Ethical Health Partnerships

Dawn Lipthrott
December 2, 2005
Orlando Sentinel: Other Views-My Word

Middle-class citizens like you and me could soon join the ranks of the uninsured unless we improve regulation and seek meaningful reform in the insurance industry. Employees in large companies are paying more for health benefits, and the self-employed can barely keep coverage.
I never used my HMO except for occasional routine screenings, but my premiums increased an average of 40 percent annually. I switched to a Health Savings Account with a $2,500 deductible, but within one year, the rates went up twice, for a total of 37 percent. I was told by the company that the increase was not due to my having surgery last year, but because of routine "regional increases."

I always assumed that much of the increase was going to my doctors, who grapple with ever-increasing practice- and malpractice-insurance expenses. I was stunned to discover that my insurance paid my surgeon less than Medicare paid for the same surgery 10 years ago, that most insurance companies base their payment to doctors on the Medicare rate, and that payment to doctors in nearly every area has gone down for many of the most common procedures.

With planned Medicare cuts of about 25 percent over the next six years and private insurance following the lead, it doesn't take a psychic to predict the future. Increasing expenses and decreasing income will either lead to closed practices or efforts to squeeze in even more patients to try to make up the difference. No wonder both doctors and patients are dissatisfied and demoralized.

The insurance industry cites double-digit health-cost increases, but national health costs rose 8 percent last year. Insurance administrative costs have gone up 95 percent in the past six years and yet profits were the highest this year that they have been in 10 years, even after HMO profits almost doubled in 2003.

In 2004, property and casualty insurance companies (which handle malpractice insurance) reported profits of $41 billion, up 28 percent. In 2004, Florida surgeons and ob-gyns paid base-rate premiums of $142,000 to $277,000, the highest in the country. Most have to self-insure.

I'm all for insurance companies making a profit, but not in a way that puts me, as a patient, or my physician, at risk. Profit gained at the damage and undue burden of another is unethical. Insurance is exempt from antitrust laws and continues to create larger mergers, reducing competition. Recent nationwide court settlements reveal patterns of unethical behavior toward doctors. Insurance should be required to focus on reducing the real drivers of health-care costs, rather than taking the easy way out, which punishes patients and doctors.

Of course, we all need to look at our own contributions to problems in health care, but requiring accountability and reform in insurance would be a good place to start.

Dawn Lipthrott is a relationship therapist in Winter Park.