Problem: Our Profit Driven Health Care is incompatible with what we need and want
and insist on-----People Focused Health Care-----
The heart of the problem is a gigantic mismatch between what drives the providers, and what drives the health insurance corporations. These two groups see the world in completely different ways.
Caregivers' Motivation and Goals --
- Relieve suffering and improve function,
- Restore productive and enjoyable life, etc.
(and, incidentally, make a living while doing so)
Corporations' Motivation and Goals --
- Generate profit,
(Note that #2 requires lots of PR and lobbying to avoid being eliminated )
The caretaker (nurse, therapist, physician, hospital, clinic) is focused primarily on the wellbeing of an individual or of a community, and the caretaker's actions are governed by very practical considerations--e.g. urgency, availability of resources, cost. In contrast, the health insurance corporation is driven by the bottom line, its profits. Actions of the corporation are governed by what generates the most profit. They maintain a delicate balance between paying for a service on the one hand, and on the other, denying that payment to increase profit, all the while risking offending society enough to be forced out of business. (BTW, we may be close to that point.) During the past decades, the U.S. insurance industry has steadily grown and strongly influenced the way we take care of our people.
We can now see the distortions, gaps, and human suffering caused by applying "bottom line" decision making to health care.
Some activities just can not be governed by the bottom line. As a society we have idealized and inappropriately applied the business model as a good measure of excellence in all areas. We applied it to medical care and it produced the disaster we have now.
We deserve a little fun, so imagine the result of regulating some of our other activities by using a bottom line approach: child care, teaching, sex (how much per quarter hour, Dearie?), enjoying nature, storytelling, operating a museum or a police or fire department, dating, fighting a war. I'm sure you can think of more.
Eliminating the business model from health care--as we should--does NOT mean abandoning measurement of efficiency and quality. We absolutely need close monitoring of an operation this large and complex. We will simply measure by something other than profits. In fact, we already use many such measurements, for example, length of hospital stay by diagnosis, infant mortality, hospital acquired infection, surgical complications, turn around time for some urgent laboratory tests, and even customer satisfaction. Now, those are significant measurements of quality care. If you combine a few of those, you can get a good picture of the overall efficiency of the system. And of course a health care system needs to monitor how much it is spending to do the job.
When we allow our health care system to be organized by Health Insurance Corporations they do NOT focus on getting the most bang for the buck, but on getting the most bucks out of the system.
OK, here's your ammunition, the brutal rules of operation for a health insurance corporation:
-- Health Insurance corporations exist to earn money. The only reason they show any humanitarian or charitable trait is to improve their public image, so they will be allowed to continue existing.
-- Health Insurance companies make a profit by collecting premiums and then returning as little of them as possible to their customers.
-- Health Insurance companies are Profit Oriented, not People Oriented, so decisions about your care are governed by their bottom line. They don't care if you stay healthy, suffer or die, only whether it costs them money.
-- Health Insurance companies HATE for you to get sick--but only because it costs them money.
-- Health Insurance companies search for ways to stop your insurance coverage if you become seriously ill.
-- Health Insurance companies prefer that you die suddenly rather than have a long, expensive illness with a good chance of recovery.
-- Denying or delaying your claims increases their profits, so they do it constantly.
-- The only useful function of health insurance is to spread the cost of serious or catastrophic illness among many people. It shouldn't cost 20% of the premium to accomplish that.
I'll try to keep this short because we need to be making some phone calls, faxes, emails...
These facts show that health insurance companies are not motivated or equipped to give us the kind of health care we want, need, and deserve. As corporations, their main purpose is to generate profit for the benefit of their owners, stockholders, and executives. That built-in bias should disqualify them from organizing, planning, or providing health care. Any plan that they offer will be in their own best interest rather than that of the public, or it will waste everyone's time figuring out if it is a truly neutral proposal.
The single useful function of health insurance is to spread the financial risk of major medical events over many people. Since these companies do not have our interest at heart, they should be restricted to their single useful function--insuring risk.
We absolutely need some form of government guaranteed health care that does not involve insurance companies. And we need it now. Not having a public option for full medical care weakens our country.
Demand a public option for full medical and dental care.!
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