The Missing Link in the Affordable Care Act

The creators of the Affordable Care Act (a.k.a. Obamacare) overlooked one essential link in the unbroken chain of historical health care service in America: the important role of the insurance salesperson. Call him/her what you will, but here we will use the term salesperson or sales representative.

For the purposes of this article, let us think of the health care chain as containing five main links: 1) patient, 2) sales representative, 3) insurance company (or other payer), 4) health service provider, and 5) patient care.

In the Affordable Care Act (hereafter “ACA”), the second link is either weak or missing. The creators of the ACA have made a fatal mistake by trying to go around the sometimes maligned and unappreciated lowly insurance salesperson. To their credit, they have made lame attempts to furnish substitutes — namely the website (which is a joke), the Navigators, and others.

Meanwhile, the United States has neglected the vast network already in place of highly educated, trained, experienced, licensed, insured, bonded, and professional insurance sales representatives, some who work on behalf of individual insurance companies, and others who are independent, representing more than one company.

At one time or another, I daresay, most adults have had the need to call upon their insurance rep/salesperson: either to file a claim, settle a claim, or straighten out a mess with an insurance company. Furthermore, I contend that those adults could probably tell you who their insurance sales rep is, or they could find his/her name within minutes. Many know him/her on a first name basis. Often times, they deal with the same person for years and know the names of his/her children. Why is this so? Because their insurance person is often a trusted family adviser, similar to their banker, doctor, clergy person, or attorney.

For fifty-plus years prior to his retirement, my husband was a servant of his clients: an insurance man. He made countless calls to clients’ homes and offices, explaining various policies and options, and helping people make informed decisions. Next, he helped them fill out complex application forms, took their checks, made sure the policies were in place and in force, and delivered and explained the policies (again and again) as often as needed. In a high percentage of cases, it was necessary to work with the insurance companies, assisting the applications through the maze of departments.

Follow-ups included regular contacts with the clients to confirm that their insurance was up to date, according to their needs. It was common to spend his days filing claims; answering telephone calls, e-mails, and letters; and managing problems, such as the applications or claims that became snagged in the process and had to be “walked through” the insurance companies.

Indeed, my husband knew all the clerks, supervisors, and vice-presidents in several companies by name, title and what they did. He knew “who to call” to untangle a mess. My husband was paid well, of course, raised our children, and provided for our retirement with that income. However, I declare and can testify, from first-hand knowledge, that his service was invaluable.

No high tech web site can possible substitute for a knowledgeable insurance person. Why, you ask? Because of that old bugaboo, GIGO (garbage in, garbage out). I do not mean to insult the American citizen; however, I think you will agree, it simply is impossible for people, even I, to make insurance decisions, fill out applications, and follow through with an insurance company without help. It is just too complex.

Even after his retirement, my husband served his clients in those instances where they were mired down trying to deal directly with insurance companies by themselves. The idea that the government can do this is a hoot! Impossible! Getting the government involved only adds to the complexity.

So, why in heaven’s name did the ACA not take advantage of the vast network of professional insurance salespeople out there? It is pure idiotic insanity! Did they think that a more than $300 million website would substitute for the reasonable commission payments the salespeople would earn? Well, bully for them! It cannot – will not – work well.

Would you hand people a law library and get rid of lawyers? Would you set up a website where people input their symptoms, diagnose their illness, and compound their own prescriptions? (Granted, some do try, but I think you will agree that, in general, there is no satisfactory substitute for expert personal service.)

My sympathy goes out to the people working in the home offices of insurance companies today. They must be going stark raving mad, trying to straighten out the garbage coming out of the websites, trying to interpret the data, get answers, find the customers, locate payments, issue policies, and deal with the ever-growing list of government regulations and the ever-changing whims and directives of the administration.

Pity the people in the (non-existent) complaint department. In addition, this is just the third of my five hypothetical links in a process of providing health care. Imagine the mess, as people try to find the right doctors and service providers, who then file claims and receive payments! Oh dear!

Is it too late, you may ask, to bring in the network of insurance reps to try and straighten out this mess?

An even better question would be, “Would the current administration allow it?”

You see, the avowed objective of most Progressives all along has been to eventually reach a “single-payer system,” meaning a government-run health care system, without the involvement of insurance companies, free enterprise, innovation, and competition. In other words, free health care for all would be provided by the government the same as it is in many other countries,  and similar to Medicaid in the United States today. Health care would no longer be a private business in any sense of the word.

In the time left in office, will the current administration be able to swing the Affordable Care Act into a totally government-run health care system?

Perhaps.

It may take longer than the time available and be left to the next president to finish up, but I think it can happen. Funding is the biggest problem, but a combination of new taxes, borrowed money, fewer services, less research, and lowered pay to health care providers, drug companies and medical schools will be necessary. The ACA has a great many of these features built into it already. It will just be a matter of the government taking over completely. It might retain the insurance companies, but merely to handle the money and do paperwork. Health care providers will be on the government payroll.

There are already doctors and hospitals that are not part of the system, either because they have decided not to accept insurance plans purchased on the health care marketplace, or because plans bought on the exchange only pay for certain providers. If this is allowed to continue, there will be those who take on private patients who can afford to pay cash. However, it remains to be seen whether the government will allow it to continue indefinitely.

We know that the best and most famous hospitals are not scheduled to be part of the ACA system. I can envision these hospitals being the only ones available to the independent doctors. Thus, a two-tiered health care system could evolve: the free government system and the “for pay” system.

Again you say, “But you still haven’t answered my question, “Is it too late?”

Perhaps.

If we had started five years ago to make the ACA a privately run, free enterprise system regulated by the government, with insurance companies free to compete, to innovate, to offer products that people wanted, that salespeople could sell – then the answer is, “Sure, of course it could be done.” But these things take time: time for actuaries to design viable products; law departments to write policies; people to be recruited and trained; companies founded, financed, bonded, and licensed; offices rented and furnished; secretaries hired; phones installed; advertising campaigns, etc.

Since the ACA has come into being, companies have withdrawn products from the market and exited out of some state marketplaces. What’s gone is gone. One cannot simply restore an entire industry and a century of experience with a few amendments and strokes of a pen.

One of Mitt Romney’s campaign sayings that I remember was when he promised the United States “would come roaring back.” That might have been able to happen had the United States electorate chosen that route. Perhaps Gov. Romney, with his unique experience, could have turned things around, but only if he had had the support of Congress, a most unlikely event given the makeup of the current and past Congresses.  But, as we all know, the electorate chose another route, and now the course we are on seems inevitable.

Dorothy May Mercer is the author of several novels, the latest of which is The Savage Surrogate, a crime thriller set in Washington, D.C.  You may visit her website at www.mercerpublications.com.