Quest for truly reasonable care

Almost 10 years after President Barack Obama signed the Affordable Care Act into law, the nation’s health care system remains a tangled mess of high insurance premiums, along with a dearth of affordable and comprehensive alternatives.

Legates who are involved in health care, which is arguably the most complex industry in the United States, either as physicians or on the business side, argue that some reforms within government and the insurance industry could help provide more affordable access to medical treatment. But there are no easy answers.

“There is not a lot of room for innovation right now,” said Dr. William Chavey, a primary care physician in Ann Arbor, Michigan who is also a professor in the University of Michigan Medical School’s Department of Family Medicine.

Some things better, some worse

Chavey, a member of Legatus’ Ann Arbor Chapter, said the Affordable Care Act, known to many as Obamacare, has “made some things better and some things worse.” The law helped millions of low-income people to get health care coverage, mainly through Medicaid expansion, but that has also helped to increase costs in the private insurance market.

“You have small business owners and you have families that do not have insurance coverage through their employers, and for those people, the costs of insurance make it unattainable,” Chavey said.

David Wilson, the CEO of Wilson Partners, a Michigan-based employee health and welfare benefit consulting and management firm, said medical costs are “very high and expensive” because of the overall mismanagement of the nation’s health care industry.

“From a business perspective, the cost challenge in the marketplace is significant. The smaller the employer, the more significant that cost challenge is because they have fewer options, at least from an insurance-plan perspective,” said Wilson, a member of Legatus’ Detroit Chapter.

In addition to the relative lack of affordable options, Wilson said employers who have moral objections to birth control, abortion, and sterilization still encounter problems trying to find employee health insurance programs that do not cover those procedures. With some exceptions, the Affordable Care Act still mandates that most employers cover those items in their health plans.

“The market is government-regulated and institutional,” Wilson said. “Therefore, given the viewpoints of government policy, access to coverage that is morally sound is even more difficult. This really requires that we think through this process very carefully to creatively structure solutions that are both affordable and moral.”

Emerging alternatives

Some alternatives to the conventional health insurance market are emerging, such as direct primary care, a membership-based model where patients, employers, or health plans pay flat fees directly to primary care providers in exchange for unlimited access to primary care and preventative services.

Christian health care sharing ministries – a nonprofit model where members pool their money to cover each other’s medical expenses – are becoming an appealing option to some employers, but that model, as well as direct primary care, is still trying to find its footing in the health care industry.

“There are a number of these sharing ministries, which I think are still evolving to the environment, post-Affordable Care Act, and trying to figure out how they can survive,” said Chavey, who added that some sharing ministries cover preexisting conditions while others decline to pay for preventative care.

“There is some potential there, but right now, I don’t think we’re sure which ones of these are going to emerge as the preferred model,” Chavey said.

Partner with a savvy advisor

In the present-day paradigm of employer-provided health insurance, working with a knowledgeable and skillful consultant who is able to negotiate with insurance companies can help employers get the best medical coverage possible for their workers.

“Who you work with, how creative and thoughtful they are, is essential in this process,” said Wilson, who added that the consulting advisor should understand the available alternatives and be able to structure an employee health plan that is Christ-centered and rooted in the Catholic moral tradition.

“You need to have a very clear and comprehensive view of the marketplace,” Wilson said.

In the Dallas-Fort Worth region, Marc Netsch works as a consultant for an insurance brokerage firm, where he helps large companies with their welfare and health benefit packages for their employees.

“Health care is probably the most complex industry in the country, and that’s unfortunate,” Netsch said. “We’re all consumers and we’re all patients in the system, but there is a tremendous lack of choice and transparency. It’s very cost-prohibitive.”

Netsch — Chavey’s son-in-law – said that with the way that the U.S.health care delivery system and medical insurance is presently structured, Americans do not have as many choices as they do in other areas of their lives.

“I’m at the mercy of what my company is offering in terms of their health care coverage. I just kind of have to go with whatever they offer, and that’s the case for about half of the country that gets coverage through their employer,” said Netsch, 30, a married father with four children under three.

Employers have more latitude in choosing their health plans. Some companies opt to self-insure, where they set aside a pool of money to pay the claims themselves instead of contracting with a private insurance company.

“The employer has some choice in what they will and won’t cover,” Netsch said. “I have a mix of companies I work with that cover things like contraception and elective abortions, and some that don’t cover those things.”

Reforming primary-care medicine

Adding that health care “is different than pretty much any other industry out there,” Netsch said striking a balance of government policy and free-market principles could stabilize costs and spur some helpful competition in the system. However, expenses are also being driven up by an aging population and accelerating health conditions such obesity, diabetes, and hypertension. “We consume a lot of health care,” Netsch said. “We’re not a very healthy country.”

Reforming and investing more in primary-care medicine – the point of entry for many Americans in the health care system – would also go a long way toward stabilizing costs. Chavey said he would like to see primary care removed completely from regular health insurance.

“Because if you think about insurance as something that should cover catastrophic care, there’s really not a lot in primary care that’s catastrophic,” said Chavey, who argued that the chances for innovation would improve if there were a more competitive market for primary-care physicians.

“I think we could make primary care affordable, and then we could find out if ultimately we’re going to have a single-payer system for major medical procedures or whether we can devise a better way for that to be provided in the employer base,” Chavey said.

Invest in employees’ well-being

The bottom line, Wilson said, is for employers to think about health care in the context of caring and investing in their employees’ well-being. He said wellness programs should be a fundamental component of any employer’s health care strategy, as well as allowing employees the opportunity to be treated by physicians who have a holistic and Christ-centered vision.

“So that the (employers) look at the person’s spirit, mind, and body, and that they provide that kind of primary care to their employees,” Wilson said. “These programs can be put together in such a way that they actually reduce the costs of the health insurance plan.” L B

BRIAN FRAGA is a Legatus magazine staff writer.