Another installment in the curmudgeon's-eye-view of the health care mess in this country addresses the second point of my nine-point prescription to make us all as healthy and happy as any Scandinavian. It's not my inherent genius that produces these telling insights, but liberal application of pragmatic, common sense. Any fair-minded person could come up with this stuff, and many have.
The prescription for reforming medical care is pretty simple, and not as hard to do as the parasites feeding on human misery would have you think. It only takes a few simple things. Here's my list.
- Ban all private, charitable fund raising activity by medical institutions.
- Ban private medical insurance. (today's topic)
- Ban medical billing. Outlaw the collection of any money, even "co-payments" and nominal "user fees" for non-elective medical care, treatment or medication.
- All medical facilities continue to provide care, with all current staff who wish to continue working there. They draw their salaries directly from the federal government.
- The U.S. Public Health Service, the established uniformed service of medical professionals sworn to provide health services to the public, becomes the administrator of all public medical facilities. The Surgeon General becomes the chief medical officer of the nation.
- Medical students receive full tuition and a stipend for living modestly in exchange for a number of years of service as a USPHS or military doctor after graduating.
- Legalize marijuana. Let all the pot smokers and dealers out of prison now.
- Treat drug addicts instead of criminalizing them.
- Stop taking any crap or suffering specious arguments from idiots who don't want medical care. Stop them short and tell them to shut up.
Insurance companies have no business collecting money, in the form of premiums, and then using any of that money for their own purposes. All profits, operating expenses, advertising, capital investment and even charitable and public relations expenses, such as sponsoring professional sports or Special Olympics, are extortion and graft. They are taking your money and spending a lot of it on things that don't do you any good. When a private party takes your money and does something with it that you don't want them to do, that's theft. If the government does it, it's taxation, and you have the remedy of electing different people to power who might do something different with your money. But, when a profit-making entity is allowed to be in a position to compel people to hand over money, but not control what is done with those funds, it's extortion. Paying government officials, with campaign funds and other handouts, to enact laws that allow such practices is graft.
The problem with the private model for health care is that it is not a real commodity. One can't easily weigh the relative merits of the abstraction of health care coverage against consumer goods. How much should one restrict one's standard of living to buy health insurance? Is it better to have health insurance than to have a home? Should one starve to pay the premiums? No, of course not. But, how about having nice clothes and a good car? Should we all shop at Goodwill and drive junkers so we can afford Cadillac medical insurance? Hmmm.... Once you get above the level of subsistence it's not as clear cut a decision. That decision, for the individual, is skewed one way or the other by how much money one has and how healthy they think they are. A lot of people are delusional and think they don't need anything, then cry and beg for charity when they get sick. Some well-off, healthy people are over-insured. They are not likely to get sick and have enough money to handle foreseeable expenses.
The whole insurance-or-stuff question is moot for the poor, anyway. There is no insurance they can afford. Any money they have goes for basic necessities. Should they be denied all medical care because they can't buy insurance? Republicans might think so, and many will tell you that to your face, but anyone with a conscience knows that this is insane. Society would break down.
If everyone who could not pay were denied medical care, think what would happen. People would bring their injured or sick family members to emergency rooms and order medical personnel at gunpoint to treat them. If ambulances were not dispatched to anyone who called them, but only to verified holders of paid-up insurance policies, illegal, unlicensed, cash-only ambulances services would spring up to carry the gun-toting relatives and their charges to the emergency rooms. There would be revolts of caregivers who would set up free clinics to treat anyone in need. There would be a huge surge in storefront medical clinics that operate on a cash basis. Oh, wait. A lot of this has already happened.
The critical factor in this analysis is that people need medical care, but they don't need medical insurance at all. If you can get insurance at a price you can afford, then you may be a satisfied consumer. If you can't, then you will find a way to get some medical care. You might emigrate to a civilized country with comprehensive medical care, but more likely you will shop for bargain medical care or do without. The point is that no one ever goes to extraordinary measures to get more insurance. When you have to economize, insurance is the first budget item to be cut.
People don't have the ability to "opt out" of the medical insurance system without putting themselves at grievous risk. Gambling that one's personal resources will be adequate for any medical needs is foolhardy and cavalierly disregards the welfare of minors under one's care. Prudent citizens provide security for themselves and their dependents by purchasing insurance from private firms. If you don't have the money for that, then you will not have adequate care in the event of a serious illness or injury. It's that simple. You buy into the overpriced and ridiculously restrictive health care denial system or you die in the street like a dog. You pay hundreds of dollars a month for years without ever making a claim, until one day you need something, only to be told that, "it's not covered under your plan". What are you paying for? Not much, it seems.
The great epiphany that still needs to occur with most people in this country is that there is no connection between insurance and the quality of medical care available. A medical system controlled by insurance companies only serves to ration what medical services are available, and to apportion those services by the amount an individual has paid. The bureaucrat between the caregiver and the patient is the insurance company clerk, not a government official, and certainly not a medical professional.
This repetitive, onerous rant is intended solely to drive home the point that insurance companies add nothing to, and take a lot away from, the care given to patients. Once you accept the premise that they serve no useful function, the inevitable conclusion is that they must be put out of business. Let me add quickly that I have no issue with life insurance, car insurance, flood insurance or even mortgage insurance. Such coverage is a commodity and people should have the right to purchase it. But, whether or not one gets treated by health care providers is not a matter of choice. You either need it or you don't, and when you do, it is unconscionable to put a price on it.
So, if you can support the idea that private companies should have no role in paying for medical care, how do you get them out of the medical insurance business? You just do. It takes a few direct steps, but some of it happens all by itself.
- You pass a law to make it illegal to deny medical care to anyone who needs it. That's what they did in Great Britain in 1949. Health care became a human right rather than a luxury reserved for the well-to-do.
- The government pays the health care provider. Now, you can create an accounting nightmare by tracking every service and billing, or you can just put the workers on salary and stock the facilities with medical supplies, as they do in all countries with socialized medicine.
- Private, for-profit medical facilities, and insurance that pays for such care, could be freely available. However, such businesses would be barred from receiving any public funds.
With the removal of any need for working people to purchase insurance, they would cease to do so. No firm would offer it as part of a compensation package. Poof! The health insurance "industry" would shrivel up and blow away. If no one is strong-armed into buying insurance, hardly anyone will.
Of course, I'm oversimplifying everything. It's too complicated to do this way! Or, is it? Realize this: The sole impediment to a single-payer, comprehensive health system in the United States of America is the economic power of the medical and pharmaceutical lobby. Once their hold on state governments, Congress and the President is broken, we can get our health care and our medication. They both will be had, and they will be paid for, but we can easily dispense with the middleman.
Please, for today's post, limit your comments to the issue of private medical insurance. I promise to do pieces on each of the remaining points. We can discuss them one at a time. Let's focus and beat the death out of this one issue first!