This commentary is by Marvin Malek, M.D., an internist who works on the hospitalist service at Springfield Hospital in Vermont. He serves on the executive committee of Vermont Physicians for a National Health Program.
Fred Thys’s article March 4 in VTDigger does a superb job demonstrating how the UVM-United Healthcare spat directly affects the lives of patients attempting to access care in UVM’s service area.
It should be required reading for anyone who looks to market mechanisms to “solve” the multiple crises that beset the U.S. health care system.
2,900 Vermonters will likely be left searching for care if UVM and United Healthcare remain unable to reach an accord on payment rates. Eliza Graves, a 34-year-old from Jericho, numbers among them. Eliza is facing a rare, frightening malignancy at a tender age, and her inability to access care with her cancer specialist at UVM is adding great stress to her life.
UVM functions as a regional monopoly, controlling much of the primary care and most of the specialty care for a large geographic region encompassing northwestern Vermont and the Adirondack region.
United Healthcare is the largest health insurance company in the world. Its profits run into the billions. Eliza’s dilemma is simply collateral damage from a big hospital facing off against a big insurer.
Both UVM and United Healthcare are behaving exactly as they are supposed to in a market system. This is big power capitalism. Both competitors have tremendous market power.
What’s especially important to understand is that — far from being exceptional — the northwestern Vermont “market area” fairly represents the situation in nearly every metro area across the US: Market concentration in both the hospital and insurance sectors has followed four decades of mergers across the U.S. A key lesson demonstrated here is that this system tends to raise rather than lower prices. The consolidated tertiary care center gets the high prices it wants, and the big insurers are no worse off, so long as their few competitors face the same high price, and are able to pass on these prices on to the individuals and businesses seeking health coverage.
The administrative costs of the interactions between these insurers and hospitals are enormous.
If the commodity under consideration were screwdrivers or napkins, there wouldn’t really be a major problem, but this commodity is instead the health and lives of real people — our friends and neighbors.
Eliza Graves could have been any one of us. My heart goes out to her. If neither UVM nor United Healthcare gives in, then she may well be obliged to make that 95-mile post-chemotherapy drive home from Dartmouth-Hitchcock, feeling nauseous and weak after each chemo treatment.
We don’t know if Ms. Graves is in a financial position to afford the deductibles and copays she’ll likely face. Will some of the numerous letters that will arrive in her mailbox from United Healthcare include the word “denied”?
This circumstance is unique to the United States. In every other developed country — each of which uses some version of a Medicare-for-All single-payer system — this type of event would be unheard of. Eliza’s coming battle against her malignancy will entail more than her share of suffering and anxiety. A completely dysfunctional health care system has already added to her burden.
Equally unique to the United States’ system of health care are numerous other dysfunctions and tragedies — job lock, medical debt-induced bankruptcy and mortgage foreclosure, nearly 70 million uninsured or underinsured citizens who can’t access the care they need, the lowest life expectancy and highest maternal and infant mortality in the developed world. And this list is far from complete.
The time is long overdue for the American people to divest ourselves of the notion that health care can be treated as a commodity. The winners in this system are big hospital conglomerates and even larger multibillion-dollar insurance and pharmaceutical companies.
It doesn’t have to be this way.
There has never been a good policy rationale why Americans have to wait to age 65 to become eligible for the Medicare program, and similarly no reason why its coverage needs to leave its enrollees with burdensome copays and deductibles.
And the ultimate irony is that all these other countries that provide superb coverage for their populations spend vastly less than we do on health care.
The obstacles to reform are exclusively political. The hospital and insurance lobbyists in Washington have thus far succeeded at protecting their privileged positions. But both the financial and human costs have simply become too high.
Eliza Graves is one of millions of victims of a cruel, impersonal health care “system” that needs to go the way of leeches and purgatives.
Read the story on VTDigger here: Dr. Marvin Malek: UVM-United Healthcare spat shows market forces at work.
