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THIEVES' MARKET
10/05/2009
One of the big debates in the country and in Congress is over whether or not we will allow the health care insurance companies to continue gouging the American people in the name of the "free market." Though I am not opposed to making a profit in most industries, health care is one where huge profits literally mean life or death. People on my side are fed up with the huge profits that are made on the backs of sick people, with those who really need help often left out of the market or kicked out when their medical expenses become too high.
The term "free market" should not really be applied to the health care industry, where the only people that are "free" to choose are the underwriters who decide who gets insurance and for how much. Consumers have almost no choice. I prefer a new name for the industry: "Thieves' Market." Not only does this market steal our money, with no real guarantees of providing the services we need, but in its relentless quest for ever increasing profits, it steals the health of many, many people by preventing them from purchasing policies.
Radically reforming this system in favor of the American people should be something we all join forces over, yet Republicans and some Blue Dogs are doing all they can to stop it or water it down. The reason there is such a heated and ugly battle over health care legislation in Congress, with massive amounts of money from insurance companies driving one side of the debate, is that there is much to gain and much to lose beyond providing health care access to all Americans and eliminating flaws in the system.
Republicans have worried for a long time that if a public option, a Medicare-like plan for those under 65, is included as one choice in a group of plans, it won't be long until we make our way as a country to a government controlled single payer system. Private insurance companies, if they exist at all, would then only provide special expensive coverage to the wealthiest Americans, and thus the health insurance industry would drastically shrink. Republicans and a few Blue Dog Democrats, who get large campaign contributions from the insurance industry, are thus fighting for the survival of those companies because they think (with some justification as money controls the airways in this country) it means their survival in power.
Republicans have been screaming about the dangers of "socialized medicine" since the 1930's, even though the government systems we already have, like the VA system and Medicare, are enormously popular and, in the case of Medicare at least, highly efficient. Furthermore, even though most Brits and Canadians are very happy with their government administered single payer systems, Republicans somehow think a similar system will be terrible for America.
Republicans say they are opposed to a single payer system because they are ideologically opposed to big government and they believe the "free" market provides better products and services in every commodity Americans need and want, from clothing to electricity to health care. They say this even though it is obvious that the Thieves Market of Health Insurance leaves too many people out, including people like me with pre-existing conditions, drops people when they get sick and charges increasingly high rates that more and more businesses and individuals are unable to afford. The private for-profit Health Insurance Thieves Market has failed.
But Republicans are also opposed to single payer and even the public option portion of health care reform because they know the politics of it. Should the Democrats succeed in passing health care reform with even a small public option that truly can compete with private insurers, that option could grow as employers stop providing health insurance in favor of allowing employees to opt into the public plan (even if they have to pay a penalty to the government for not covering their employees). As individuals find the public plan more affordable, it could conceivably happen that a majority of the country may choose to enroll in that public plan. (It should be pointed out that the public plan Congress is actually considering is not a government run plan. It is started with government funds, but then it is run as a private non-profit insurance company, with no government bailouts. It would have to survive on its own. This is not the same as Medicare.)
If the satisfaction those over 65 have with respect to Medicare is any clue, however, those under 65 who opt into a similar, though more independent, plan will also be satisfied. Not only would insurance company lobbies no longer have a budget to buy politicians, it could make Democrats enormously popular and give them a lock on power for decades.
While the Democratic Party has been trying to reform health care since Harry Truman was president, and has a genuine desire to guarantee access to health care for all Americans, they too are aware of what is at stake here politically. I think that is why in recent weeks we have seen some big names in Congress step forward and begin pushing hard for the public option. It isn't that they necessarily want a single payer system (though some do) it is that they realize guaranteeing universal access to health insurance (which of necessity would have to include a non-profit public option for those who cannot afford insurance from the for-profit companies) will be a huge political win for them.
Too often in political fights in this country we look only at the immediate picture. We see the two sides fighting and we argue points that they and their pitch men outline for us. Rarely do we step back and look at the big picture. So let's do that. Let's step back. No, not just a few steps. Let's step way, way back. Let's look at the big picture from a historical and then a contemporary perspective.
Health care from a big picture perspective is simple. People get sick. People need doctors and medicine. Doctors and medical helpers and medical facilities must be paid for their services. People who want to access those services have to have some means to pay.
Before the 1920's, medicine was not terribly expensive because prior to then doctors didn't know enough to help people get better. However, advances in medical research in the early part of the last century improved care enough that cost became a huge factor. Most people simply couldn't afford to pay a doctor or hospital for a major illness. Hospitals were going to lose money and close unless people could pay for their services. Enter the first real health insurance company, associated with Baylor Hospital in Dallas. It was a nonprofit, community based company, charging the same premium to everyone, and became the model for many new companies throughout the country. Eventually, these companies became Blue Cross.
A second factor in the growth of insurance companies came during WW II when government wage and price controls, instituted to keep financial stability on the home front, made it hard for some businesses to lure workers away from the jobs they already had. However, businesses could offer benefits, like health insurance, which even gave them a tax credit. This was the beginning of our employer based health insurance system, something unique to our country. That system is now falling apart as increasing costs hurt struggling businesses, prompting them to end employee benefits, and forcing even employed individuals to pay for their own increasingly expensive health insurance.
