Health Insurance Intermediaries: Critical Advocates or Middleman Bloat?
There’s little question in my mind that the maelstrom of health care reform proposals we’re suddenly seeing from every corner of the political and business landscape is starting to converge on a two key concepts: 1) universal coverage backed by individual mandates and 2) some kind of public/private hybrid approach that allows the mighty insurance industry to stay largely intact. Ron Wyden’s proposal is the latest and among the most comprehensive attempts to pull these ideas into a single, cohesive concept.
I have to admit to some ambivalence about all this. It’s great that we’ve finally reached a point where meaningful reform ideas are taken seriously and universal coverage is no longer dismissed as socialist bunk. And clearly the current employer-based system is broken and needs to be completely overhauled. But here’s what I worry about: almost every proposal from extreme left to extreme right leaves individuals largely alone to navigate an opaque and imposing bureaucracy (either public or private). Big Government scares me as much as Big Business, and they can both provide for Kafkaesque experiences when trying to get information or conduct routine business.
Sara Horowitz from the Freelancers Union thinks that the missing link in the health care debate is a need for intermediaries. She mentions church groups and the like, but she’s surely thinking of the Freelancers Union as well, which is one of the biggest intermediaries around. Of course, my paycheck comes from Fractured Atlas, which is another big one.
Sara’s post got largely skewered by people who accused her of wanting to impose more bloat on an already bloated system, in the form of middlemen who aren’t directly involved in the health care transaction. These folks do have a point. There is enormous administrative waste and financial inefficiency in our health care system. Anytime you add a link to the chain you risk slowing things down and adding someone else who needs to get paid.
But my extensive personal experience suggests that Sara’s concerns are extremely valid. At Fractured Atlas we deal with artists every day who are lost, confused, and beaten down by the bureaucratic brutality of health insurance. (Heck, I’ve had some pretty horrible experiences with my own personal health insurance, and I’ve been immersed in this stuff for seven years now!) Fractured Atlas is able to penetrate the bureaucracy, advocate on our members’ behalf, and solve problems for a few simple reasons:
- In the seven years that we’ve been doing this we’ve encountered just about every situation imaginable at least 2-3 times. We’ve learned a lot, from which laws are relevant in which situations to what phone numbers can be used to bypass an autoattendant.
- Our business is worth millions of dollars each year to the insurance companies we work with. They’re a lot more afraid of pissing us off than they are of losing an individual policyholder.
On a macro level, I can’t deny that middlemen like us do add some costs to the health care delivery system. But as an individual policyholder, I sure as hell wouldn’t want to go it alone.
Tags: health insurance, wonkishness
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