Home > Uncategorized > Navigating the Health Care Market Requires “Agents”… Navigating “Choice” in Schools Will Require the Same

Navigating the Health Care Market Requires “Agents”… Navigating “Choice” in Schools Will Require the Same

November 12, 2017

An article in today’s NYTimes by Robert Pear describes an emerging market niche in the health care industry: “…insurance agents and brokers who are often paid by insurers when they help people sign up.” It seems that with the Trump administration’s cuts to support the enrollment process, many people seeking information about health insurance options are turning to consultants, many of whom receive commissions from some of the health insurers. Mr. Pear writes:

The administration said in a recent bulletin that it was “increasing partnerships” with insurance agents and viewed them as “important stakeholders” in the federal marketplace, where consumers are now shopping for insurance. But some health policy experts warned that a shift from nonprofit groups, which are supposed to provide impartial information, to brokers and agents, who may receive commissions for the plans they recommend, carries risks for consumers.

“Insurance agents can educate consumers about the marketplace, and that is a good thing,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. “But I worry that they work on a commission and therefore have a financial incentive to steer consumers to particular products, which may or may not be in the consumer’s best interest.”

In its bulletin, the administration said agents and brokers who are registered with the federal marketplace can “get sales leads” and new clients. And it offered them tips for “making the most of your marketplace participation during this open enrollment period…”

Buying health insurance is unquestionably complicated, which is one reason why Medicare was put in place. It ensures that the elderly will not be unwittingly taken advantage of by insurance companies and also ensures that the elderly will receive baseline health care. Medicare is also an illustration of how a well functioning and well funded government program can help citizens receive essential– and complex needs– at a relatively low cost since those administering the program have no stake in making a profit. Indeed, the cost-effective operation of Medicare makes many voters question why “the marketplace” is a valid mechanism for funding health care for those under 65!

My daughter lives in NYC where parents are provided with the opportunity to enroll their children in the school of their choice. Witnessing her experiences with the “opportunity”, it is clear to me that providing public schooling is as complicated as providing health care. Indeed, there are a number of parents who seek the advice and counsel of consultants who are familiar with the complicated system needed to navigate the application process and to sift through the schools that are available so that the child can get the optimal experience out of their schooling.

In reading Mr. Pear’s article, it strikes me that public education is like “Medicare for All” with one key difference: where we have effectively defined and funded a baseline of medical care that we, as a society, agree we should provide for all citizens over the age of 65, we have not agreed upon and funded a baseline of education that we, as a society, should provide for the children in our nation. At this writing a majority of states in this country, including my home state of New Hampshire, have pending litigation on the funding formulas for their schools because we are failing to meet the baseline standards set forth in the State’s constitutions. But instead of addressing the root problem with the funding mechanisms, which is the lack of insufficient revenues earmarked for public schools, many states— including my home state– are developing “choice” mechanisms that will presumably address the inequities by allowing parents to “shop for schools” the same way we can now “shop for health insurance”.

The failure of the ACA is a failure of the marketplace. Free markets cannot provide universal services in a fair and equitable fashion. The free market will not, for example, provide access to high speed internet in my relatively isolated part of the community I live in. The free market would not maintain the road I live on or the electric service I receive at an affordable rate. And if I was shopping for health care as a 70 year old I might not be able to afford it in the marketplace.

If the marketplace is incapable of assuring adequate and equitable health care for all of its citizens, why do we think that the marketplace will solve the dilemma of providing adequate and equitable educational opportunities for all of the children in a state?

The bottom line is this: we need to restore our faith in the ability of government to assure the delivery of fair and equitable public services and recognize that unregulated free markets will fail to do so. We need to acknowledge that some basic services and needs can only be met by the government and engage in a debate over which level of government can do it most effectively. And last, but not least, we need to acknowledge that the taxes we pay to the government at any level are the price we pay to live in a safe and healthy world.


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