BGSU discussion: Who is really providing your health insurance?


The implications of public health care being managed by private corporations will be the topic for the next Science Café at Bowling Green State University on Tuesday.

Amanda Cook, Ph.D., teaches economics at BGSU, where her specialty is the economics of the U.S. healthcare industry.

The discussion is titled “It’s Not Who You Think: Who is Really Providing Your Health Insurance?”

Cook will head a panel including Illinois State University professor Tice Sirmans, Ph.D., and student Maricait Gillespie as panelists.

Cook discussed some of the questions the panel will discuss.

There are many implications to the way we think about insurance and public policy, but most Americans think of it as both a public and private system.

On the surface it appears that Medicaid and Medicare, as public insurance, are government-run programs. Meanwhile, the private health care system is largely organized around employer-sponsored insurance.

“Private is really all we’ve got,” Cook said.

She explains that with Medicaid, 70% of policies are administered by a private health insurer.

“What do we want our health system, broadly, to do and what sort of consumer protections do we want within our health system?” Cook said. “When we think about the spirit of those public programs, it’s about protecting society. (Medicaid) is about making sure older people have access to the prescriptions they need and to procedures they need, as they age. When we think of Medicaid, we’re thinking largely about children and dual enrollees, older Americans who are both poor and elderly.”

Cook noted that the Kaiser Family Foundation reports that total enrollment of Medicaid is 91 million. Approximately 41 million Medicaid enrollees — 46% of the total — are children.

“We think about these public-private programs as having clear societal benefit, so we think of taxpayer money to make sure kids have vaccines and to make sure elderly folks are not dying destitute because they have a simple infection and they can’t afford medication,” Cook said. “So we anticipate that those programs are run without profit as an objective function, that they are governmental programs and we’re not thinking about a for-profit entity trying to profit from covering these individuals.

“When we think about this public and private division, we think about a private insurance company, a commercial insurer has as their objective to make money. In fact, are traded on the stock exchange, so they have a legal obligation to the shareholders to make money. Whereas when we think about when these programs were developed, and their inception, it was about serving high-risk populations,” Cook said.

Cook’s research shows that the reality is more complex.

In those combined public options, more than 240 million Americans are in a plan administered by a private company. Two out of three Medicaid enrollees have plans that are administered by a private company. More than half of enrollees in Medicare are enrolled in Medicare Advantage plans, which are also run by a private company.

“This notion that we have a division between our public and private system is largely simplifying in a way that is not accurate in helping us think about the healthcare landscape, specifically how we are financing health care,” Cook said.

She pointed out that of 350 million Americans, approximately 30 million are uninsured.

There are things she said that the private sector does well, such as creating a network, negotiating rates and administering claims, “which they are optimally set up to do. We have competition encouraging them to be efficient in those dimensions.”

To sign up for this free and public virtual event, use this link:

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