"Let's meet the corporate power structure head-on and go toe-to-toe with them in the marketplace!" At least that's what more of you think will get rid of insurance companies faster than anything else. I'm not so sure.
I was really surprised to find that the most popular choice among those voting in last Monday's poll on a way to get rid of health insurance companies was for the government to try to play the game with the existing rules.
- 31%: Compete with private insurance using a public option that does not exclude pre-existing conditions, does not limit or rescind and guarantees never to cancel. All checkups and preventive procedures have no copayment.
Most readers may not have been as intent on getting rid of private health insurance as I am. Those who prefer the public option competition strategy may be more focused on just getting health care and think it's possible to do that while allowing "free enterprise" to co-exist alongside a robust, universal, public health system.
Let's have a reality check here. Allowing for-profit entities to continue operating in any way allows them to hold health care for ransom. When health care has to be bought and paid for, even in a single-payer system, it is constrained, hindered and inevitably diminished.
The question in the poll was, "How do we get rid of health insurance companies?" I asked this because I'm convinced that that is what we need to do to get decent medical care for everyone. For 31% of you to have answered as you did, it means that you really think that having the government compete with private insurance companies, that is, offer health insurance coverage to people just like a private company, will get rid of the private companies. I'm not saying that this couldn't work, but I don't see any reason why it should. Competing with the private sector, using their rules for the game, would drive them all out of business quickly only if the government were allowed to run the operation at a loss and undercut premium rates. Given that unlikely scenario, what would the insurance companies do when their market share began to slip? We've already seen how their stooges in Congress screamed bloody murder about the inclusion of a public option in any health care reform bill, and we've seen the lengths they went to to kill the public option. What makes you think that private firms would just roll over and die quietly as the government ate into their current stranglehold on medical care?
They would fight, long and hard, to keep the sweet deal they have now. We heard the first arguments about "unfair competition" and their longing for a "level playing field". Didn't that strike you as odd? These champions of free enterprise were griping about competition. What would they really like? They want the competition rigged so that they will win, that is, make more money and be chosen by prudent individuals over any government plan which would cut them out of the action. The only way for that to happen is to require the government's premiums to be just as high as theirs. What's the point of having a public option like that? Doesn't anyone want to cut the cost of care, which now includes the 30% rake-off by insurance companies? If anyone thinks that this could work, please tell me how in a comment. I don't think it can. Here's why.
The insurance companies want to stay in business, that is, keep making money without providing any added value to their product, the health care that everyone needs, but only some can afford. They want complete laissez-faire in extracting wealth from the populace by holding the health care services we should have as a human right for ransom. There is no way to placate the dragon by sacrificing virgins or a share of the crops. The dragon just gets bigger and bigger until it eats you. Sooner or later, you have to slay the dragon or be consumed by it. So, who or what is our St. George? Have you got it yet? It's us (the people) or them (the corporations). It's a struggle to the death and only one side can win.
And, that's why I asked all of you how to get rid of insurance companies. I'm tired of pussy-footing with these bastards; I've been getting jerked around by them all my life. I thought that no one would pick the public option competition strategy because they would see it as inherently flawed as I do. I was wrong about what people would think and now I am trying to figure out why.
The attraction of that option must have been my enumerating the features we would all like to see in health insurance as we now know it. Getting rid of exclusions, rescission and pay-out limits evidently made a lot of you salivate. You were thinking that such a system would mean good medicine at an affordable price. The idea of putting a greater emphasis on preventive medicine, by banning fees for routine checkups and disease prevention, such inoculations and diet counseling, was the cherry on top. Yippee!
