Convincing employers to abandon the status-quo of annual increases in favor of new and improved solutions is one of the biggest hurdles facing innovative benefits advisors these days. Often it comes down to a tipping point where the pain of the increases outweighs the fear of change.
But employers who continue to resist these new solutions are doing themselves a major disservice, one that could potentially bring down the entire employer-sponsored health care model.
“Our country is creeping—in some cases jogging and even sprinting—toward a government-dominated health care system,” former Florida Governor Jeb Bush said during his keynote at this summer’s BenefitsPRO Virtual Broker Expo. “The challenge is that those who believe in markets, choice and patient responsibility haven’t been offering creative 21st-century suggestions. Expanding Medicare benefits has become the norm, and there has been very little discussion about alternatives.”
Indeed, the drive for a government-run health care system has grown and will only continue to gain popularity—and not just among consumers. “If you ask companies today, should we expand Medicare and go to a government-run public option, a lot of them are a lot more open to it,” says James Gelfand, senior vice president of health policy for ERIC, the industry committee for ERISA. “It’s because of the health industry. They got greedy. They thwarted attempts to make reasonable, paced reforms.”
In the past year, for example, health care industry stakeholders have shot down attempts at surprise billing reform, resisted calls to bring drug prices down, and are currently challenging the pending implementation of the HHS’s price transparency rule. “What they have done is create a metric boatload of momentum for Medicare and Medicaid expansion,” Gelfand says.
The good news for those who would prefer not to see a government-run system is that there’s still time to step in with solutions to ease that pain. In fact, there might never have been a better time, due to increased pressure as a result of the pandemic. “COVID is this WWII-like period in terms of accelerating change, and things are fundamentally resetting,” says Dave Chase, founder of Health Rosetta. “To think otherwise is just naive.”
Whether that reset results in a government-run system or a reformed private system remains to be seen. But one way or the other, it’s becoming clear that our current health care system’s days are numbered.
Employers in the hot seat
It’s increasingly evident that the necessary changes won’t come from within the system. “So far, what we’ve been seeing is a complete circling of the wagon by the medical-industrial complex,” Gelfand says. “If the change won’t come from within, then it will have to come from without. Maybe we can do that, but those who want a government system have a lot of solutions if we can’t.”
Many have looked for a solution from the big names in disruption: Amazon and its Haven health care venture, Google, Apple, Microsoft—the list goes on. In addition, many smaller startups are looking to disrupt the system, from health insurers such as Bind, Sidecar and Gravie to consumer shopping tools such as GoodRx. Chase calls this “techno-Utopianism.”
“It’s just a sideshow,” he says. “If employers had done a good job, you wouldn’t need GoodRx. It delivers value, but if you actually had a functioning health care system, you wouldn’t need it. The first thing I learned as a new consultant is you fix the process, and then you apply technology. Health care is riddled with throwing technology on top of broken processes.”
There are some big names making a noteworthy impact, he says, though they’re doing so as employers. Amazon and Walmart, for example, have been in the headlines for their investment in primary care for employees.