Profit-Driven Health Insurance Has Outlived Its Usefulness

As I read C. Burke King's Sunday Commentary last week -- "Government Health Plan Would Hurt Quality, Innovation, Choice" -- I wondered what health care system he had been living in until I glanced at the bottom line and realized he is the president of Anthem Blue Cross and Blue Shield.

King asserts that the extension of a government plan, such as Medicare for all Americans, would hurt quality, innovation, and choice. After 29 years practicing family medicine, I will have to call him on these claims. His fear is that "a government plan would destabilize the market, increase cost of private coverage, and reduce quality of care," and that "private insurers would not be able to compete on an un-level playing field."

He repeatedly writes about "government-run plans" as if Medicare or Medicaid is actually "run" by government bureaucrats. The truth is, Medicare is funded by all of us through our taxes and is delivered by the private doctors, nurses, and hospitals that provide health care -- not health insurance.

Medicare and Medicaid patients have complete freedom to choose physicians all over the U.S., as nearly every provider participates in Medicare. Medicaid participation is limited only by the fact that reimbursement is so poor that providers must limit numbers to ensure financial viability.

Employer-based insurance, on the other hand, is chosen by the employer, not by the patient, and the insurance company limits selection of providers to those who have signed a contract.

Which brings me to King's next really irritating claim: "Private plans negotiate with providers to set reimbursement rates." Never once in my career did Blue Cross/Blue Shield representatives ever offer to negotiate rates with me. It was always the 800-pound gorilla presenting a take-it-or-leave-it contract in my office -- while all through the managed-care revolution, insurers were steadily raising my overhead, bundling my codes, and denying my patients care and coverage.

The multiple lawsuits won by physician organizations will attest to the truth of these statements, though as a small private practice, my partners and I never saw a dime of the settlements.

Let's talk about quality and innovation next.

I have worked in the medical quality improvement field for 15 years and am proud to be a Patient Safety Fellow trained at VCU.

My small private practice implemented the use of "hospitalists" five years before the first one was hired at local hospitals, we practiced open-access scheduling 10 years ago, and for a year in the 1990s, received a $30,000 bonus for preventive care guidelines -- until the insurance company unilaterally changed the reward program and pulled the rug out from under us. (It was clearly too expensive to reward us for quality.)

An important article published in JAMA, The Journal of the American Medical Association this year decisively proved that the intrusive, over-the-phone chronic disease management programs touted by insurance companies do not work. What does work is a proactive team in the primary care doctor's office working through the longstanding doctor-patient relationship.

But if I have to hassle with 1,300 different private insurance companies (even though five companies control 80 percent of the market) and spend my time fighting with them over whether my patients need an MRI or can continue taking the drug they have been stabilized on for several years, I don't have time to proactively manage patients' chronic care.

A recent study by Drs. Steffie Woolhandler and David Himmelstein of Physicians for a National Health Program showed what my partners and I always knew: The average primary care doctor spends two hours a week -- and her staff spends a whopping 16 hours a week -- on paperwork generated by the insurance industry. There goes my overhead!

King is right to be worried about competing on a level field with the government plan. Medicare overhead is 3 percent, while the private insurance industry takes 30 percent of the health care dollar for CEO salaries, profit, and administrative overhead.

For those who really want to look at quality metrics, please note that the Veterans Health Administration (the only form of truly socialized medicine in the U.S.) has been beating private hospitals on quality metrics and implementation of electronic records, as well as transparency and medical errors, for 10 years.

What King is worried about is not that "many Americans will be forced into government-run plans" but that when the truth is known, many Americans will choose the government-funded plan.

In fact, 60 percent of the American public does prefer Medicare for all, and 72 percent recently said a governmentsponsored public option should be included in any health care reform.

The 16,000 -- and growing -- doctors of Physicians for a National Health Program, of which I am one, are actively working to protect the health of our patients from a profit-driven health insurance industry that has outlived its usefulness and needs to get up from the table of health reform and allow the providers of care who are in the trenches every day for the people of this country to redesign an American solution: Medicare for all.

Susan A. Miller, M.D., is a clinical professor at Virginia Commonwealth University's department of family medicine. The views expressed in the column are those of the author, and not those of the university. Contact Miller at .