Health Care Could Take a Lesson from the Airlines

Despite endless promises from Republican members of Congress over the past seven years to repeal and replace Obamacare, our mess of a healthcare payment and delivery system remains the law of the land. It’s afflicted with a terminal illness in terms of rising premiums and fewer plans to choose from, with no sign of relief from Congress, other than consigning Obamacare to hospice care.

Except that hospice care means dying pain-free and with dignity. When Obamacare dies, patients and providers will share the pain. Congress keeps its dignity as they exempted themselves from the clutches of Obamacare.

Can the airline industry provide a pathway ameliorating one of the more notorious aspects of Obamacare? No I don’t mean dragging patients out of hospitals and physician offices as United Airlines did earlier this year. Instead, I mean offering a lower cost option for air travel. And for healthcare insurance.

President Trump must like this approach as his recent executive order does just that, allowing insurers to offer less comprehensive benefit plans compared to Obamacare-mandated plans. How does this work in the airline industry?

United this year started offering a lower cost “basic economy” fare class in addition to its “standard economy” ticket. How can this apply to healthcare insurance?

Under Obamacare, all insurance plans must cover ten essential health benefits. Aside from outpatient, emergency and hospital care, which should be standard in any insurance plan, other services must be covered as well. These include pregnancy, maternity and newborn care. Mental health and substance abuse treatment. Pediatric services too.

A fifty-year-old man neither wants nor needs pregnancy and maternity coverage. A middle-aged couple with grown children doesn’t need pediatric care. Yet everyone is forced to purchase insurance coverage they don’t want and won’t use, and they still must pay for it. Like forcing me, living in Denver, to purchase hurricane insurance.

United’s standard economy fare gives passengers benefits that are appreciated by some but are just an added cost for others. For example, their standard fare earns miles toward premier status whereas the basic economy fare does not. For frequent fliers climbing the premier ladder, this benefit might be worth the added cost. Not so for the infrequent traveler, or one who normally flies another airline. So why make them pay for it?

Standard economy tickets are upgrade-eligible whereas basic economy fares are not. Most people don’t care about an upgrade and don’t want to pay extra to join a long upgrade queue, still never getting bumped to first class. The basic economy fare doesn’t allow passengers to choose their seats or sit with their family, unlike the standard fare. If for a two-hour flight, you don’t care where you sit or don’t mind if your travel companion is in a different row, why not save the money?

The point is that United is providing an alternative to their more expensive fares, the airline version of “essential benefits”, allowing passengers to forgo the more expensive perks that they don’t want or need for their flight. Giving passengers a choice.

Which is what President Trump’s executive order does.

Aside from the absurdity of the government telling a private business what it can and can’t sell, and forcing Americans to buy what the government decrees, United, by offering a discounted fare with fewer benefits, is better able to meet the needs and budgets of travelers.

It turns out that United, a few months after implementation of basic economy, is paring it back. Mainly because passengers, when purchasing their tickets, never paid attention to the details, not realizing the restrictions on choosing seats or carry-on luggage. In essence, creating “a circus” at the gate with confused and disgruntled passengers.

Sound familiar? How many people purchased Obamacare plans believing, as they were told, that they could keep their insurance, their doctor, their hospital. Instead being informed at the gate of their healthcare encounter that they couldn’t see the doctor they wanted, or that that they had all these extra fees to pay. Just like United’s passengers not having the money for their carry-on bag and realizing that they can’t sit next to their child.

There will likely be surprises for those purchasing scaled down insurance plans, but it gives consumers an affordable choice, unlike what they have now. As Republicans have done nothing, it was left to President Trump to make this happen. The only alternative being Bernie Sanders’s “Medicare For All”, already garnering the support of 17 Democrat Senators, a third of their caucus.

Common sense solutions, like United’s basic economy fare, are out there. Unfortunately, political will and pragmatism are in short supply in Congress. With the President leaving his party in their Congressional playpen, taking matters into his own hands.


Brian C Joondeph, MD, MPS, a Denver based physician and writer. Follow him on Facebook,  LinkedIn and Twitter.

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