Three additional states have joined California in an investigation alleging that Aetna’s medical director denied a $20,000-per-dose infusion to a patient suffering from common variable immunodeficiency. The medical director admitted in a deposition that he never looked at the patient’s medical records. Aetna says that the patient refused requested medical tests. It’s unclear why the tests were refused.
The media and public have cried out that the insurer put profits over patient health. News stories like this have fired up the healthcare debate, but it’s important to note that the alternative to insurance carrier self-oversight is government oversight, and this case has played into the hands of the single-payer movement. I am not sure that’s the answer.
The debate over the future of healthcare needs to head in the direction of transparency and real cost reduction. Present issues like unreasonable drug cost inflation, misaligned incentives, and wasteful duplicative care are not only exacerbating cost issues, but they make healthcare bewildering to the consumer.
Benefit advisers and employers need the tools and resources to help employees navigate healthcare and cost decisions. Health insurers and not the government are best suited to lead the transformation.
Insurers are aligning payment incentives and creating tools to increase consumer understanding of our overly complex healthcare system. They manage the introduction of medical innovation and provide oversight of medical appropriateness. The government is not nimble or knowledgeable enough to do these things. Would you rather argue with an insurance carrier or the government about a care issue?
Our government should focus on pricing oversight for drugs and overseeing insurance carrier solvency. They should put aside thoughts of creating a new single payer system, which burden us with a whole new set of issues. We need steady, incremental change, and I believe the insurance carriers and benefit brokers should take the lead.
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