Tag: profit-driven health care system

America Has A Health INSURANCE System, Not A Health CARE System; They’re NOT The Same Thing

~ A L Katz ~ Leave a comment

Repeat: America does not have a health CARE system. What we have is a health INSURANCE system. They are not the same thing. The first question we ask anyone who walks in the health system’s door isn’t “How can we fix you?”, it’s “How’re you gonna pay for this?” That’s deplorable. It’s disgusting. We are the only civilized country on earth where that happens. Correction — because that happens here? There is no way we can claim to be “civilized”. Civilized people don’t put profit incentive at the core of their health CARE system

It’s a testament to how thoroughly the insurance companies have bamboozled Americans that most Americans don’t even realize what they’re fighting for when they insist they want to keep the health insurance they have no matter what. Insurance companies don’t provide health care. They provide “GATEKEEPING” services. That’s it. Their job is to stand between us and our health care providers, deciding whether to let us see them or not. A “good health insurance plan” will let us see the health care providers we want — provided they’re “in-network”. A crap plan doesn’t cover anything so why bother figuring out which doctors you like; you aren’t seeing them regardless.

The health insurance companies — like for profit hospitals — are not in the business of curing patients so much as they are in the business of charging them maximum dollars for minimum services. For profit health insurance companies LOSE money every time they have to pay for an insured’s medical expenses. In their ideal world, everyone’s paranoid about their health — paying in — but incredibly healthy — requiring no paying out. Keep in mind, a publicly traded company has a fiduciary responsibility to their shareholders, not to any “patients”. Patients (that cost money) and profits are mutually exclusive propositions.

That’s why Americans have to worry every time they get sick even IF they have decent insurance. The insurance might not cover what they need — and they won’t know about it or know how desperately they need it until it’s already happening. And that’s IF they have insurance. Without the insurance, they’d be completely at the system’s mercy — and our health insurance system has zero mercy.

How the hell did we get into this mess? To a degree, it started during WW Two. In order to direct as much money as possible to the war effort, we made it verboten for big companies to give good employees raises or to raise the salary being paid to new, skilled hires. Big companies still wanted to incentivize their best employees to stay or to motivate new, quality employees to hire on, so they started offering “hospital insurance”. The new hires seemed to like it.

In time, the war ended. So did the moratorium on raises. But, the employer-provided health insurance didn’t end. In fact, it became the “state of the art”. Though the logic behind employers providing their employees health INSURANCE (not the actual care) no longer held, the idea flourished. That was the beginning of our national health care nightmare.

While more big, medium and (now) smaller companies were forced to offer health INSURANCE to their employees, they didn’t have the ability or desire to administer the policies and their implementation. They turned to the newly burgeoning “health insurance business” to do that. The insurance companies, once empowered, were not going to give up that power easily — because that power (to decide what they’d pay for and what they wouldn’t) was the source of their money. The unions — as they should have — took full advantage of their negotiating power to carve out the best health insurance plans with the most coverage for the least out of pocket for their members. Of course they don’t want to lose that!

But even so — what the unions have isn’t the health CARE, it’s the commitment of the insurance company to cover more care. To be a “good gatekeeper” instead of a “mean one”. That is, after all, what insurance companies are: GATEKEEPERS — standing BETWEEN Americans and their actual health CARE. The reason some Americans got angry about Obamacare is because their gatekeepers refused to play along — and deliberately kept Americans from the health care providers they preferred.

I’ve joked here about the kind of health “care” coverage Republicans would create if they were honest about their intentions. I called it “TrumpCare Pick-An-Organ” because the concept was why insure organs that might never go bad on you? Why not gamble a little and save some money. You’ve got two lungs, two kidneys, two kinds of intestines — who needs it all? More to the point, who needs to waste money insuring it all? Why, nobody, of course! It went something like this…

Ask yourself — why are Republicans so opposed to universal health coverage — where every American, as their right, receives excellent health CARE. Who pays for it is never a question because WE DO. Through out tax dollars.

One of the problems Americans have with paying taxes is that we see all that money as wasted — like it was deliberately shoveled down a black hole. Throw waste atop that and the whole idea of paying taxes feels like theft. But, what if every citizen was given an itemized statement every year that showed to the penny where THEIR tax dollars went, what they were spent on and what they bought FOR that taxpayer.

We’d see clearly where our money was being wasted, for sure! But we also could point to things that our tax dollars bought for us — that we wanted — that our tax dollars could provide far more economically than via the private sector? Health CARE, for instance… Every other civilized country on earth does this more cheaply than we do and with far better outcomes.

That’s because socialized medicine is better medicine. Yes, profit incentive creates an environment conducive to innovation. One could get rich. But, in the health care environment, getting rich is counter productive. The need for profits and the need for good patient outcomes are not natural allies. In our insurance-based system, the profits always win out. The people almost always lose.

Or end up with medical bills that, ultimately, will kill them.

Universal single payer is the only answer. Personally, I’m with Bernie Sanders here — to keep the health insurance companies around is to invite abuse and just more stratification of services. Money will attract those more interested in greed than health care. The promise of health care is merely the bait in the “bait and switch”.

