**4. How private health insurance and multi-payer financing have failed the public interest**

These are some of the ways in which private health insurance and multi-payer financing have failed the common good in this country.

*Health Insurance in the United States: Failure of Private and Multi-Payer Financing DOI: http://dx.doi.org/10.5772/intechopen.103937*

### **4.1 Unaffordable costs and increased cost sharing**

Our market-driven system, now consolidated to a small number of corporate giants, can charge what the market will bear. Predictably, the cost of medical care has doubled compared to the consumer-price index over the last 25 years [14]. **Figure 2** shows the cumulative growth of the cost of premiums for employer-sponsored health insurance compared to annual average earnings of the bottom 90% over the last 20 years [15]. As a result, four in ten people with that insurance do not have enough savings to cover the deductibles and one in six have to cut back on food, take an extra job, or move in with friends or family [16]. Even when insured, many enrollees defer or avoid needed care, while many others receive high surprise medical bills that drag them into poverty, often ending them up in medical bankruptcy [17].

Predictably, increased cost sharing cuts access to care ranging from ER visits and office visits to hospital care and mental health [18]. As Dr. Veena Shankaran of the Hutchinson Cancer Research Center observes:

*High-deductible plans are really the epitome of the access to care problem. People do not have the liquid cash to meet the deductible, so you see delays in care or even avoiding treatment altogether [19].*

### **4.2 Inadequate benefits**

Private insurers have many ways to game the system at the expense of patients and taxpayers. Even after passage of the Affordable Care Act (ACA) in 2010, they discriminate against the sick by such benefit designs that limit access, high cost-sharing, restrictive drug formularies, inadequate and ever-changing networks of physicians and hospitals, and deceptive marketing practices. Meanwhile, they market new kinds of inadequate gap insurance, immune from the ACA's requirements, that include, for example, copays for treatment and lump sum payments upon diagnosis of such conditions as cancer, heart disease and stroke [20]. Short-term plans are another way

**Figure 2.** *(Figure 7.2 MIC 104).* to evade the ACA's requirements, providing very limited coverage for up to 1 year at exorbitant costs. Correctly labeled as "junk insurance," the aptly named Golden Rule Insurance has brought big profits to its owner, the giant United Health Group [21].
