Much debate pits a government-run health care system against the private insurance system. I believe we are seeing the development of a third option: The Market Option. More and more health care costs are being shifted to consumers in the form of High Deductible Health Plans and Health Savings Accounts. These options are terrific for selected constituents. But we must ensure that as we give consumers more spending power, we also provide them with the education they need to use it properly. Preventive and necessary medical care must be utilized. We must also focus on patient wellness so consumers wind up paying less of their own money for their own health care.
Key Citations

* Definition of High Deductible Health Plan (HDHP): gov
* New ruling shifting chronic diseases costs to insurers for HDHP enrollees: WSJ
* Definition of Health Savings Account (HSA): gov
* Information about the Health Savings Account Expansion Act of 2019: Bill Track 50

Transcript
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Welcome to The Powers Report Podcast. I am your host, Janis Powers. The show brings you candid, unique and data-driven perspectives on the health care industry. I believe that any solution that is going to positively impact the American health care system has to satisfy two major criteria: financial viability and behavioral incentive alignment. In other words, access to high quality care can only be achieved if we can afford it, and if we behave in ways that optimize our health. Please subscribe to our show on i-Tunes or on your preferred podcasting platform and connect with us on social media. Again, this is Janis Powers, and welcome to The Powers Report Podcast.
I can’t think of any American who likes dealing with a health insurance company. I could spend an entire show talking about how maddening it is to pay so much and get so little back – even when certain drugs or surgeries are covered. The insurance industry literally makes people sick because for all the good it’s supposed to provide us, we somehow always feel screwed.
Maybe that’s because health insurers make so much money. UnitedHealthcare Group, the country’s largest health insurer, earned $17.3 billion from operations in 2018. That’s about half the GDP of the entire state of Vermont. One company.
Alas, if you beat up on the insurance industry in favor of public health, there are a few things to know. First off, the government underpays providers for care. Medicare payments don’t cover the cost of care for most hospitals, which means that a hospital loses money every time a Medicare patient walks through the door. Given that Medicare is the largest payer for most hospitals, that’s a problem.
Reimbursement from Medicaid isn’t any better.
This is a major reason why over 100 rural hospitals have closed since 2010. Populations continue to move to urban areas making it harder for small hospitals to fill up their beds – and when they have patients, more often than not they’re on government programs which don’t pay enough to cover costs.
Some in the health care industry argue that the cost structure in hospitals is simply too high, and that hospitals should do a better job of reducing expenses so they can stay in business. In part, I agree with this, especially with regards to the high fixed costs and overhead that characterize many hospitals. (For more on this topic, please listen to Part Two of my podcast series, “Let’s Find out about the Hospital”.)