Coronavirus Has Revealed All The Things America Sucks At — Health Care, Food Supply, Emergency Response; We Can Officially Add CAPITALISM To The List

~ A L Katz ~ Leave a comment

The coronavirus pandemic has ripped the bandage off a thousand flaws in how Americans do things.

Health care was the first thing we were destined to slam into because we don’t HAVE a health CARE system, we have a health INSURANCE system. Not the same thing. As I’ve often said here, when people walk in the door of any part of our health system, the first question we ask isn’t “How can we fix you”, it’s “How’re you gonna pay for this?” Can’t pay? Sorry, pal.

That’s not health care speaking, it’s profit incentive. And while having profit incentive in our health care system may be profitable (the capitalism part), it was deadly to a staggering number of Americans before coronavirus. Think of all those Americans who couldn’t even think of getting tested — if they felt like shit — because they feared that if covid-19 didn’t kill them, the hospital bill surely would.

That’s the crony part.

Watch Mitch McConnell. He is dead set against doing anything even remotely “socialistic” to save America. The idea of UBI is anathema to him — even if it means saving ordinary Americans from ruin. Mitch even thinks letting New York or California go broke is the way to go. Never mind the fact that states like NY & CA are the economic ENGINES of the economy. The consumers in those states — they POWER the consumer demand that fuels the engines. People with actual expertise in economics are already saying that what Mitch is thinking wouldn’t just drive us into an economic depression, it will plunge us there. What part of capitalism is that good for?

It turns out America is especially bad at capitalism. There’s nothing inherently wrong with capitalism in the abstract. If we accept the fact that — if humans are involved — there are no perfect ways of doing anything — then one can argue that compared to everything else humans have tried, capitalism can give more humans more opportunities to enjoy a decent standard of living. The “social democracy” brand — where the commonweal always has a good seat at the economic table — makes capitalism fairer (though never ever fair enough).

Crony capitalism — what America calls capitalism — is bad for everyone ultimately — as the coronavirus is demonstrating relentlessly. It set us up for failure and damn if we’re not failing.

While the pandemic was descending upon us, Donald Trump and Jared Kushner were selling OUR supplies for profit and cornering the market on everything that was left. Rather than taking profit out of the picture — because this is a national emergency — Trump made profiteering and even outright price gouging part of the process!

Trump and the Republican Party don’t care if opening the economy kills hundreds of thousands of Americans (so long as it’s not them — then they’ll care plenty). Their bottom line, as always, is the money. And the power.

They have no idea how much rage against them is building outside their bubble. It was already building because of three years of lawlessness and treason. Throwing a daily death list into the mix is not going to expand Trump’s base. In fact — because it’s mostly Trump voters who are refusing to social distance or in any way behave safely — two weeks from now, it will be Trump voters who start dying in droves.

And Trump — as I said — won’t be adding voters. He needs every voter he can get. Or keep from dying.

As we know, Donald Trump is a horrible president just like he was a horrible businessman, a horrible father, a horrible husband, a horrible son, a horrible friend, a horrible associate, a horrible citizen, a horrible human.

He’s also a horrible capitalist. Just like every other Republican.

You CANNOT Have Profit Incentive At The Core Of A Health CARE System

~ A L Katz ~ Leave a comment

Some ideas are so stupid, you have to marvel how they don’t die at their inception. Example — having profit incentive inside a health care system.

Of course we want people to “make money” doing their jobs in a health care system. That’s not the same thing however as having corporations step in as gatekeepers between Americans and their health CARE. Our system is screwed up foundationally. We’ve let the inmates run the asylum — literally.

The reason America’s system is so different than everyone else’s goes back to World War Two. Once America entered the war, every available dollar in the economy was directed toward sustaining America’s war effort. Large companies weren’t allowed to offer employees raises. If a competitor could offer skilled workers more money (because they paid more to start with), the competitor was going to get all the talent.

To counter this freeze on wages, American companies offered to pay for employees’ health care. More precisely, they offered to pay for their health insurance (not the same thing). Most major American companies did this. And then the war ended. But this practice did not.

In the abstract perhaps keeping this idea going wasn’t a terrible idea. But it was a terrible idea. Example — a big, big company like Boeing pays for the health insurance (not care) of a huge number of people (Boeing employed about 161,000 people in 2015). Airbus Group — Boeing’s largest (and main) competitor (though it employs around 136,600 (as in 2014) — by comparison paid ZERO for their employees’ health insurance.

That’s because all the countries that help build Airbus products have socialized medicine systems where tax dollars pay for everyone’s health CARE. Everyone can walk in the door at a universal single payer system. We know already who’s paying for it — we are. As we should.

In a universal single payer system? No one loses their house or goes broke (for a generation or so) because you or someone in your family got sick. Where Airbus is concerned, unlike Boeing, they DON’T have to add the cost of all that health insurance to the bottom line cost of each and every Boeing aircraft.

Consequently Boeing enters every competition with one hand tied behind its back. Our insurance driven system makes that a fact of life. It makes America less competitive. It hurts us — and then makes it hard to get healthy again.

