Transparency or Medicare for all?

With the midterm elections and year-end benefit plan renewals right around the corner, you can expect to hear a lot about healthcare in the coming months. Small group and individual premiums have largely stabilized here in Wisconsin, even though Obamacare was neither repealed nor replaced. Nonetheless, this is no time to be complacent.

Healthcare remains a hot-button issue, and unless all of us – providers, carriers, advisors, employers, and consumers – succeed in fixing the current system, I fully expect that we will hear more and louder calls for truly socialized medicine in 2019 and beyond.

As I see it, we now face a binary choice in how we can solve the problems still plaguing our healthcare system, even if these choices are not in the ballot booth quite yet. First, we can all commit to making our private healthcare system more transparent, efficient, and effective. The second option is to conclude, tacitly or otherwise, that the private sector is incapable of delivering quality, affordable, and accessible healthcare, and that the government must play a larger role in this critical part of our lives.

Failure to fix the current system or adopt something new will only lead to economic stagnation, civil unrest, or both.

I strongly prefer the first option, as I assume you do as well. So what can we do to eliminate the problems that proposals like “Medicare for All” aim to solve? The answers depend on your role and responsibilities within our current system.

Healthcare providers and executives

If you are a healthcare provider or system executive, support opportunities to compete openly and move beyond the traditional fee-for-service payment model. Your success should be determined by how well you care for your patients, not your ability to perform a greater volume of services. Share your cost and quality data with consumers, researchers, and other interested stakeholders.

Insurance benefits administrators and managers

If you work for an insurance company, benefit administrator, or pharmacy benefit manager, continue to search for innovations that will push down unit costs and reduce waste without creating unnecessary barriers to necessary care. Giving consumers the choice of lower priced plans that encourage the use of efficient or integrated care is one great idea. Encouraging the use of on-site clinics and near-site clinics, as well as telemedicine, is another.

Brokers and consultants

If you are a broker, advisor, or benefit consultant, resist the temptation to put your own interests ahead of your clients’. I know from experience how variations in insurance company compensation can mean the difference between feast and famine. Never forget that there is always another sales cycle, but you only get one reputation.

Employers and plan sponsors

If you are an employer or plan sponsor, do your due diligence during annual renewals and don’t be afraid of change. Although continuing with the status quo may be the path of least resistance, you’ll never get better results if you keep doing the same thing. Look to make changes when times are good, before circumstances force your hand.

Consumers

If none of the above apply to you, you are the most important piece of this puzzle, the healthcare consumer. Do your best to live a healthy lifestyle, get your recommended preventive care, and consider a second opinion when facing major medical decisions. Understand that in healthcare there is always a tension between quality, affordability, and access, and that more (or more expensive) care does not always mean better outcomes for you. And try to keep an open mind about changes to your health plan.

Saving our healthcare system won’t be easy, but it certainly beats the alternative!