The latest healthcare statistics on birth and pregnancy published by the Journal of Pediatrics reports that “… in 2007, among nations with populations larger than 2.5 million, the United States was only the 29th lowest in infant mortality, behind such countries as Croatia, Cuba, the Czech Republic, Hungary, Poland and most of Western Europe and Scandinavia.”
Other medical journals echo these health statistics in such areas as adult mortality (death rates) and morbidity (rates of sickness found within a population). Our standing in these statistics is even lower than infant mortality.
American physicians and medical scientists win more Nobel Prizes for individual achievements in medicine than any other nation. Yet our healthcare system operates just a little bit better than a Third World country.
To hear America’s healthcare system lauded again and again as the best in the world (instead of the most expensive) during the nationally televised President’s White House meeting with Congressional leaders on pending healthcare reform legislation, indicates that: our elected representatives can lie without conscience, are delusional or are inexcusably ignorant of the facts.
TRYING AGAIN
We have spent a year listening to the debate over the expansion of our healthcare system to cover 30 million citizens who have no insurance. The debate has emphasized the seriousness of the ever-increasing costs of the system, the danger to our entire economic system and what should be done to reform the system. It has included concerns about the cost of adding those 30 million to the system; people suddenly losing coverage for critical care, or failing to receive it because of pre-existing conditions; the uncontrolled premium increases; the hundreds of millions of dollars in fraud and waste in the entire system including Medicare and Medicaid; how the almost punitive cost of malpractice insurance and the dollar amounts of jury awards combine to pressure the medical profession into practicing “defensive medicine” and so add tens of millions of dollars to the expense of healthcare – a vicious circle, indeed.
The struggle has been about whether the proposed changes to the system will reform it and make healthcare affordable, accessible and accountable.
During this long year of talk we have never heard one word about how to make the actual delivery of healthcare better. Rather, the debate has been about regulating the total control that profit-making insurance companies have over the health of all Americans. The debate has been a war between profit-driven private interests and their financial influence over decision-makers and a government attempt to provide reform and relief.
In a very real way, this is liberalism at work: government seeking to provide a level-playing field for the public against the monopolistic excesses of big business interests overwhelming an important element of public service – healthcare. Everything that can be done to maintain the status quo – lobbying, campaign donations, arm-twisting etc. – is being done. Insurance industry control has given us an economically destructive and woefully inadequate healthcare system and the new Administration and its leadership is trying to stop it.
But don’t tell anyone this is a liberal fight – or reform will stand even less of a chance than it does at this writing.
One thing is certain: the good guys cannot win unless they break the domination of the insurance industry. As premiums continue to soar even as the debate wears on, the industry knows that as long as it controls the way the system works, it will continue to profit.
DOMINATION
Think for a moment about your automobile insurance. Has your insurance agent ever told you how to drive your car? What directions to take on your next trip? When to wash it? When to trade it in? How to fix it or even how to change a tire?
Think about the insurance on your home. Has your insurance agent ever told you when to buy a new house? What color to paint the outside of the house and all the rooms within? What kind of water heater to buy? When to clean out the garage or how to change a light bulb?
Think of your life insurance. Has your insurance agent ever told you how to live? Where to live? What activities to be involved in? Whether to have another child? What job to take?
These questions seem silly and the answers are obvious.
We buy insurance to protect ourselves against an event we don’t want to happen. So, concerned about an auto accident, or a house fire, or premature death we buy insurance to protect ourselves and our families against possible negative and costly results. We don’t want these events to happen and we so buy insurance to protect us against possible negative results.
We buy health insurance for the same reason: to protect us against the costs of chronic and/or catastrophic illness.
What then does health insurance have to do with the health of each American?
The health insurance industry dominates the entire medical profession and influences every act within our healthcare system.
Health insurance companies dictate the very choice of a doctor, how a doctor should diagnose the symptoms of illness, the tests the doctor orders to reach a diagnosis, the treatment plan he or she recommends, the drugs or procedures involved in that plan and how long treatment should take, what hospital to go to, how long to stay – and on and on and on.
In no other system in our society does the insurance industry dominate a field so completely as to direct its thinking and activities, with absolute control of its every human service.
