Health insurance leaders will place their stockings over the fireplace on Christmas Eve. They will put out milk and cookies for Santa Claus. All that will be left is the big morning when these executives head downstairs, gaze at the gifts Santa left, and rip open their presents.
But what exactly does a health insurance leader want this year—besides the early gift they received Tuesday? Here are four gifts they would like to see under their Christmas trees:
An olive branch from physicians. Despite some inroads, such as quality contracts, doctor-health insurer relations remain icy at best.
Physicians view insurers as money-grubbing, procedure-declining, patient-interfering companies that provide no benefit. Insurers, meanwhile, think of physicians as procedure-happy, cash-cow doctors who are a major reason health costs are skyrocketing.
If these two sides could only find some common ground and work together, Americans would have better healthcare. Better data exchange between insurers and physicians would lead to better outcomes. Doctors would know when their patients visited the ER or another physician immediately and insurers would get clinical data that could help them catch at-risk patients before they develop a chronic illness. Physicians would get paid and know when claims are denied—and why—immediately.
Progress has been made, but there isn't an olive branch under insurers' Christmas tree this year.
Healthier Americans. This is at the top of health insurers' lists each year, but much like the girl who excitedly puts a pony on her list, this isn't going to happen.
That's not to say that it's not a lofty goal. In fact, imagine the impact on healthcare costs if Americans ate better, smoked less, and exercised more.
Instead, we supersize everything—starting with our food.
As I wrote in August, all the talk about health reform is pointless if Americans don't take better care of themselves. If we continue to gorge ourselves and stay away from the gym, don't expect much to change in healthcare.
An individual mandate. Health insurers would love to find a neatly-wrapped individual mandate under the tree—and they're even willing to accept everyone in their plans, regardless of health status, if they get this gift.
The problem is there are just too many elves who don't want this happen.
The individual mandate has fluctuated from DOA in 2008 to a distinct possibility earlier this year. I would say the current odds of an individual mandate in the final health reform bill is somewhere between the chances of an underfed Santa Claus and a White Christmas in Miami.
A best-selling, Oprah-recommended book called "Why Health Insurers Are Important." During the healthcare debate, public insurance proponents and many Democrats have bashed health insurers as an expensive, unnecessary third wheel in healthcare.
Alas, there will be no best-selling, pro-health insurance book that will catch the nation by storm. Instead, health insurers will need to continue to promote their positive work and try to raise their voices above the din of health insurance critics.
That will be difficult—and likely will not happen. It's up to individual insurers to promote their offerings to members in order to gain loyalty. At that point, insurers can take some comfort in at least knowing their members are happy with their offerings.
Those are four items on the top of health insurers' lists, so needless to say it's going to be a disappointing Christmas morning when they see none of these presents under the tree.
What will they get instead? A watered-down health reform package that will not include anything that they despise like the public plan or anything that will rejuvenate the private insurance industry. In other words, insurers will get the health reform equivalent of a sweater rather than a pony or—much worse—an inedible fruitcake.