A simple solution to the health insurance marketplace: Authorize interstate competition


Allowing out-of-state competition for health insurance would significantly benefit the U.S. healthcare system, which is dominated by commercial payers, according to two spine surgeons from DISC Sports & Spine Center in Newport Beach, Calif.

Question: What is the most pressing issue in healthcare today?

Note: Responses are lightly edited for style and clarity.

Grant Shifflett, MD. One of the simplest and most effective changes that could improve our healthcare system would be to remove the restriction on interstate purchase of health insurance.

Currently, no state offers a fully insured national network PPO. What this means is that if you live in a state with poor insurance options, you cannot go find a state that has better options. This also means that if you have good health insurance and you move to a new state, you have to give up your old insurance and accept the new state's options. It might be difficult to understand why such restrictions would exist until you realize that these restrictions limit competition and drive profits for the insurance companies.

Health insurance companies have reshaped modern medicine, with their growing power resulting in less access to and coverage of care, higher costs to patients and lower payments to physicians. The net effect has been insurance company CEOs taking home multimillion-dollar salaries and bonuses and healthcare giants seeing record profits. A fundamental part of achieving these outcomes is the limitation of choices for patients. Unfortunately, with fewer quality, low-cost options to choose from and nowhere else to turn, many patients have to make the difficult decision of simply not buying health insurance or just taking the best of the bad options available to them.

Opening up the health insurance marketplace to interstate competition would result in more choices and the ability to select coverage based on your own needs and financial situation. With deductibles, out-of-pocket maximums and premiums being driven down, patients would not have to face the difficult choice of short-changing their health.

Robert Bray Jr. MD. The Affordable Care Act has had both significant gains and challenges. It would be great to see a bipartisan fix so it's a functional system long term. The elimination of preexisting clauses and lifetime caps has helped many Americans, but the system has serious faults in funding. A rework rather than throw-out approach would be best for all.

A single-payer, government-run system, or so-called Medicare For All, would be a disaster to our system, in my opinion. This approach has only pressed a two-class system in most places and would be unacceptable to most Americans. It would severely limit access and quality that we are so accustomed to.

Pandemic and medical disaster response needs a complete rework of priority, who's in charge and should not be a political issue. We have spent far too much inefficiently on too many agencies with no clear direction. We are not done with COVID-19, much less second waves or new variants. Legal blame needs to be removed and decisive information that follows science should be organized, consolidated and independent of politics.

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