Karen Ignagni: Decoding the Health Care Debate

As all of us at EmblemHealth listen to candidates debate health care, we do it from the perspective of our work bringing working families, employers, and beneficiaries of public programs access to affordable health care every day. This mission is crucial for the many members we serve throughout the tristate area. 

Over the next 15 months, those who are running for president will debate the question of how our country should approach health care. Two things underlie this debate: what should be the role of government, and how can costs be brought under control. Single payer and Medicare for All proposals are meant to address these issues. There are (and will be) many opinions expressed. Unfortunately, political discussions often don’t get past the headlines. 

Let’s decode those headlines. For almost a century, our country has debated the role of government in health care, with some favoring a market-based system and others favoring a public system. While these debates have proceeded, Medicare now has one-third of beneficiaries choosing to be in plans like EmblemHealth’s through Medicare Advantage. States have turned to health plans like ours to assist with Medicaid, and now 70 percent of Medicaid beneficiaries are covered by private plans. The Affordable Care Act set out stringent rules and our plan, among others, stepped up and brought coverage to millions of Americans who were uninsured. 

With health plans being selected by seniors, counted on by states, and making the promise of the Affordable Care Act a reality, what is driving the current debate? It’s health care costs. But, what is frequently not mentioned in policy discussions is that the cost of coverage reflects the cost of care. While the Affordable Care Act mapped out a path to expand access and it imposed rigorous requirements around how we must provide coverage, there were no similar provisions around how the cost of care should be contained. Now, almost ten years later, costs continue to rise.

Politicians are calling for single payer or Medicare for All with the objective of reducing out-of-pocket costs and premiums. Eliminating not-for-profit organizations like EmblemHealth – which has longstanding community roots and has shifted payment mechanisms from rewarding the volume of care provided to rewarding the value of care – is not the way to achieve these important objectives. It would remove all of the innovative approaches that health plans have brought to the health care system that the public so highly values, such as preventive care, wellness, care management and patient navigator services. The unique roles that plans like EmblemHealth play have not yet been part of the political discussion. But they will be.

Medicare for All, single payer, or public option proposals also would require hospitals and physicians to accept government payment rates and have the government put limits on drug cost increases. If government were willing to limit the cost of care in this manner today, our plan could slash premiums and out-of-pocket costs. However, it is difficult for politicians to tell hospitals that their rates could be cut by 200 percent or more, or that pharmaceutical companies charge too much and their price increases will be capped. Thus far, the political discussions haven’t gone there.

If politicians now are ready to address costs, EmblemHealth can assist by bringing proposals to the table and working with our provider partners. No individual, union member, or employer needs to lose their plan, and no American needs to pay more taxes. EmblemHealth has a clear mission: putting members first, commitment to service, valuing our provider partners and providing the comprehensive coverage that keeps our members healthy. That’s a mission that is important and valuable to the people we have served for more than 80 years.