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

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.

Dear America – We Have A Health INSURANCE System, Not A Health CARE System; They’re NOT The Same Thing

Until we get the framing right, we’ll never fix the problem: our health CARE system is broken because it’s NOT a health CARE system. It’s a health INSURANCE system.

The first question anyone gets asked when they walk into any facility for health CARE isn’t “How can we fix you?”, it’s “How ya gonna pay for this?” Right off the bat, that’s ass backwards. The inmates are in full control of the asylum.

No other industrialized nation has a system like ours — where most Americans get their health INSURANCE (not care) through their employer. There’s a reason — and it’s not because we’re so clever and exceptional. It’s a historical anomaly that we’ve simply never dealt with, addressed or even admitted to.

Back during World War II, every available dollar was put toward the war effort. Rules prohibited companies from giving employees raises or raising salaries for new hires. Big companies, wanting to compete for the best employees, needed another incentive so they began offering free health care — well, they’d pay the insurance premiums.

Note — big companies were able to do it because they could afford (at first) to handle the additional admin and cost of running a health insurance program. As the war went on, more big companies offered the same health insurance benefit. Then the war ended… but the health insurance benefit didn’t — even though it should have.

After the war, all those big companies looked to get out of the health insurance business. They subcontracted out the work to the burgeoning health insurance industry to serve as the “gatekeepers” between workers and their health CARE. To keep costs down, the insurance companies eventually cut deals with doctors to get better rates. All very reasonable except that the insurance companies had now created EXCLUSIVITY where there wasn’t any.

Suddenly insurance companies could control which patients a doctor could see. And then they made their gatekeeping integral to the whole health CARE system itself.

Corporations — like health insurance companies — have a fiduciary responsibility to their shareholders (the preferred class, not the regular class of shareholders) first and foremost. They have NO actual responsibility to “patients”. The insurance company doesn’t actually care what happens to any patient. It’s in their interest to spend the least they can get away with on each patient while collecting the maximum amount of income from him/her.

Is universal single payer perfect? FFS, there’s no such thing as “perfect”. But at least it takes the FOR PROFIT gatekeepers out of the health CARE equation. There will still be gatekeepers for sure — government gatekeepers. But We The People can control how they keep the health care gates for us. We can’t do the same with a corporation.

It is even more absurd to run around all Chicken Little-like about Elizabeth Warren says she’d pay for her Medicare For All plan — without comparing it to either 1) what our current health INSURANCE system costs each & every one of us in cold, hard cash terms or 2) ever asking a Republican EVER what their “health care plans” cost or how THEY might get around to paying for it.

FFS – the Republicans pulled off a massively destructive (to the middle class) tax cut to the rich that they had no intention of every paying for — except by gutting social security and welfare.

America keeps getting tripped up by greed. Greed is what allows Big Pharma to charge extortionist prices for insulin when it’s inside America’s borders and reasonable prices everywhere else.

Greed never makes anyone smarter. It ain’t gonna cure anyone’s ills either.

Can We PLEASE Get This Straight? NO ONE Loves Their Health INSURANCE…

Somewhere, an evil genius is smiling so hard his face hurts. It might be the same evil genius who came up with a “Mission Accomplished” banner for the background of a speech by George W. Bush — on an aircraft carrier — during a war he started for no reason.

Yeah, I know the banner SAYS “mission accomplished” but I doubt BushCo could have actually pointed to what mission they meant and what, if anything, had actually been accomplished. “Americans love their private health insurance” comes from the same wellspring of evil-genius-strength bullshit.

The core problem with American healthcare is that its emphasis is immediately on the wrong syllable. When anyone walks in the door of the American Healthcare System, the first question isn’t “How can we help you?”, it’s “How are you gonna pay for this?”. If you can’t answer that question satisfactorily, you might just be screwed. But, hey — even if you DO have insurance? Between the co-pays, the deductibles and all the other out-of-pocket bullshit, you could STILL be screwed.

