by Terry O'Neal-Cox MD

Created on: April 14, 2009

I am not quite sure, exactly, what the insurance companies expect from the politicians in return for their campaign contributions. But one would be terribly nave to believe that nothing is expected. After all, we are still in America, and the phrases "no free lunch" and "you can't expect something for nothing" still apply; so to explore the expectations should not be too daunting a task.

First, what is the advertised or commonly believed function of a health insurance company? The answer, simply put, is that for an up front fee, the insurance company agrees to cover (pay for) medical expenses, for their policy holders, when the need arises. If there is no need, the insurance company gets to keep the fee paid to them, no questions asked. Policies can be had in a range from thumbing a ride to the luxury of a chauffer driven Rolls Royce. But you wont get any more than what you paid for.

Second, we, including the insurance companies and our government, have agreed that the costs of health care have gotten prohibitive. Not to defend the insurance companies, but we must see the picture. The insurance companies are not the delivery system, even though many are incline to see otherwise, their responsibility is to pay for their policy holders. So, if the cost of health care escalates it stands to reason that the fees charged by the insurance companies will increase accordingly. They "have to meet their profit margin for the share holders". Employed individuals are feeling the pain because the employer was the sole, or majority, payer of insurance health policies. When the insurance companies swings the hammer of increase to raise their premiums, employers suffer the first blow. When the employer shifts some of the burden to the employee, the employee suffers the second blow.

Conceding that the costs are too high and the suffering too great, what could be expected in return for a campaign contribution? If the government agrees that health care costs too much, decreasing cost SHOULD be at the heart of any reformation effort. How can this be achieved?

A. The government could go to the "delivery system" (doctors and their staff, hospitals and their staff, pharmaceutical companies, equipment manufacturers, and drug dispensing corporations) and attempt to lower prices. Then have the insurance companies lower prices accordingly.

B. The government could approach only the insurance companies, have them accept a lower margin of profit, and thus lower their premiums by the same percentage

C. The government could make employers undertake the burden, unconditionally. But this would only protect the employed.

D. The government could undertake the responsibility of paying for cost as is, and increase taxation, while lowering direct out of pocket payments. In other words, shift the responsibility of current and continued cost escalation to the taxpayer. This would result in an expanded form of Medicare or Medicaid.

Therefore an obvious expectations of the insurance companies, in return for campaign contribution, would be to leave their profit margins alone and do not attempt to manipulate their fees or fee structure. It is an obvious attempt to protect their bottom line.

My question is, how can the government change the cost of health care without shifting the burden of cost?

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