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With the end of Medicare’s annual enrollment period rapidly approaching (Dec. 7) and the ACA reenrollment period going strong (through Jan. 15), our office is a whirlwind of activity. As each client leaves, I can’t help wondering why the wealthiest nation in the world continues to treat those of us on health insurance as a commodity to be traded like cows, pigs or soybean futures.

The five largest insurance companies — UnitedHealth Group, Elevance Health (previously Anthem), Kaiser Permanente, Centene (Ambetter) and Humana — control more than 50% of the market with a combined revenue of more than $600 billion in 2023. Their goal is to make money for their shareholders. The lower utilization of services the greater the profit margin. They do it by controlling access to care and they do that by continually increasing the cost for services we have to pay for.

I recently read in an industry report, “Health insurers began seeing warning signs that members, especially Medicare Advantage seniors, were utilizing more healthcare than expected and driving higher medical spending earlier this year. Payers’ medical loss ratios, or MLRs — a marker of spending on patient care — rose as a result in the second quarter, though the impact was more muted than investors feared.”

How dare you actually use the health insurance we sold you and mess with our MLRs. You made our investors nervous. UnitedHealth was so concerned that they had to put out a statement reminding investors of the “normal seasonal cost bump in the fourth quarter from cold and flu.”

We are nothing but a commodity that fills the coffers of the insurance companies. The more they can dissuade us from using the coverage, the higher the profit margins and investor satisfaction. They accomplish this through a series of maneuvers that culminate in people putting off medical treatment because the out-of-pocket cost is overwhelming.

The Commonwealth Fund recently released a survey regarding the deferring of medical treatment and how income levels impact those decisions. They found that 46% of those surveyed in the U.S., with average or lower income, had cost-related reasons for putting off medical treatment.

You probably just read the above and thought, “well, duh, Fred. That makes sense. If you don’t have the money, you wait.” And you are right — if you have health insurance here in the United States.

Although the survey showed that individuals with lower or average income levels struggled in every country polled with medical cost, the United States, by far, had the highest percentage of those with medical cost fears. The seven countries surveyed are considered high-income countries with lower-than-average poverty levels. They were New Zealand, Netherlands, Germany, France, United Kingdom, Australia and the United States.

What the other six countries have in common that the United States doesn’t have is universal healthcare. The closest we come is Medicare. Even then, people on original Medicare with a supplement can spend thousands of dollars on premium or those on Medicare Advantage can have no premium but still face high maximum out-of-pocket costs. A grim choice when you’re on a fixed income.

Yet, it’s still better than a young family whose coverage is through the Affordable Care Act. In most cases, they are faced with a very high deductible before the plan pays for any treatment at all. Paying a $5,000 deductible or feed your family isn’t a choice someone should have to make.

The survey found that 51% of working-age Americans struggle to afford healthcare and a third have medical debt.

Even those with employer coverage struggle with high deductibles and co-pays. The Commonwealth Fund sadly concluded that “Americans have the poorest healthcare system among other high-income nations.” I agree.

Remember: we’re not talking about health care. Without a doubt, we have the best health care anywhere in the world. The problem is that the insurance companies place financial blocks in our way to access it. What we lack is an equitable system that provides healthcare to all people — no matter what level of income.

One day I’d love to find myself out of business because we finally woke up and made healthcare a right not a burden. But until then, I’ll keep working to provide the best options out there.

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