Sara Horowitz

The Missing Link in the Health Care Debate

Blame it on the zeitgeist: this election cycle, everyone wants to get in on the health care debate. It used to be political poison, but now it's a required talking point for every presidential candidate.

In all the plans we're seeing from Democrats, which Jacob Hacker has helpfully anatomized, one thing seems to be missing: intermediaries. There's the single-payer model; the public/private hybrid, which assumes that competition will drive efficiency; and the mandatory buy-in, like in California and Massachusetts.

But all these proposals force consumers into a direct relationship either with the government or with an insurance carrier. Neither is a particularly good fit. In the former, the individual is one of millions; in the latter, a consumer is merely a source of potential profit. The reason the employer-based system works -- to the extent that it does work anymore -- is that the employer acts as an intermediary. It creates a group, and spreads risk across a diverse pool of consumers.

What we need, now that fewer people are getting insurance through employers, are new intermediaries. Professional associations, community groups, and even religious congregations could aggregate their members and negotiate with insurance carriers for lower rates and better coverage. And a group that represents a big chunk of revenue for an insurance company can throw its weight around for its members' benefit, acting as an ombudsman when a consumer needs to dispute a claim.

One thing I've learned from talking to freelancers is that America is a country of entrepreneurs and innovators. It's time for policymakers to take an innovative approach to health care. We don't have to duplicate the Canadian system, or even anything else that's out there now. Let's just think about what works: forming groups and building institutions to act as intermediaries. I'd like to hear something new from a candidate on the stump, and talking about intermediaries as part of the health care solution would certainly be that.

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Posted at 6:45 AM, Apr 24, 2007 in Health Care
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