“I want individuals to have their own insurance. That means the insurance company will have an incentive to keep you healthy. It also means that if you don’t like what they do, you can fire them. I like being able to fire people who provide services to me. You know, if someone doesn’t give me the good service I need, I want to say, ‘You know, I’m going to go get somebody else to provide that service to me.’ ”I agree with that sentiment, though I wouldn't state it with such dickish Trump-like bluster. But Romney's statement was made to discredit the new health care law and on that score he's wrong. In fact, the new law brings us closer to being able to fire our health care providers than the system we currently have.
Right now very few Americans are in a position to fire their health insurance company.
First off, the vast majority of Americans have no real choice for health insurance, because it's provided by their employer. You might get to pick from a limited set of options, but your company decides what those options are, and if you don't like them, the only way to fire your health insurance provider is to quit your job.
But Mitt doesn't get this, because he's a business owner and has never seen how health insurance works from the employee's viewpoint. Of course Mitt can fire his health insurance provider if their service sucks -- he's the boss. His employees have no such luxury.
And Mitt is also wrong if he thinks that the insurance company has an incentive to keep you healthy: the insurer's only incentive is to make their costs be less than the premiums the employer is paying them, while providing just enough medical care to shut the employees up.
In employer-based health insurance Employer A pays Insurance Company B to pay Medical Services Company C to provide health care to Person D. The amount of overhead and paperwork is insane, and there's no incentive for anyone to get anything right. The biggest incentive is for insurance companies to deny and delay medical care to employees who may not be working for the employer in six months or a year, or for employers who may not renew their contract.
People who pay for their own health insurance can ostensibly fire their provider. But practically speaking, it is all but impossible for anyone over 40 to fire their insurance provider. Insurance companies can turn you down for preexisting conditions, and everyone over 40 has preexisting conditions.The companies also have lifetime limits on coverage, and your insurance provider can fire you if you get too expensive for them. Since the downturn started in 2007-2008, there are literally millions of 40+-year-old Americans who have lost their jobs and health insurance, and can't get private insurance even if they can pay for it, because of preexisting conditions. If 40-year-olds can't get insurance, they're going to be in a lot worse shape by the time they're old enough to get on Medicare, and that will cost a lot more.
A lot of this is changing under the new law, and we'll have more protections and a greater ability to retain and switch coverage. Is it perfect? Nope; it's based on Mitt Romney's Massachusetts plan, after all. It could have been better, but the Republicans in Congress categorically refused to work with the Democrats. The Republicans' self-proclaimed goal was to make Barack Obama a one-term president, and they have done everything they can to torpedo the health care initiative.
In the long run, employers have no business paying for employee's health insurance. It's just an accident of American corporate history that it works this way. It's an unfair burden on companies, and it's a huge competitive disadvantage for American business. Everyone should be responsible for their own health care, just as they are for other necessities like food and shelter.
Yes, such a transition would be messy: it would require everyone who gets health care benefits to get an equivalent raise, and a subsidy for people who can't afford it. In addition, industries that cause health problems should also pay more taxes to counter those effects: that is, fast-food chains, and soda, alcoholic beverage and cigarette companies. There will be many sticking points. Companies will short-change employees, and over time employees will complain that their salaries aren't rising fast enough to cover the constantly-increasing cost of health care. And the right will oppose government subsidies for those who will never be able afford to pay for their own health care because they're stuck in part-time jobs like store clerks, bus-boys, hotel maids and cashiers. Millions of Americans are stuck in minimum-wage jobs that are totally necessary for our country to function, but jobs that will never pay well enough to allow someone to buy their own health care, a car or a house.
Our system is the most expensive in the world, but the aggregate quality of outcomes across all America is inferior to most of the developed world. Under our private insurance model annual cost increases have outstripped the rate of inflation by up to five or ten times, and for decades private insurers have totally failed to achieve the only service they supposedly provide: contain rising costs.






