New Republic Natalie Shure points out the absolute, crashing idiocy of getting private health insurance companies involved in procuring free Covid testing, because their whole reason for being is to prevent the efficient procurement of health care:
This rollout will be a disaster. And really, that should have been obvious: There’s a reason that the Covid-19 vaccines, monoclonal antibody treatments and antiviral drugs have been made free at the point of use, rather than routed through private insurers. It’s because the insurance industry is structurally incapable of achieving anything universally or efficiently.
That’s not hyperbole, it is by design: The role of private insurers within a for-profit multi-payer system is to restrict access as a gatekeeper, determining who is entitled to use which healthcare services and how much they pay for this. To keep these obligations profitable, they employ an army of claims assessors to argue with you, erect arbitrary hoops for providers and patients to jump through to prove you actually need certain care, raise copays and deductibles as high as possible, and foist as much of the paperwork as possible onto patients.
Insurance companies play the single ghastliest role in a legendarily ghastly healthcare system: Whatever invective you can hurl in Big Pharma’s direction, they at least produce something we actually need. Health insurers offer no value whatsoever; they have nothing to do with care itself and if the industry vaporized completely tomorrow, no one would mourn its demise—we’d all be better off. We’re maddeningly stuck with them for now, owing to a host of reasons ranging from inertia to political capture by industry.
[T]his is an object lesson: We’re in the hands of an industry that was never built to serve patients, a problem which no regulatory tweak will ever fix.
Yes, this is true. I learned that early in my career, leading to a long-standing policy of never working for a health insurer in any capacity.
Let me catalog some of my own experiences when big health-insurance companies have claimed to pay me to write software:
- The first time, a major health-insurance company hired me to write software using a then-current technology, but the project wasn't ready to start, so they involuntarily put me on a team working with obsolete technology and a process so stultifying I didn't actually get to write code. I literally picked up my signing bonus on the way to several interviews in New York, and quit the day I got back. The entire division got dissolved about a year later.
- Well into my professional career, I went to another major health-insurance company along with 8 other developers and managers, but under the aegis of a moderately-big consulting firm. The on-site project cost the client of about $150,000 per week. Of course, they couldn't get us network access or even a project charter. After about a month and about $750,000 spent, the company cancelled the project. I never even found out what software they proposed to build, had they gone through with, you know, building it.
- More recently, a major health-insurance company hired me through a recently-acquired subsidiary as the 6th member of a team writing software in a language less than 3% of software developers ever use. I only took the gig because the subsidiary claimed a level of autonomy from the parent company it did not, in fact, enjoy. It occurred to me less than a week after starting that if the product we were building worked, it would undermine one of the key revenue streams of the parent company. Nevertheless, they hired a new developer to the team about every three weeks (despite an admitted 6-month ramp-up time in the language and product), at an average all-in cost of $18,000 per month per developer. I left after three months, as the team grew past 12 people and yet only completed about 5 function points a week.
The parent company killed not only the project but also the entire acquired company about two years later. The software never shipped, though I did hear they had completed about half of the planned function points.
On my way out the door I asked my manager what it said to him that the parent company didn't care about burning $200,000 a month on software that he and I both knew a couple of us could build in a garage in four months. He didn't say anything, but Upton Sinclair did*.
You may not see the connection between these failures, or why I jumped ship so quickly the third time, but it's actually really simple. In all three cases, the companies needed to show their shareholders ongoing investments in technology, and needed to show the general public plans for really great tools to make people's lives better any day now. But the best way any of these companies could have made anyone's lives better would be for the US government to obviate their health divisions by paying for our health care directly.
According to the World Bank, the US spends 17% of GDP on health care, behind only Tuvalu and the Marshall Islands (combined populations: 72,000). The first OECD countries on the list are Switzerland (11.9%), Germany (11.4%), and France (11.3%), all of which have vastly better outcomes than the US. How do they achieve this? By not having fat, bloody leeches draining their health spending on useless bullshit. Example: the National Institutes of Health found in a 2020 study that a staggering 34.2% of health-care expenditures in the US went into administration, compared with just 17% in Canada—and Canada has better health-care outcomes overall than we do.
Shure ends her column with an inescapable truth:
[I]t’s pretty telling that the very moment a life-threatening pandemic necessitated mass vaccination, the idea of involving private health insurance companies with that project was absolutely unthinkable. Who in their right mind would attempt to involve them in something urgent? And if they’re such a dismal way to confer access to Covid-19 testing to anyone who needs it, why the hell are they still playing the role they do in the healthcare system writ large?
Let's end this farce and get real single-payer health care in the US, so we can finally enter the 21st century with the rest of the OECD.
* "It is difficult to get a man to understand a thing when his salary depends on him not understanding it."