Oh, the irony…

Insurance companies — being publicly traded — have a fiduciary responsibility not to any “patients” (those are cogs in a much larger wheel from an insurance company’s perspective) but to their shareholders. And not to the common class of stock shareholders either (yes, there’s a theoretical fiduciary responsibility) but to the PREFERRED CLASS of shareholder.

Ya know how Facebook users mistakenly think they’re Mark Zuckerberg’s customers? They’re not (of course), they’re the thing Zuckerberg’s SELLING — to the people who advertise on Facebook (aka ACTUAL customers). Same deal. Americans have it in their heads that they’d be screwed without their private insurance.

No, your insurance company is just a gatekeeper actually. Different insurance companies try to carve off different doctors as part of their “network”. Go outside their “network” & pay lots more. The people in the network have agreed to whatever fees the insurance company has decided to pay. The insurance company, if you notice, is ALWAYS in the driver’s seat.

Keep in mind — from the insurance company’s point of view (and fiduciary responsibility), they are OBLIGATED to deny and refuse as much coverage as the can get away with because that makes the company more profitable and being more profitable makes their shareholders happy and the company more financially healthy. Money — not health CARE — runs everything.

It’s not just money, remember — it’s PROFITABLE money. It’s profit INCENTIVE.

It’s completely antithetical to what a health care system is supposed to do — if anyone inside it has ever taken a Hippocratic Oath.

You can’t “But first do no harm” by asking “How’re ya gonna pay for this, Sparky?” These two things are mutually exclusive propositions.

Hey, America — Here’s A Really Dumb Idea: Let’s Put PROFIT INCENTIVE At The “Heart” Of Our Healthcare System…

~ A L Katz ~ Leave a comment

There’s a very good reason no other industrialized country has profit incentive built right into its healthcare system: a corporation’s bottom-line fiduciary responsibility is to its shareholders (the ones holding preferred shares, not the poor, dumb humps holding “common” shares) and NOT “health care customers” aka “patients”.

If a profit-driven health insurance company gave in to patients instead of providing a generous dividend next quarter, it might face a stockholder revolt. The price of its shares might plummet — and with it, the value of the company. All because it did the right thing instead of the financially expedient thing.

Ever wonder why pharmaceuticals are so much more expensive here in America than in pretty much any other country? Have you seen Big Pharma’s bottom line? They’re making money hand over fist from ;us. Be thankful you’re not a diabetic in America. The real production cost of a vial of insulin is between $2.28 and $3.42, while the production cost for a vial of most analog insulins is between $3.69 and $6.16, according to the study in BMJ Global Health.

“Anyone with Type 1 diabetes should be able to buy insulin for under $100 per year, including the long-acting forms,” said Andrew Hill, a study co-author and senior visiting research fellow at the University of Liverpool. “Pharmaceutical companies cannot justify charging governments $532 per person per year in the U.K. and $1,251 in the U.S. Yet, they do.

$100 vs $1251 for a year of insulin. That’s quite a mark up for a LIFE-SAVING PRODUCT. Know why that mark up exists? Profit incentive.

It’s the same reason an ibuprofen tablet that costs a few pennies to make costs $100 if a hospital hands it to you. It’s not costing $90 to make, package and transport that tablet. Virtually all of it is profit.

How did we get here? How did we let the biggest wolf of all – the insurance companies — become head gate-keeper in our health care chicken coop? That’s what insurance companies are — they’re gate keepers who get to decide which doctors we get to see. No one — repeat, NO ONE — loves their insurance company. They like that the company — with its clever “plan” — allows them (with deductibles and out-of-pocket costs) to see the doctors they like. They like that the GATEKEEPER says yes.

But the gatekeeper can say no, too. And often does. The gatekeeper can make up all kinds of bullshitty rules to “explain” why we CAN’T have the care we need.

The fact that we have insurance companies as gatekeepers is a historical anomaly. During WWII, all financial resources were poured into the war effort. Companies weren’t allowed to give employees raises. That made attracting new talent to a company (or retaining good talent) harder. To incentivize workers, large companies offered health insurance. People liked it. Why wouldn’t they? More big companies started to do it.

Then the war ended. But the employer-provided health insurance didn’t. In fact, it proliferated despite the fact that it really wasn’t good for any of the companies to keep providing it: it’s expensive — and when you factor in the cost of providing this perk, it makes the good or service that much more expensive. Example — in the competition between Boeing and Airbus to build and sell large commercial airplanes, Airbus always had a huge advantage. The cost of worker healthcare was built into the cost of every Boeing plane — making them more expensive to buy and less profitable for Boeing. Airbus, on the other hand, didn’t have to pay for its workers health insurance — that cost was born by whatever government the worker lived under because that country provided universal singer payer health CARE.

Europeans needing health care get it — no one asks how they’re going to pay for it first. Everyone KNOWS how it’ll get paid for. They skip that and move right on to the health CARE — like they’re supposed to.

America has great health care for those who can afford it. Otherwise, we have a system designed to make rich people richer and sick people die.