I'm not faulting anyone for this optimistic, hopeful vision of a benevolent, caring society growing ever more happy and secure as a direct result of a dynamic, capitalist economy structured to permit unbridled free enterprise. We were all taught that in school, just as we were taught that anything that sounded like socialism, such as social democracy, was really just a euphemism for communism. We all knew how bad that was. Today, if you say "socialized medicine", an alarming number of people still think only of brutal, totalitarian dictators like Stalin and Mao Tse Tung, and visualize an Orwellian nightmare of gray-garbed industrial slaves trudging from their drab, prison-like apartments to even more horrific, prison-like factory workplaces. I know; I still have an occasional nightmare like that, but it's about working in a cubicle for corporate America and seeing no release but death.
The reason for my cynical, jaundiced world view as opposed to the Pollyanna-like orthodoxy of official American culture is that I went to college (the first time at least) at a major public university in the late 1960's. That experience forever biased me against the assumption that our political, economic and religious leaders knew what they were doing and had our best interests at heart. I was shocked to find that there really was no valid rationale for depleting our national treasure and spilling the blood of our youth to fight an unjust, unwinnable war in Southeast Asia. The slogans of "fighting communism" and "defending democracy" were unmasked as false fronts for neocolonialism. We didn't have any better reason to be in Vietnam than the Chinese or the French, who each spent centuries trying to dominate it. We were being told to fight and die to the sake of corporate profits. Our popular national philosophy, as touted by corporate media, was exposed as a crock of excrement that in no way resembled anything the founding fathers actually thought, said or wrote. That's the problem with political science and economics classes at the college level; you get a whole different slant on these topics than you did from the distorted, watered-down drivel they spoon feed you from kindergarten through high school.
Given these philosophical epiphanies, and a modicum of exposure to tear gas and police batons in demonstrations (where we protested against such things as the theft of student-owned property by university administrators or their refusing to name an auditorium, built with 90% student funding, after Martin Luther King, Jr., but named it after the corporation that kicked in the other 10%), I was wary of anything the government did that increased corporate wealth and power.
That's why now, years later, when Republicans tell me that the solutions to the health care crisis is to let private enterprise continue to run amok, pillaging the public coffers and rationing health care the way they have been since the rise of private medical corporations starting in the 1950's, I say, "No more!" I didn't buy it in the 1960's when they wanted me to kill brown people in Asia for their greed. I didn't buy it in the 1980's and 1990's when Reaganites took over and converted the USA into an engine to exterminate the middle class and reduce them to wage slavery, extract wealth from the working class and drive them into poverty, and squeeze every last dollar they could from the misery and despair of the poor. And, I'm not taking it now when they tell me that some private company is going to take a whole lot of money from me, and provide me with all the health care I need. How big a sucker do they think I am?
The so-called "public option" and "free competition" for health insurance will inevitably degenerate into another scam to funnel ungodly wads of cash straight into the pockets of the super-rich corporate elite. The details of such plans are irrelevant: Any scheme that permits private insurance companies and medical service corporations to continue operating more or less as they do now will end up being a bonanza for them which will be funded by continued suffering and misery among the general populace. Medicine has to become a public utility, like police and fire protection, before everyone can get the care they need.
And that's why I think that health insurance should be abolished. I'm firmly committed to that idea and not likely to be dissuaded.
The highly touted "public option" might be a lot better than what we have now, and I would support it if it were in place, but I'm wary of taking this path because it is still based on fee-for-service reimbursement. I think that making health care professionals keep books and bill for payment perpetuates the institutionalized health care denial system we have now. No matter how you slice it, putting a price on each atomic health care service delivered shifts the bulk of effort from providing those services to keeping the books, which is of no use whatsoever. But, paperwork isn't the topic today; it's whether or not a government-backed insurance plan would be viable in today's market.
Well, of course it would be viable. Any government-backed plan would have to allow anyone in. That means everyone who was gouged because of a high risk profile would stop looking in the private sector and go with the public option as soon as they were identified as a "poor risk". Similarly, anyone who had ever been canceled or denied coverage by a private company would immediately go with the public option because they would have no where else to go. What about the poor, who cannot afford $700 or so a month for insurance? The public option's sliding rate scale would be their only option. Soon, everyone the private firms didn't want, who could afford to pay anything at all, would be enrolled with the public option.
