If you have health insurance but no primary care physician, the process for getting a physical can be a bit complicated. Whether or not you get your health insurance through an employer, you’ll probably have to find a practice in your area that is in your network. Then you’ll have to find out if it’s accepting new patients. You may have to wait months until the office will let you come in for a physical. You’ll have to figure out if you’re responsible for a co-pay. Even after the visit, you may need to cover the additional cost of any blood work or other tests, and you probably can’t figure out how much you’ll be billed for that ahead of time. At some point, you’ll also have to decide whether it’s worth the trouble to set up a tax-advantaged account to cover the unpredictable costs of this visit or any future ones.
My colleague Dr. Robert Graboyes encourages us to instead think about how to produce better health (not health insurance—not even health care) for more people at a lower cost, year after year. This requires allowing and fostering the kind of revolutionary innovation in the health care industry that we’ve seen in other fields, like information technology. It requires allowing consumers to choose treatments, even high-risk ones. But it also requires innovation in the provision and payment of health care.
For instance, advancements in gene therapy and personalized treatments could one day offer a cure for cancer or disorders currently considered incurable, sometimes with only a single injection. In 2017, the Food and Drug Administration approved its first gene therapy treatment, Kymriah, for acute lymphoblastic leukemia. The FDA expects 10 to 20 cell and gene therapy approvals annually by 2025.
At a town hall event, Sen. Kamala Harris (D-Ca.), who recently launched her presidential campaign, said she wants to eliminate private insurance entirely, which would mean that about 177 million people would lose their existing plan.
After noting that the Sanders-sponsored Medicare for All legislation that Harris supports would totally eliminate all private insurance, moderator Jake Tapper asked, “So for people out there who like their insurance—they don’t get to keep it?”
Harris responded with a somewhat winding answer that amounts to a yes.
“The idea,” she said, “is that everyone gets access to medical care and you don’t have to go through the process of going through an insurance company, having them give you approval, going through all the paperwork, all of the delay that may require. Who of us have not had that situation where you have to wait for approval and the doctor says, ‘I don’t know if your insurance company is going to cover this.’ Let’s eliminate all of that. Let’s move on.”