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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Why Employers Should Not Be Saddled with Providing Healthcare Benefits

There is a growing reluctance on the part of the private sector to provide healthcare for the public. Aetna announced this week that it is withdrawing its policy coverage in the healthcare exchange for the Affordable Healthcare Act (often referred to as Obamacare). It cites loss of revenue as the reason. This comes after the Republican bill which passed the House of Representatives last week which would eliminate coverage for millions and would go back to not covering pre-existing conditions in addition to placing a cap on coverage for cancer and many chronic illnesses. 

All of this brings to light the economic burden that healthcare-for-profit places on employers as well as private citizens. Families can easily be pushed into bankruptcy and poverty by a single illness, and businesses face a competitive disadvantage on the global market when they have to factor in the cost of employee healthcare.

I posted the following essay in December of 2013 and I offer it again today because it is becoming ever more clear that the private sector is lacking in both motivation and in resources to provide the level of healthcare that all other industrialized modern countries currently provide for their citizens.

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It is often difficult to have a rational conversation these days about healthcare. People often speak in near-doctrinal terms when expressing their views on healthcare delivery. To question their views may bring on a plethora of accusations about one’s loyalty, faith, or patriotism. Here are seven brief reasons why I think that the provision of healthcare should not be left to the realm of employee benefits provided in the work place.  

• Employers, especially large companies recently, have shown a reluctance to grant employee benefits by shifting to the use part time employees. Moreover, some companies now claim that they cannot do more job creation as long as healthcare coverage is required.
• Small companies (with fewer than 50 employees) are not required to offer health coverage at all.
• When healthcare is linked to employment, the unemployed have very limited  healthcare  options. I know a case in which a man became ill and was diagnosed with cancer. Fortunately, he had decent health insurance. Unfortunately, when he became too sick to work he was terminated from his job. With his termination from his employment, he lost healthcare coverage while he was in the midst of fighting his illness.
• In the global economy, U.S. companies are competing with companies in other countries where employee healthcare is not part of the employer's operating budget, making it more difficult for the U.S. to stay competitive. This makes it more likely that U.S. jobs will continue to dwindle, increasing unemployment rolls. (See The Wall Street Journal's break down of employer's benefit costs here)
• Employees’ income is often at the whim of employers and at risk in times of recession and corporate cost-cutting measures. At the very least, their healthcare should not be at the whim of employment circumstances.
• A healthy workforce is good for business, therefore good for the economy. It stands to reason that access to healthcare should be available to all potential workers as well as all current workers.  
• Part of the government’s role is to foster an environment conducive to enterprise. Roadways, bridges, water supply, postal service, and education are a few examples of what the government does to foster a productive community.  Providing access to healthcare is another important factor in insuring an adequate workforce and fostering a healthy environment for business and industry.

A Society that Works

There are three things that make for a society that works for all of the people: access to education, access to transportation, and access to healthcare. When a society can insure that its populace has access to education, transportation, and healthcare, there will be a higher level of productive participation on the part of its citizens.  Industry and society can only benefit if there are better educated workers whose health needs are addressed and who have adequate transportation. Just as the private sector alone cannot be expected to build a society’s infrastructure, the private sector cannot be expected to adequately provide for the population’s healthcare needs.  When we can learn to take the burden of healthcare off individuals and employers, as in a single-payer healthcare format where all are covered, then we can make better progress as a society.

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