Wednesday, May 31, 2017

Healthcare vs. Corporate Care

I posted the following essay in November or 2015. I think it is still a relevant picture of our healthcare situation in the U.S., and I think we can still say "With profiteering companies balking at providing health coverage, it is the perfect opportunity to look for other models of healthcare delivery."

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United-Health Group, Inc. is demonstrating what is wrong with healthcare in America – and it is not the Affordable Healthcare Act. The problem is our expectation of profit rather than access to healthcare as the measure of success.  The front-page news in last Friday’s Wall Street Journal (11/20/2015) read that UnitedHealth, the largest insurance provider in the country, is losing money on Obamacare and may pull out of the ACA exchanges altogether. The truth is that they are not losing money – it is just that they are not making as much money as they would like. A look at the New York Stock Exchange reveals that UnitedHealth has made profits for the first three quarters of 2015, and has done better than it did in 2014. The fact that the company would threaten to back out of its participation in the Affordable Care Act due to less than expected profits demonstrates that quarterly gains are more important than covering people’s healthcare needs.

Healthcare in America took a wrong turn when someone figured out that it could be a moneymaking industry. For-profit hospitals began to set the standard, then insurance companies and pharmaceutical companies quickly accelerated their profit making as well. One problem with the for-profit model is that not only is a profit expected, but the profit also has to be greater than last quarter’s profits in order to make shareholders happy.

There is a difference between making money and making a profit, as Peter Ubel pointed out in an article in Forbes Magazine last year (“Is the Profit Motive Ruining American Healthcare?”). Hospitals, insurance companies, and pharmaceutical companies have to generate enough income to pay salaries, cover expenditures, and have some operating capital. It is certainly important that hospitals and clinics remain solvent so healthcare workers can be paid for the work they do. It is also important that people have access to the healthcare we provide. As Peter Ubel put it, “No one should go bankrupt either paying for medical care or providing it. But that doesn’t mean health care businesses, whether profit or non-profit, should enrich themselves at the expense of society.”

If it is getting to the point that insurance companies cannot deliver policies that will cover the healthcare needs of the people because they think it is too risky for the company, then perhaps it is time to look for a different model. If UnitedHealth is representative of health insurance companies’ attitudes toward healthcare, then it is demonstrating the need for Medicare for all, or some other version of a single-payer healthcare system. Every other developed country has figured out how to provide healthcare for their citizens.

Political Opposition

From the day that the Affordable Care Act was signed into law, there has been continued opposition to it from Republicans.  Many of the arguments have to do with costs. Companies claim that added insurance costs hurts their ability to maintain a profitable business. Now the Republicans are jumping on the news that UnitedHealth cannot profit from ACA exchanges. They will look for any reason to make Obamacare not work.

The sad thing is that it is people in need of healthcare who will suffer in the ongoing political debate of how to make healthcare work and who will pay. One measure of a nation is how it cares for its citizens, particularly the sick, the elderly, and the needy. While other countries find ways to make healthcare work, the U.S. is mired down in politics and profits.

Putting People ahead of Profit

Steven Hill, a contributing writer to the book, Dream of a Nation has an article, “Tackling the Profit Problem in Healthcare: What the US Can Learn from Europe?” Hill poses the question,  “How do the French, Germans, British and other European countries manage to provide better healthcare than most Americans receive for about half the per capita cost?” One big reason, he says is one of philosophy, namely that “The various European healthcare systems put people and their health before profits.” He goes on to point out that not every European country has a single-payer, government-run healthcare system. “France and Germany have figured out a third way,” he says, that “appears to perform better than single-payer, but it also might be a better match for the American culture.” That “third way” is a hybrid that allows for private insurance companies as well as individual choice of doctors who are in private practice. In France and Germany, this hybrid is apparently working, but our own hybrid attempt with the ACA is being threatened now by corporate greed. We are missing that ingredient of putting people and their health ahead of profit.

Businesses seem reluctant to provide healthcare as a benefit, and insurance companies seem reluctant to accept a reasonable profit in providing healthcare policies. Therefore, it is time for the U.S. to make an investment in its citizens and find a way to deliver healthcare for all. If we had a single payer universal healthcare system, for example, it could be a boon for the economy and a shot in the arm for every entrepreneur.  I personally know of people who would like to launch their own business, but do not want to risk losing healthcare benefits they have in their present job. Indeed, there are many who are working at a job they don’t particularly like just to have insurance coverage.  So not only would big business benefit from not being saddled with healthcare costs, small entrepreneurs would have more freedom to do what the Republicans say this country is all about – start new businesses.

Why must we lag behind other developed countries when it comes to providing for healthcare needs of the people? There are some great ideas out there that put people ahead of profits and look to the common good. With profiteering companies balking at providing health coverage, it is the perfect opportunity to look for other models of healthcare delivery.


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