It wasn't long before what started as a non-profit industry, with a standard premium for all subscribers, turned into big businesses looking for big profits, at the expense of the people. As medical costs rose, companies sought ways to increase profits and decrease costs. There were several ways to do this. One was to have a rating scale, with premium costs higher for those who had more risk factors. Another was to only insure the healthy, and deny coverage to anyone with pre-existing conditions. Another was to write complicated policies with fine print that allowed companies to cap the amount they would pay for an illness or an individual, or drop coverage altogether for arbitrary reasons.
The bottom line with the for-profit companies was this: they were in the business of making money, not in the business of providing health care. In fact, the payment of doctors and hospitals, in the insurance industry lingo, is considered "loss."
As the health insurance industry focused on gaining more profit for their shareholders, the people who were in the business of actually providing health care – doctors, nurses and hospitals – found themselves struggling more and more with insurance companies for payment. In addition, our hospital system itself moved from a predominantly non-profit one, to an increasingly large segment of for-profit hospitals. For-profit hospitals coupled with for-profit insurance companies resulted in even higher costs for health care, as layers of employees no longer associated with direct patient care, and the stockholders who had invested in the company, all required their share of the health care cost.
Add to this one more problem. We are, in general, a benevolent people, who do not believe people should be left to die, even if they don't have health insurance. So we have instituted at least some rules regarding treatment of the uninsured and/or the destitute – including those here illegally. One law is that no one can be turned away from an emergency room if they are ill. So our emergency rooms are packed, the insured must compete with the uninsured for beds, and the hospital has to eat the loss, though it is more accurate to say they simply pass the cost of the uninsured onto the rest of us through increased fees which translate into increased health insurance premiums. In other words, as we all know, we are all paying an extra premium for what amounts to an unofficial public option – emergency room care, the most expensive type of care.
Now, Congress is poised to act, either in a big way, or a small way to fix this mess. We don't yet know how much, if anything, they will actually accomplish. Liberals want individuals to have choices, including the choice of a government administered program, and greater regulation of the health insurance industry, while conservatives want to keep things as they are and only tweak a few things around the edges, leaving the private for-profit insurance system intact.
No matter what comes out of Congress, however, some individuals will say the government should "stay out of their business." They ignore the fact that things simply can't go on the way they are without the country as well as individuals facing bankruptcy, and the population divided into those who live and those who die based on who can afford private health insurance. Conservatives and libertarians will protest against a public option and will resist any mandate to buy insurance. (However, almost all of these individuals either already accept or will be happy to accept the government being "in their business" by offering them Medicare.)
So what should we be rooting for? What should we want? As long as Democrats thought the Republicans had won the "socialized medicine is bad" argument (especially after the noise of the lobbyist funded "town hall meetings" this past August), they were weak and willing to cave. Democratic Senator Max Baucus, who is no progressive and seems to be in the pocket of the insurance lobby, is caving to his Republican and Blue Dog colleagues on a daily basis.
But others in the progressive wing of the party are finally stepping up and demanding a public option. They see the polls, with 65 to 70% of the people wanting such an option, and they are feeling the momentum shift. We may still get true reform. We may still be able to start putting the genie back in the bottle, and defeat the dominance of the for-profit, price-gouging, health destroying thieves' market of health insurance. And yes, it may mean we will eventually progress to a single payer system. If so, let's be sure we make it the best one we can.
Or, there is another possibility for those who insist they hate "government" and want to put their heads in the sand and leave the system alone. These people, who think as long as their needs and wants are met, no one else's needs or wants matter. (As the tea party protestor's sign so aptly summarized this attitude: "Get your own damn health insurance.") Why are we not calling these people "selfish?"
Here's the possible solution for those people. It's not a very charitable one, but I don't think we would have to worry about it succeeding, because the same people who might initially praise it would be the same people demanding its end.
Here's the solution. We continue with a private insurance system, with a public option for those who cannot afford private insurance and who are willing to kick in a few dollars of their own. The very poor can already use Medicaid, and those in between could get a government stipend to help pay for the public option. Stay with me, because there's a kicker.
Anyone who thinks they don't need insurance, or who refuses to buy insurance for ideological reasons, can stay out of the system. However, if they get sick, they must pay out of their own pocket for any care they need. No more free emergency room care. If they have no insurance, even though they were offered affordable or subsidized options, and don't have cash with them when they seek medical care, they will be turned away. Hospitals would no longer be required to treat the uninsured or the independently wealthy.
How long do you think it would take before these same "leave me alone" types would be screaming for the government's help?
Not very long, I imagine.
Of course, we will never do this because the majority of us are not that cruel and we know that leaving some people untreated, those with communicable disease, for instance, endangers all of us.
Some of us are really serious about reforming this system. Some of us think the only ones who should be paid for health care are those directly providing care or doing the essential work of keeping records and billing for services. We don't believe people who have no medical expertise at all, who do not care about the best interests of sick people, who deny care to other people, or who profit when people are denied care, should be able to make any money at all.
That won't happen of course. Many people who are not in the business of providing health care will continue to get rich because of sick people. But at least we can provide more universal care, we can get everyone in some system, we can demand the for-profit companies compete with non-profit public plans, and we can reduce the incentives for denying care to people.
Some of us really want to do this. Others just want to prevent the Democrats from achieving a political victory so they can – they think - return to power. But if a majority of the American people want health care reform, a minimum of 65% wanting a public option, do the Republicans really think they will return to power by working against that majority?
All content © 2005 outragedcitizen.com
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