on the morality of our current broken health care system...
As a medical provider who receives payment form insurance companies for my services I am curious as to where the dramatic cost increases the system puts upon the insured every year go. I know it's not coming to me, nor does it seem to be coming to my fellow providers. In fact in a conversation this past week with a colleague who is an MD he tells me his reimbursements have been decreasing over the past decade. Mine have remained stagnant. I suppose this means we as providers are not part of the problem of rising costs for health care.
What is the problem? As I see it as long as we have a health care system that is motivated by profit, we will never have a good quality of care. If I am a for profit insurance company providing health insurance, any of the premium dollars I paid by policy holders that I don't have to spend on health care I get to keep as profit. As a profit oriented business that is my primary concern, not the health and well being of the policy holders.
How did that work out for the largest insurers....
The five largest U.S. health insurance companies
sailed through the worst economic downturn since
the Great Depression to set new industry profit
records in 2009, a feat accomplished by leaving
behind 2.7 million Americans who had been in
private health plans. For customers who kept their
benefits, the insurers raised rates and cost-sharing,
and cut the share of premiums spent on medical
care.1 Executives and shareholders of the five
biggest for-profit health insurers, UnitedHealth
Group Inc., WellPoint Inc., Aetna Inc., Humana
Inc., and Cigna Corp., enjoyed combined profit
of $12.2 billion in 2009, up 56 percent from the
previous year. It was the best year ever for Big
Insurance.
The outsize earnings are a vivid reminder that
without comprehensive national health care
reform the gatekeepers of our broken health
insurance system always will put the short-term
interests of Wall Street before the needs of millions
of patients and a national economy plagued by
joblessness.
The 2009 financial reports from the nation’s five
largest insurance companies reveal that:
• The firms made $12.2 billion, an increase of
$4.4 billion, or 56 percent, from 2008.
• Four out of the five companies saw earnings
increases, with CIGNA’s profits jumping
346 percent.
• The companies provided private insurance
coverage to 2.7 million fewer people than the
year before.
• Four out of the five companies insured fewer
people through private coverage. United-
Health alone insured 1.7 million fewer
people through employer-based or individual
coverage.
• All but one of the five companies increased
the number of people they covered through
public insurance programs (Medicaid, CHIP
and Medicare). UnitedHealth added 680,000
people in public plans.
• The proportion of premium dollars spent on
health care expenses went down for three of
the five firms, with higher proportions going to
administrative expenses and profits.
More on this here
So when I watched what little of the "health care debate" I could stomach it became clear to me that the process was mislabeled. It should have been called the insurance company profit preservation debate. 12.2 billion in profit means 12.2 billion that did not go to cover actual health care for people. In my mind this is both unethical and immoral. It is the symptom of a broken system. I tell the people that I provide services that symptoms are messengers trying to tell you something is wrong. The discomfort they cause is ideally a source of motivation for one to try to figure out what is wrong and how to fix it. If you ignore symptoms they tend to yell louder over time. Increasing costs, rising numbers of uninsured, record breaking profits for insurers, are all symptoms of a seriously ill system. The sad reality is that it's not just our health care system that is ill. How do were treat the illness. Make health care nonprofit, and reduce administrative costs to no more than somewhere around 3%. If 97% on the dollars spent on health care actually went to health care people would likely be amazed at how much better the quality of care will become at a lower cost. If the system is nonprofit it will then not matter if you have many insurers or a single payer system. Either way most of the dollars spent on health care would actually go to providing care.