It is no secret that the health insurance industry – in which the five top companies showed a combined $12.2 billion dollar profit last year (second in profits to the oil industry) – has spent hundreds of millions in campaign gifts and corporate lobbying to protect itself against any reform that would limit its profits or its influence on the practice of medicine and the lives of those who need medical services.
Their profits have grown to such an extent that they can all but ignore the admitted hundreds of millions of dollars in waste and fraud – in Medicare and Medicaid and everywhere else in the system – which adds to the ever-growing expense of healthcare. Why bother correcting the problems, it’s just another reason to increase premiums.
Their profits have enabled them to build an all but impenetrable barrier against anything that threatens the present system. Decades and generations pass and those attempting reform never get it. Their domination continues unabated.
The connection of insurance to health is artificial and unnatural. Health is about the attempt each and every one of us makes to live a long and productive life. Health is about the well-being of hundreds of millions of individuals. Insurance is about profits.
THE HARD REALITY
It is no accident that the first and most important casualty of attempted reform has been the so-called ‘public option’ – the introduction of a non-profit insurance entity that could sell health insurance on a very competitive basis to anyone wanting to buy it.
The immediate and overwhelming opposition to this plan by the insurance industry was powerfully effective. Nothing in the enormously complex bill was met with more fury or fear by the industry. Here was a direct (and easy-to-understand) threat to their unregulated profits.
Despite layers of complications and complexities in the legislation, people could understand this: they would be able to buy a decent health insurance policy directed by a not-for-profit company whose very existence was not to make a profit but to make a better healthcare system. Government involvement was much like Medicare health delivery and for those who have grown old enough to use it – that was fine.
The industry erupted in opposition. Despite a promising reaction in the House of Representatives that led to the eventual passage of a healthcare reform bill which contained the public option, and despite strong poll results which indicated that the public understood the ‘public option’ and clearly approved of it, Republican Senators from around the country immediately attacked the concept – complaining as they made the industry case – that such a competitive entity would be unfair to private industry because a non-profit’s rates would be so much lower that no private entity could compete. Many influential Democrats silently agreed.
The negative campaign was extraordinary – and it worked. The Senate indicated that there was total opposition from Republicans and perhaps some Democrats and that it would be impossible to get the votes to avoid a filibuster. Eventually the Senate bill approved by Democrats did not contain the ‘public option’.
Once upon a time in America Teddy Roosevelt and FDR broke up the monopolies and busted the trusts. That was a different America in which Presidents had the will and the power of public opinion to control and direct big business – knocking it from its omnipotent positions and forcing it to accept unions representing workers’ needs and a fair marketplace where profits were part of a whole – and not the only thing. Those attitudes developed into America’s middle class and our position as the ultimate world power.
Today that country is gone. This President struggles futilely to regulate the unbridled power of the financial and health insurance industries. Giving up the fight to establish the public option – the only way to level the playing field of competition and so hold down ever-increasing costs – the President offers cost-saving substitutes like buying exchanges which seem weak, confusing and no match for the power of the industry.
Now at last, the President begins to use the bully pulpit with his campaign-like rallies for passage of a bill he has at last put his “name” on. But bully pulpits are designed to move a like-minded population to make itself heard. And polls today indicate the public’s real confusion, fear and uncertainty. Polls indicate that a small but growing majority of the public openly doubts whether the Administration really wants to alter the insurance industry’s power and believes that the President favors them as he seems to do with the so-called “greedy” leadership of the financial industry. ..despite his public tongue-lashings of both of them.
The national mantra is clear today: leave (all) markets alone – let the markets take care of themselves. We expect that conservative view from Republicans. But the inability of Democrats to counter it with their superior voting numbers in order to gain genuine reform (Americans did elect a Democratic President and his promise of ‘change’ and the largest Democratic Congressional majority in decades) is a tribute to the power of the insurance industry’s long-standing influence. When New York Senator Charles Schumer, who receives more money from the industry than any other senator, reluctantly began working with the Obama Administration to pass a reform health bill, he began to read that his election this year would face mounting opposition from the health industry because they resented his activities. We’ll see.
