Editor's Corner: US healthcare beholden to shareholders

Premiums in the Healthcare.gov insurance exchanges are expected to rise an average of 25 percent for 2017. It's been a fairly big story, one that Donald Trump used to score some points in the final weeks in this election campaign.

My colleagues in the media have been mostly irresponsible in their job: Shining a light on the healthcare issue so that the voting public learns of it from professional explainers--as opposed to someone who has variously described the Affordable Care Act as a “disaster,” a “catastrophe” or as “just blowing up” without ever once saying why.

One issue that often goes overlooked in the debate about U.S. healthcare delivery is that vast tracts of it--including most health insurance--are controlled by publicly traded companies. That means the primary duty of these companies is not to enrollees or patients, but shareholders.

As I have written here previously, UnitedHealth's decision to pull out of the state exchanges was portrayed in much of the media as a financial debacle, suggesting it was pulling the company down. Most ignored UnitedHealth's surging profits, and the fact that leaving the exchanges would merely make them surge even more, likely allowing the company to make its quarterly numbers a little easier and continuing to appease their shareholders.

But this also thins out competition in the exchange, meaning premiums would rise. This has mostly gone unreported. Instead, it is limited to sound bites that suggest the ACA has been nothing but a massive failure that the Obama adminstration has been feckless in controlling.

Even less extensively reported has been Hillary Clinton's proposals to tweak the ACA, which includes a variety of measures intended to cut premiums and increase competition. The RAND Corp. and the Commonwealth Fund have estimated they would help insure 12.6 million more Americans. Trump's healthcare policies--essentially repealing the ACA and replacing it with “something terrific"-- is estimated to cut 20 million people from the insurance rolls.

The differential between the two candidates is nearly 33 million Americans being insured or not. That's fully 10 percent of the nation's population. If you're a hospital executive, which proposal works better for you?

The media has done slightly better portraying the greed behind the practices of pharmaceutical companies jacking up the prices of their drugs by 10-fold or more (which in turn also leads to higher premiums). But in my state of California, little has been said of the mind-boggling $109 million spent by drug companies to defeat a Bernie Sanders-backed ballot measure that would index drug prices in the state to what the U.S. Department of Veterans Affairs pays for medications. This would probably only moderate costs slightly; that Big Pharma is fighting so fiercely for its defeat should be considered troubling --if anyone knew about it at all.

How this all resolves remains to be seen. But a vast amount of Americans are wholly uninformed about how their healthcare is financed and delivered. No one expects Donald Trump to explain it, and Hillary Clinton really hasn't had the time. So whose job is it? – Ron (@FierceHealth)