This is exactly what the insurance companies would like. The government would take over delivering health care to those who really need it, leaving them to "cherry pick" whom they cover. If anyone didn't look like a chump who would faithfully pay premiums and never make a claim, the private sector insurers would price them out of the market or just deny them coverage altogether, driving them to use the public option. Insurers are in the business of collecting premiums from their clients, not the business of paying for their clients' health care. Remember, every dollar they do pay out is a "medical loss" and every dollar they don't pay out is available for necessary operating expenses, like offices, equipment and miserly salaries for their wage-slave workers in cubicles, but also for outrageous executive salaries and bonuses, Lear jets for executives, conventions at resort hotels for executives and a handful of mid-management suck-ups, and, lest we forget, (drum roll...ka-ching!) PROFIT! Is this what you really want?
Giving the blood-sucking bastards at big insurance companies a free ride is not the best way to deliver health care. Such a system would not only shift the burden for paying for the bulk of health services actually rendered to the government, but allow the private sector to maintain and expand their highly profitable skim operation. If anything, it would make them more profitable. They take 30% off the top right now. Imagine how not having to deal with sick people would affect their profitability! The Wall Street model of socializing losses (through government bailouts) and privatizing gains (with obscene salaries, bonuses and stockholder dividends) would reach its ultimate expression. Eventually, the only people with health insurance from a private company would be very rich, very healthy people. Everyone else would be covered by a government plan.
The problem with this two-tiered system is that we would still need to keep track of charges. Have you ever looked into the back office of a hospital? There are rows and rows of desks manned by clerks filling out forms for insurance companies and Medicare. If they don't outnumber the medical care staff, they are still a sizable segment of the personnel for any large facility. But, again, we're not talking about the inherent wastefulness of useless paperwork today. OK. Fine.
If we did have a public/private split in the insurance system, the private firms would always be bickering about how to get more money. Their behavior in the last few decades proves that there is no limit to their greed. The more money they make, the more they think they should be able to get. Placating them and buying them off by, as they like to say, "letting them keep a place at the table", is nothing more than letting them continue to exploit us all.
No, no, NO! This craziness has got to stop. Private, for-profit entities have to be cut out of the game completely. Letting them keep even a toe in the game perpetuates the dysfunctional management of the health care system. They have to be put out of business to allow unrestricted access to health care services. That's what we want, isn't it? When you need medical care, you get it, no questions asked. I don't want anyone to second-guess the medical professional who thinks I should receive any kind of care. If he or she decides I need it, then I should get it. That's right. No government bureaucrat ever stands between the doctor and the patient in a socialized medicine system. It's an insurance claims adjuster, working for a private firm or a government agency, who tells the medical professional that they will not pay for the service to be provided. Only in a fee-for-service model does the decision to give a patient a service hinge on its cost. There may be other factors involved, like supply and demand, but the mere fact of a person not having enough money never in and of itself excludes that person from getting the service.
Why is it necessary to destroy a capitalist enterprise to facilitate the distribution of its product? Isn't that burning down the barn rather than opening the barn door? No. It is not the same thing at all. It is necessary to remove private enterprise from the scene to keep health care from being an economic good. You might ask, "What's wrong with that?" Plenty. Being an economic good is at the crux of the problem. All our problems with medical care stem from this fact. It's no coincidence that where medical care cannot be bought, at any price, but is dispensed immediately at the discretion of a medical professional, they don't have any of these problems.
