I was eight years old when Richard Nixon signed the Health Maintenance Organization Act, a piece of legislation that essentially created the HMO system we know today. I remember all the promises made through the 1970s and early eighties, promises that improving access to primary care would reduce healthcare costs. Some fifty years later, primary care still does not live up to those promises.
Unfortunately, the primary care-healthcare cost reduction myth continues unabated. A recent article published by the Boston Business Journal is yet another piece advocating for increased access to primary care among people who cannot afford it, in hopes of somehow bringing down insurance premiums.
Premiums Continue to Rise
You do not need to be a rocket scientist to know that health insurance premiums continue to rise. They go up every single year. And more often than not, premium increases outpace inflation. According to the Boston Business Journal, employers in the state expect their healthcare costs to increase another 6% in 2023. But wait. There’s a problem here.
An employer doesn’t have any healthcare costs if it does not offer a health insurance plan. And if it does not offer health insurance, its employees are left to pay for primary care out-of-pocket. Said employees are ostensibly the ones who don’t have access because they can’t afford it.
Meanwhile, an employer down the street sees its healthcare costs go up because it offers employees a health plan. Those employees utilize primary care; their health plans make it possible. Yet their premiums continue to rise.
Covering the Uninsured Doesn’t Help
This really is common sense if you think about it. Giving access to the uninsured does not help the insured. People with health insurance keep paying higher premiums despite having all the access to primary care they want. Providing free or reduced-cost care to the uninsured doesn’t help them. In fact, it arguably hurts them. Why? Because the insured ultimately bear the cost of reduced or free primary care for the uninsured.
It is mystifying to me that this strange myth has persisted since the 1970s despite decades of proven failure. An emphasis on primary care, preventive medicine, and the whole HMO concept has had the opposite effect. It has not reduced healthcare costs. Quite to the contrary, costs have only gone up every year since.
Insurance Companies and Government
The inconvenient truth is that healthcare costs are high because insurance carriers and government regulators cannot keep their hands out of it. If we really want to reduce costs, the best way is to extricate our system from the current controls government and insurance companies place on it.
Temporary pandemic rules prove the point. When healthcare facilities were forced to shut down, many of them turned to telemedicine solutions to continue providing patient care. Companies like CSI Health, out of San Antonio, TX, stepped up and supplied healthcare facilities with telemedicine solutions, remote screening options and corporate wellness.
This was only possible because the federal government relaxed some of its stringent Medicare and Medicaid rules and, at the same time, forced insurance companies to cover telemedicine. Essentially, the government rules and insurance company restrictions were forcibly relaxed. Patients continued to seek care and the per-visit cost of that care either remained static or actually fell.
Expanding primary care access to people who currently cannot afford it is not a bad idea. In fact, it is a good idea. But it’s not going to reduce healthcare costs. No one’s insurance premiums are going to fall because primary care access is expanded. It is time to put that myth to bed.