[Note: This post is part of an ongoing series on Big-Picture Health Care. The introduction to the series is here.]
Now that we have addressed the most basic level of health care–the relationship between patient and medical professional–and the mechanisms that both pay and restrict it–insurance and government–one last bit of stage-setting remains. There are four key groups of players who influence the American health care system: employers, taxpayers, medical suppliers, and lawyers.
Employers. Employers are in an interesting situation with health care. The American system has linked health insurance with employment, which means that most people who work get some sort of insurance, and that most employers have to offer it. Corporate HR departments are set up to administer health coverage as a benefit, and a lot of people have jobs doing just that.
The problem is that health insurance is a hefty expense to employers. Your company usually pays the greater share of your premiums, and it carries heavy administrative costs in dealing with you and your coworkers. Many employers use their health care options as a means of recruiting talent, which sets up an arms race among employers. Employer-provided health care is a barrier to entry for some businesses and an anchor on performance to others.
The news isn’t all bad for your boss, though. Insurance providers compete (to a degree) to offer their services to your company. Theoretically, the company ought to be able to shop around for the best deal. Unfortunately, the costs of switching providers increase with firm size. Many employers would be just as happy to show health insurance the door.
Taxpayers. Sometimes taxpayers are patients, and sometimes patients are taxpayers. Your insurance source, amount you pay, and level of health have a lot to do with how you feel as a taxpayer or a patient.
Assuming you are healthy and have decent coverage at work, you’re probably not crazy about paying anything more than you already do in health insurance or taxes. If you are healthy and do not have coverage through work–either because your employer is small enough not to offer it or because you are one of the 10% of Americans currently out of work–you might be a little worried about what would happen if you got sick, but still not crazy about paying more (although you might not be paying taxes at the moment). If you are sick and have coverage through work, you might worry about keeping your job, but you probably aren’t interested in paying more in taxes than you do now.
Those who aren’t in peak health and don’t have coverage present a different problem: many pay little to nothing in taxes and yet need health care. People who already have coverage or are healthy might worry a little, but they really don’t want to pay much more. Around 80% of taxpayers are covered and are not interested in paying more in taxes. These are also the people who elect their representatives and expect them to carry out their will in Washington. The uninsured shouldn’t expect much more than empathy from a great many taxpayers.
Medical suppliers. There are many of these, but one gets a lot of bad press: the pharmaceutical industry. There are all kinds of medical suppliers–companies who make MRI machines, thermometers, prosthetic limbs–but it’s the big drug companies who raise hackles among the general public. It probably has something to do with five-star golf trips to Hawaii.
Among the medical suppliers, it’s the drug companies who have disproportionate influence on Congress (probably because of campaign contributions and five-star golf trips to Hawaii). Expect the eventual outcome of the health care debate to have some measures favorable to pharma and other medical suppliers.
Lawyers. No discussion of health care would be complete without the attorneys. Their primary interest for the lawyers is in medical liability (and the liability insurance medical professionals carry to defend against them). Doctors make mistakes, and lawyers are there to attempt to correct these injustices–for a hefty fee. Lawyers also are good lobbyists, though there are signs that any legislation may place curbs on the amounts they can earn. Look for them to be a strong player in the Congressional back-and-forth.
We haven’t talked much about Congress, and perhaps we should, but their interests are straightforward: they want to do the right thing and keep their jobs, but not always in that order. We’ll examine their dynamics more closely in tomorrow’s post.
Those are some of the major players who will determine what health care reform ultimately looks like. In the next few posts, we’ll dive into what keeps the current system in place, what could change that would make it different, and how to analyze the back-and-forth over the next few weeks. I’ll continue to keep that discussion largely non-partisan, and I hope to get some questions and challenges.