insist on an affordable system.

Donella Meadows is a system dynamicist and an adjunct professor of environmental and policy studies at Dartmouth College. She writes a weekly column for the Plainfield, NH Valley News.

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