One of the things that struck me funny in the 2008 Presidential campaign was the claim by the Republican ticket (McClain/Palin) that the then-proposed government-run “single-payer” health insurance would result in the government having “death panels” to determine who got what healthcare covered, and who didn’t. That made me laugh, because, even then, we’d had “death panels” for years and years.

We’ve always called them “claims adjusters.”

The recent murder of United Healthcare CEO Brian Thompson has reignited the debate over the state of healthcare and healthcare insurance. Or, I should say, brought it back into the public consciousness. Well, the media, anyway; for those of us who must rely on insurance coverage for our basic healthcare it’s a never-ending issue…

Anyway, it’s 16 years later and the debate still rages on, unabated, although the term “death panel” died a quick death itself. And it can be a depressing subject to discuss, but discuss it we must if we are going to see any meaningful change. And there must be meaningful change. But whether or not it’s going to happen…

At first, the discussion is going to center on money. There’s too much money in the pot for any meaningful changes to happen. Insurance companies bring in too much money to go quietly; there’s too much money being made, too much profit in their greedy pockets. That’s what we’re hearing now. But is that really the case?

There is a ton of money in the Health Insurance industry. All of us – all but a true handful – are paying into that industry. Hundreds of billions of dollars annually flow through those companies. And, there is profit being made off of those billions and billions of dollars passing through their hands which is, after all, the whole purpose of going into business. But actual profit margins are barely over 3%, according to the NAIC (National Association of Insurance Commissioners). Assuming this is accurate (and you can bet they’re very careful with their numbers), that’s a pretty slim margin for any company to operate on; one event could bankrupt a company with that slim a margin. And most of those profits are, apparently, derived from their investments in care delivery, not their “core business” of health insurance (https://www.axios.com/2024/08/08/insurer-profits-health-care-delivery-pharmacy).

But there are calls for the implementation of a single-payer system, run by the government, to put billion-dollar companies like UnitedHealth Group, Cinga, or CVS Health out of business.

OK, for the sake of argument, let’s say the government grows a pair and implements a single-payer system for everyone. “Medicare For All” (or whatever they would call the new system) gets implemented, and all the healthcare insurance companies fold, throwing tens of thousands out of work. Except the majority of those laid-off workers will actually wind up working for the government system, making just as much money as they are now, making the same decisions they’re making now. The only thing they’ll notice change is the signature on their paychecks; it’ll be the taxpayers paying them instead of insurance companies.

Think things will get better? If you want to see how well our government can run a healthcare system, take a good look at our Veterans Administration, which is, for the most part, a complete cluster f…. mess. Google it; there are problems at VA facilities all over the country; incompetent staff, botched surgeries, delayed treatments… Take a look at the National Health System in the UK, and in Canada. See the delays, the denied or stalled treatments, the cost overruns. Sure, you don’t have to worry about paying for it, except when your taxes go up because they keep running out of money – and they’ll always run out of money – if you can get in to see the doctor before you wind up in critical condition and sent to the wrong hospital. And there are limits to what they’ll allow, too; it’s not an “anything-goes” system, either.

(OK, yes, there are success stories in the NHS, and I have a friend who works in that system; she’s good people and looks out for her clients/patients as she should, but even she agrees that the system itself is something of a mess.)

The US has the best healthcare in the world – or would, if it wasn’t for the layers and layers of suits in a decision-making process that should be limited to between doctor and patient. Right now it’s insurance suits. Government suits aren’t going to be any more efficient or less intrusive; in fact, since Government is by its very nature terribly inefficient, they will be more intrusive and less efficient than their insurance counterparts.

So, in short, government-run single-payer is not the answer. Single-payer will only make matters worse.

The larger tragedy of Brian Thompson’s murder is that he was a reformer. According to profile articles I’ve read in the last couple of days, he knew what his bosses are now saying publicly, that the system needs overhauling. He was working to that end when he died.

Yes, it does need reform. Doctors and their patients should be the driving force in healthcare, not adjusters who only know what a computer algorithm tells them. And the cost… We’ve got to make basic healthcare affordable again; preventive exams and minor procedures shouldn’t require a second mortgage if you’re not insured.

The only actual health insurance we should need is catastrophic care insurance, like ER visits, hospitalization, major surgery, etc.

The only way to get there is to greatly simplify the insurance process, reduce the overhead costs that drive medical bills up – including (especially?) malpractice insurance. Drug prices will have to be addressed, too; there’s no reason US patients must carry the cost burden of supplying the rest of the world.

Government can do this. Government can set the stage, create the atmosphere where the necessary changes can happen, and then get the hell out of the way and let them happen.

Which is the other reason why I expect it never will.