Are we in an abusive relationship with health insurance?

A physician says we're like someone in an abusive relationship who cannot see what is plain to all of our friends — that we need to move on.

Only 30% of Americans have a favorable view of our private health insurance industry, and 80% say the cost of health care is too high. Over 60% agree it’s the responsibility of the US government to make sure all of us have health care coverage…but we’re still hanging on to the idea of private insurance. That’s despite employees giving up almost 20% of their total compensation to help employers purchase health insurance, contributing nicely to the insurance industry’s $25B in profits, and earning the chance to pay more now than ever before for the benefits they do get.

And we’re right: it’s not working. In comparisons with peer countries, we rank 11th out of 11 countries in access to care, administrative efficiency (a key component of our high costs) and outcomes—the measure of whether we accomplished improved quality. And despite spending nearly twice as much per capita on healthcare compared to similarly large and wealthy nations, the United States has a lower life expectancy than peer nations, with even worse health outcomes since the COVID-19 pandemic.

We didn’t need the recent shooting of the CEO of the largest US health insurance company to point out it’s not working. In a new opinion piece, physician leader David Oxman is right: we are in an abusive relationship with health insurance. Worse, we can’t seem to imagine a way out—the very definition of an abusive relationship.

There is a fix for this, and it’s relatively easy, but defaulting to old dog whistles about the horrors of ‘socialized medicine’ won’t get us there—particularly since peer countries with universal or near-universal health care systems—like the UK, Canada, Australia and Germany—all have higher ppublic satisfaction with those systems than we do. Note those systems are usually hybrid; most countries with universal health care also offer private pay options in addition to the foundational commitment to first meet the basic needs of the population. For a good overview of health care payment systems elsewhere, click here.