No matter what happens in the weeks ahead to whatever compromise bill is finally approved (or not), one fact is clear: as long as our healthcare system continues to be controlled by the insurance industry, neither the problems of cost (which threaten our entire weakened economy) nor the poor quality of medical and healthcare, will be genuinely reformed. All of this effort and struggle will be for nothing; no program that is eventually passed will matter very much even in the short-term if the insurance industry continues to control the system.
Gaining 30 million new customers will help them. Being told that they can’t deny coverage to anyone because of a pre-existing condition won’t bother them as long as they are able to raise premiums for everyone within the system whenever their expenses go up. They raise premiums when they pay their top executives more money for the same reason – their operating expenses went up. They act just like any other monopoly – Con Edison in the New York City area comes to mind.
CONTROLLING PHYSICIANS
The obvious complexities in the healthcare system have to do with its size, the entire cost of running it on local, state and national levels, the varying demands of those who must be helped and the enormous expense of education and the technological advances that do in fact make servicing that diverse community possible.
Wherever we look into this very complex system of sick people and the medical and health services available to them, we see problems. And in every case, those problems have to do with the control of the insurance industry.
If you have a health insurance policy, why must you look into a book your company sends you to see if your doctor or a doctor you have heard about is “covered” and part of the insurance company’s “stable”. Some policies allow you to choose your own physician but if you read the smaller print, you find out that it will cost you more money to see a doctor not listed in that book.
To a great degree that’s how the health insurance industry controls your choice of a physician – it’s not a matter of talent or experience but a matter of money.
But how does the insurance industry control physicians? Malpractice insurance rates are part of every physician’s expenses – along with rent, staff and all the other costs of doing business. But what he or she pays in malpractice insurance is the factor that boosts the entire cost of our healthcare system.
The amounts of money involved in buying malpractice insurance have limited the number of General Practitioners now in practice in this country. The costs for that specialty are so high that doctors going into that field cannot make a living…because their fees or payments from the insurance field do not cover their malpractice costs.
Worse, all physicians do what they have to do – examinations, tests, consultations with other specialists – to reach a diagnosis. Then, practicing defensive medicine, they order a whole series of additional diagnostic tests just to be “on the safe side” – to protect themselves against a possible lawsuit should something go wrong.
The number of lawsuits against physicians and the healthcare system in general is so great that there are legal specialists – plaintiff lawyers – making an enormous living just suing doctors and hospitals. These are the lawyers who charge a patient nothing for their services during the case, but then take one-third of a jury award to the plaintiff at its conclusion.
In most cases, typical juries in these matters are not and cannot be experts in medicine and treatment. In many cases where only a judge hears the case and makes the decision, the judges themselves are not expert enough to understand all the nuances involved. The enormous dollar awards to plaintiffs drive up the cost of insurance policies and so of the healthcare system and another vicious cycle exists.
SOLUTIONS
As this is written, it is apparent that Congress will either have voted for or against some kind of healthcare reform bill – or that no vote will come to the floor of the House of Representatives because the Speaker cannot find enough Democratic votes to pass a bill.
Of course the record will show that the House has already passed a healthcare reform bill – that even included the “public option” – but all of that has disappeared in the endless give and take between the President, Congress, media coverage, the political wars and so-called public opinion.
What is clear is this: without competition the healthcare insurance industry will continue in control and costs will continue their steady spiral up severely limiting our economic viability as a nation. At this writing no such competition really exists in the proposals now being discussed and analyzed.
Further without some form of cap on malpractice costs and awards, physicians will continue to practice the most expensive healthcare in the world.
While there must always be some way in which aggrieved and injured patients can receive just compensation for mistakes, negligence and just bad performance, changes must be made in the way courts hear and judge issues.
Some have suggested that six experts should form a medical malpractice jury: three judges and three physicians from a general pool of medical experts ready and able to work in this new configuration. The trial should have a two or three day limit – which would also keep costs down – and the decisions should come based on a financial scale which fairly compensates the aggrieved parties.
Genuine competition that breaks the monopoly of the insurance industry and the end of the need to practice defensive medicine will not only greatly reduce the costs of healthcare, they will become the turning point of a national effort to improve the performance of the healthcare system.