"We Have Brought This Upon Ourselves"

by Tim Foley

category: Forprofit Insurance

Published March 07, 2009 @ 07:59PM PT

(Programming note:  I don’t ask for a lot.  No name-calling, no cussing, no hijacking a comment thread with an unrelated topic.  And your feedback – so go on ahead and submit a question for next week’s debate, OK?)

Karen Ignani, president of America’s Health Insurance Plans, made some waves at the White House summit on health care on Thursday.  When called on by the president, she didn’t ask a question so much as pledge her support, saying, “We understand we have to earn our seat at the table.”  It’s a good line (she used it once earlier at the same event), but doesn’t say much about the depth of private insurance’s willingness to be partners throughout the process of health care reform.  And it sounds positively shallow compared to the heartfelt words of John Sinibaldi.

Sinibaldi is a “health underwriter,” selling insurance primarily in the small business and individual market.  He’s also a frequent contributor to The Health Care Blog.  And his post from yesterday deserves to be read in full.  It can be summed up in one word – accountability.

We have brought this upon ourselves, because we (the industry, maybe not each of us individually) have ignored what folks want in favor of what WE want. The industry has ignored calls for more efficient claims and billing, lower bloat, curtailing outrageous CEO and executive salaries, and a more reasonable approach to return on investment. Our industry has ignored any attempt at out-of-the-box thinking to get reasonably priced health insurance to most low-wage Americans, instead focusing on miscommunications to get Americans to buy into what the industry wants ("High Deductible Health Plans are good for you. We don't care if you can't afford the deductible. Now accept that fact and shut up.") Most of all, our industry has simply ignored an ever-louder clamor for us to get our act together. Instead of focusing on a long-term vision for the future of the industry (one that actually includes the very consumers to whom we sell products), the health insurance carriers have instead bellied up to the short-term trough of immediate reward (executive compensation, shareholder value, golden parachutes).

It takes a lot of courage to be able to look into the mirror and say, “We bear responsibility.  It’s time to do our part.”  But as much as the insurance companies are showing that they’re willing to be part of the discussion, they have not shown much willingness to be part of the solution.  Behind the nice words from AHIP, we also have a ramped-up defense of Medicare Advantage, an experiment that has not worked.  If I’m going to pay you 12% more for the same level of coverage, you better have something else going for you—like Michael Jordan’s personal endorsement.  Similarly, I’m hearing a lot from conservatives in Congress about how private insurance couldn’t be expected to compete with a public coverage program.  I’ve heard lip-service about experiments with new ways of delivering health care that could improve quality, like the medical home, but no attempt to actually implement it unless a major client like IBM offers to walk without it.  What I haven’t heard – and it takes a truth-teller like Sinibaldi to say it - are four simple words that you’d hope every American entrepreneur would say when faced with a competitive challenge.

“We can do better.”

Better for our customers.  Better for our innovation in ways that delivery a quality product and doesn’t just pad the stock price.  And yes, better for the country by accepting the challenges of new regulation and new competitors instead of fighting them, and then showing determination to win on the new playing field.  I don't have much sympathy for companies that made obscene profits and then whine to the refs at the first sign that they'll merely have to make surprising profits.

That’s why it’s hard to take anything AHIP says seriously right now.  They’re all words, and no heart.

(Photo credit:  merfam on Flickr.)