If being treated by medical caregivers is an economic good, then it must be bought and sold. Thus, if you need it, you don't get it unless you have enough money. There's no way around that. If you can purchase insurance, you are pooling your risk (and allowing the insurer to make money by administering that risk pool), but you're still screwed if you can't afford insurance or your insurance doesn't pay out. Health insurance, no matter how it is structured or who administers it, relies on the premise that, at some point, someone can be denied medical services for want of money. It doesn't matter if it's your insurance company denying your claim, Medicare saying that it doesn't cover the procedure or the fact that you can't pay in cash, you must suffer and possibly die because someone, somewhere, will get less money if you're treated. There is no way around that if medical care is an economic good. There is also no way for that to happen if medical care is not an economic good. I'm sorry if that sounds too pat or looks suspiciously like an artifact of Marxist dialectic. Explain why I'm wrong.
Before you start weeping for the health care providers and the insurance clerks whose lives might be ruined by excising the profit motive from the health care sector, calm down and consider the true nature of supply and demand. The notion that per-incident payment for services is necessary for a health care system to function is a hysterical fallacy fostered by exploitative capitalist fear mongers. If health workers got paid without keeping track of everything they did for billing purposes, they would be just fine with it. They have no vested interest in fee-for-service. It's a bother and a distraction from what they are really interested in doing, which is providing health care. Making a living is important to them, just as it is for everyone else, but it's not even the most important reason they do what they do. Like educators and artists, they generally love their work, and would reluctantly abandon it only if it failed to provide a standard of living roughly equivalent to others with a similar level of training and experience.
If insurance companies were outlawed by a wave of a magic wand, what do you think happen to the health care delivery system now in place? Would the workers shut the doors, go home and mope? I don't think so. Look at what happened in countries with socialized medicine where the government fell apart and stopped paying them. When the Soviet Union collapsed, Russian health workers wages were frozen and sometimes they were not even paid at all. Inflation ate away at their purchasing power. Still, most of them continued working at their jobs. Plenty of them took up another line of work, but most of them couldn't do any better anywhere else, so they hung on. Some kept at it because they felt a sacred obligation to practice medicine and would do so as long as they could.
I don't think Americans would behave much differently. With no payments coming in from insurance companies, the only entity who could be billed, outside of the patients, would be the government. People would pay in cash when they could, but clinics and hospitals would keep operating. What else are they going to do? All medical services would come to be dispensed in the same way emergency rooms operate now. When someone is brought in with a gaping wound, they treat them first, then see about filling in forms.
Here's where supply and demand come in. When supply exceeds demand, the price drops. When the opposite is true, the price rises. How long do you think hospitals and clinics would remain vacant while steadfastly demanding payment in advance? We have a lot more medical care resources than most people can afford to pay for out of pocket. We have the highest medical costs in the world, and it's not even close to being the best there is. How long do you think it would take for market forces to start bringing costs down? How long would it take for the people to demand that Medicare be extended to everyone?
The workers' livelihoods and lives would not be destroyed. In our free market economy, they might do quite well. Those who had better opportunities in another employment sector would change jobs. Those who didn't would make do as best they could, just like the Russians. Sooner or later practical people would figure out innovative ways of using health care resources (people, facilities and supplies) to address the demand for health care services. Remember, health insurance is illegal in our alternate reality, so anyone who didn't want to be a hard-hearted Scrooge and turn away Tiny Tim for lack of ability to pay would have to do something else.
There would be medical care subscriptions, where they treat you for whatever you've got as long as you pay your regular subscription fee. That sounds like insurance? It does, but the subscription would have to be a "no matter what" contract, without exclusions and not subject to cancellation, or it would fall under the blanket ban on health insurance. There would be low-cost, shoestring clinics where they did their best to give you some kind of care that you could afford. There would be charitable clinics that did not charge at and only took money in the form of donations. Oh, wait. We have all those things now, medical service subscriptions, cash-only strip mall doctors and free clinics.
Why aren't these alternatives to insurance-driven medicine more popular? It's fear. People are terrified of taking risks and will pay almost anything for a promise, even if it's mostly empty. That's American health insurance, a pig in a polk. It's got to go, and I'm still trying to figure out how to do that. The free clinic and USPHS angle is as close as I've been able to get to a realistic plan.