While reading 'The Wrecking Crew' by Frank Thomas, I came across the following passage.
"Rule two. Congress can regulate all it wants but without enforcement it is meaningless. Immediately upon taking office, (Anne) Gorsuch did away with the EPA's Office of Enforcement. She then came up with a series of schemes that seemed designed to make the agency's work impossible: turning over enforcement power to the states; making toxic waste reports that had been mandatory into a handful of questionnaires that would go to only a hanful of polluters. ... But for the true believing wingers it was never enough. In a memo leaked in 1983, a particularly zealous member of Gorsuch's inner circle assailed a slightly less zealous colleague for being too strict on pollution enforcement and thus "systematically alienating the primary constituents of this Administration, the business community." " ('The Wrecking Crew', by Thomas Frank, Metropolitan Books, copyright 2008, pg 159)
It set me thinking about the primary constituents of the insurance companies and the motives of big business as it pertains to health care and whether or not it may be possible to entirely redirect the business motives of an industry into something more humane.
Currently, we are laboring under a system where the profit motives of insurance companies are entirely tied to providing as few services as humanly possible. With their feet held to the fire by shareholders and driven not only by the monumental profits that they have already racked up, but by the staggering amounts that it may be possible to reap by those whose growing bank accounts seem only to fuel their greed, it is no wonder that insurance companies act as they do. It makes good business sense to do so.
Every dollar that goes to customer care is one less dollar in their pocket. It is a zero sum game of chilling properties where total benefits for the customer can mean the death of the business, but total profits for the business means the death of the customer. It is a business model that exists as a permanent floating non-sequitur, but one where customers are currently powerless and all the rules are made in the corporate office, a situation entirely devoid of humanity.
Let's imagine, however, that it may be possible to change, at will, how the entire health insurance system works. What if we could change the game entirely at a single stroke?
Let us say that instead of an insurance company banking their profits directly from the customer, the monies derived from premium payments go, instead, into a holding company that is a mandated part of the insurance business structure. This holding company, a kind of health care escrow account, holds all payments by consumers.
The insurance company does not take its profits directly from this pool, but recieves a percentage of the monies that are paid out of it to the health care system when services are provided to their customers. Every time a medical bill is paid from the fund for health care for a patient covered by the insurance company, the company is paid out of the fund according to a percentage of the billing. This would put the focus for profits not on the lack of services provided, but on the number of services provided for the customer. The greater the number of customers, the greater the payment to the insurance company.
Additionally, since it is difficult to count on a constant rate of pay from the possibility that people may or may not need services, a certain amount of the total fund will be invested by the holding company in solid stocks with a good, consistent return rate. The profits from these investments would be split between the insurance business and the holding company at a rate of 80/20 in order to ensure a consistent flow of profits to the insurer for the continuation and expansion of business.
How interesting would it be to see insurance companies that, rather than purge their rolls of customers, actually go out hunting for more people to sign up? How different would it be to see the profit motive placed within the proper context- that of gaining profits from the services provided to the customer?
While I'm certain that this plan would have its own holes and areas of abuse, it may be something to think about. Maybe we can make this thing work after all.