Private health insurance has formed the basis of Obamacare and it will retain importance under President-elect Trump and his HHS Secretary-designate, Tom Price. The main difference is that Obamacare was designed with the unrealistic hope that private insurers would be the drivers of an accessible, affordable health care system. Trump and Price, on the other hand, want private insurers as docile administrators for the interests of physicians and hospitals. In either case, the fact that private health insurance operates at the center of American health care is the biggest reason why the U.S. pays more per capita than any other advanced nation, yet offers worse access than most of these countries.

This system has its roots in the 1920s when the American Medical Association (AMA) started flexing its legislative muscle to establish health insurers as a whole new sector of the country's health care system. Why? Because the AMA despised the concept of government sponsored health care and knew insurers would defer to organized medicine for setting directions and implementing tactics.

In recent years, however, insurers have been seizing the reins.

Organized medicine now chafes under insurance constraints. The very thing the AMA sought to prevent by creating a dominant insurance sector – large corporations hiring and controlling physicians to work as salaried employees – is becoming the prevailing modality of medical practice.

Under Trump and Price, organized medicine is poised to reassert its dominance and set back American health care many decades.

As described by Christy Ford Chapin of Johns Hopkins University in her book, Ensuring America's Health: The Public Creation of the Corporate Health Care System, and by Physicians for a National Health Program, a coalition of progressive physicians, the AMA succeeded in its campaign because it deployed class hostilities, red baiting, deceptive appeals to frontier individualism, and by associating public programs with charity and personal failure. Even more importantly, the AMA was able to remove the middle class from the coalition of advocates for a national health system by promoting private Blue Cross plans as an alternative.

According to Chapin, AMA leaders threatened physicians in prepaid groups by using their influential positions at hospitals and on state licensing boards to revoke hospital admitting privileges and medical licenses.

Trump and Price also want to push the private insurance industry out of the driver's seat by, first, relying on nostalgia for times that can never return, exploiting feelings of resentment and, finally, instituting policies that hurt the country's most vulnerable people.

Specific examples of their approach include the following.

  • · Block granting Medicaid to the states, meaning each state would receive a lump sum and discretion over how to use the money. Block grants would permit rightwing states to restrict Medicaid coverage for the poor.
  • · Expanding what Vice President-elect Mike Pence already did in Indiana by booting limited-income Medicaid recipients off the rolls if they weren't able to pay monthly premiums.
  • · Defunding Planned Parenthood, scaling back access to birth control, and eliminating abortion.
  • · Requiring seniors to pay more by eliminating limitations on what insurers can charge the elderly.
  • · Jeopardizing coverage for individuals with pre-existing conditions so that people who are unable to maintain continuous insurance coverage may not be able to buy any health insurance if they have health problems. The RAND Corporation, a private think tank, has determined that under legislation already proposed by Price, perhaps 20 million people would lose their coverage.

In sum, Price's approach to altering the role of private health insurers involves reducing the health care risks for government and insurers, making physicians a protected class, and imposing greater burdens on the elderly, the sick, women and low-income individuals.

Is that any way for a health care system to work?


Read more from the Check Up blog »