For leaders, this is the beauty of health insurance companies (better called managed care organizations, MCOs).
For places like UK and Canada, leaders have to answer to everyone for why access and quality of healthcare is declining. In the US, using the MCOs, leaders can more easily direct sufficient healthcare to who they want it to go to without being able to be identified as the cause.
For example, leaders can tell MCOs to reimburse healthcare providers less for Medicaid (poor people), and more for Tricare (military) and Medicare (old people who vote), and even more for federal government employee health plans (for themselves). Or they can tell MCOs to require more “prior authorization” (PA) for Medicaid so people give up more quickly at getting medicine, whereas federal government employee plans can require fewer PAs.
Add employer specific risk pools/deductibles/copays/out of pocket maximum limits into the mix, and there are multitude of levers that can be pulled to ensure people are getting the quantity and quality of healthcare corresponding to their socioeconomic level.
Rich people always had concierge medical care. But with the use of MCOs, you can drill it down to income/wealth/political quintiles or even deciles.
For places like UK and Canada, leaders have to answer to everyone for why access and quality of healthcare is declining. In the US, using the MCOs, leaders can more easily direct sufficient healthcare to who they want it to go to without being able to be identified as the cause.
For example, leaders can tell MCOs to reimburse healthcare providers less for Medicaid (poor people), and more for Tricare (military) and Medicare (old people who vote), and even more for federal government employee health plans (for themselves). Or they can tell MCOs to require more “prior authorization” (PA) for Medicaid so people give up more quickly at getting medicine, whereas federal government employee plans can require fewer PAs.
Add employer specific risk pools/deductibles/copays/out of pocket maximum limits into the mix, and there are multitude of levers that can be pulled to ensure people are getting the quantity and quality of healthcare corresponding to their socioeconomic level.
Rich people always had concierge medical care. But with the use of MCOs, you can drill it down to income/wealth/political quintiles or even deciles.