No other civilized healthcare system anywhere on the planet has profit incentive at the core of its healthcare. There’s a reason. Profit incentive and human well-being are completely incompatible when they’re both dependent on the same dollar. A corporation has a fiduciary responsibility to do the very best it possibly can for its investors. That means a choice between an expensive but uncertain procedure that might save a customer’s life (that’s what they are to the insurance company after all — customers) and a happy board of directors able to announce a bigger dividend at the next shareholder’s meeting. Guess who the corporation’s gonna choose?

Like I said — it’s their responsibility to do that. It’s not their fault exactly — it’s history’s. Ever wonder why it is that only in America does anyone’s employer pay for their health insurance? For real. This doesn’t happen anywhere else. And there’s a reason. It’s bad for business.

FDR toyed with making universal healthcare part of social security but the AMA didn’t want doctor’s fees limited by the government (cost controls, in other words). FDR made the political decision not to risk losing on both social security AND universal healthcare. He put all the chips on social security alone. Then WWII happened — and history caused American healthcare to zig when maybe we should have zagged.

Because all available money needed to go to the war, employers were not allowed to give good employees raises. Those same frozen wages made it hard to lure new talent (who could go elsewhere to an employer whose wages were frozen at a higher level). Thinking outside the box — what other benefits could be offered that would feel like salary? — produced the first direct employee sponsored healthcare.

The idea spread. People liked the benefit. In their minds, it was saving them money and providing them comfort. What’s not to love? Then the war ended.

With the war over, companies were free again to offer whatever salaries or bonuses or raises they wanted. They also were free to end the war-time benefit (replacing it with salary). They didn’t. Hell, instead of ending these programs, the big companies held onto it. This was back at a time when your average middle class American (remember them?) entered the work force at 18 or 22 (if they went to college) and whatever employer they started with? That was likely to be the employer who’d be handing them a gold watch upon their retirement 40 years hence. Your employment relationship was supposed to be as durable as your marriage.

While the big companies (who’d done a shitload of the hiring during the war) held onto providing healthcare to their employees, they farmed out the work of administering this employee benefit — and the healthcare insurance industry was born. Didn’t take long before the baby took over the nursery. Then the whole house.

Ask a company like Boeing what having to provide healthcare insurance to its tens of thousands of employees does to its bottom line and its competitiveness. The cost of that healthcare is massive and it gets reflected in the cost of each airplane.

Airbus, by contrast, doesn’t have to pay for its employees’ healthcare. In Europe, the government takes care of it, paying for it with tax dollars. That gives Airbus an advantage because they don’t have to build that cost into what they charge for an airplane. See? Employer-based healthcare is bad for American business because it makes them less competitive.

As for the healthcare itself — all the employer is providing is the insurance coverage. What that coverage is? That’s up to the insurance company.

The insurance companies can make up any rules they want. And they do. The most important rules of all — to them — is who they contract with and therefore who their customers will be allowed (by their made up rules) to see. Every last bit of this, remember, is made up. By a company put there to administer this thing.

To gate-keep.

Insurance companies are gatekeepers. Border guards that — so long as we pay our premiums and stay employed by the same bosses — will smile at us benignly each time we pass by. But we fear them. We dread them. What if they don’t smile next time?

What if, next time — when we’re really sick — they turn us away? What if they point to language in their dense boiler plate (something on page 58) that says our particular situation (as they’re interpreting it) means they don’t have to cover the procedure we need. We’re free however to pay for it retail-retail out of pocket.

Hey — we charge hundreds of dollars for insulin that costs relative pennies in Canada. Every last penny of that difference is profit. Let me repeat: PROFIT. People are dying cos they can’t afford their insulin. Retail-retail in American healthcare means the cost of a procedure and the procedure’s actual cost have nothing to do with each other. It’s like being charged a million bucks to go three blocks in a taxi.

What’s wrong with America’s healthcare system isn’t that the inmates are running the asylum. It’s that insurance companies are. And they couldn’t give a rat’s ass what happens to any of us.