Letters to the Editor
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In sickness and in health
Mr. O'Hehir's piece is right on the mark on this...
The point of the [for-profit healthcare] system is to treat as few people as possible as cheaply as possible, and those who get ahead in the healthcare industry are those who find ever more devious ways to deny coverage.
Denial of coverage is the name of the game, where experts (doctors, usually) are on the payroll of HMOs to come up with reasons to deny care to those who need it, or to second-guess your doctor's decisions (assuming your doctor hasn't already been compromised by lavish pharmaceutical incentives like sponsored trips or free samples or so on).
Our system works great, at least at generating revenue for the insurance industry and the HMOs and the pharmaceutical companies. Costs began to skyrocket in the mid-90s, per some Clinton-era changes in favor of HMOs, which then caused administrative and advertising costs to mushroom.
Now we end up with the crowning irony of drugs being advertised on television ("ask your doctor about Refusitol") to people who can't afford the drugs being advertised, or who'll be denied the drug if their doctor's not already on the payroll of the company in question.
There's so much ideological gunk (queue up unmonied defenders of the status quo or worldly opponents of "socialized medicine;" line forms hard to the right) in American heads on this issue that odds are we'll continue to avoid doing the sensible thing and adopting national healthcare until either the for-profit industry has wrung every cent it can from us (and gets out of the business), or until enough Baby Boomers get sick and old and pissed off about it to force a change.
Then we'll see an interesting clash of interests -- military budget versus health of citizenry. Maybe we should present it as a national security issue, as a way of getting attention to it: for-profit healthcare is killing Americans! We need to stop it before it kills again!
Perhaps the quickest way to start a revolution in healthcare would be to try to wean Congress, the Judiciary, and the Executive branch from the national healthcare they enjoy -- you ever wonder why Congressmen tend to live so damned long?
They wouldn't if they used the healthcare normal Americans used. Our "representatives" aren't representative when it comes to us -- so, anytime a GOPeon or a DINO rails against national healthcare, keep in mind that they're being hypocrites, that they enjoy national healthcare themselves.
So, maybe there needs to be a movement to call out representatives on that, on making them actually representative of their districts, where healthcare is concerned. If they won't push to grant us national healthcare, we should push to deny them national healthcare. It's only fair. That'll get those hypocrites to change their tunes pretty quickly.
And if they plead "we can't afford it" -- we can, if we just reprioritize our budget needs in this country. Every other First World country has it. They're doing fine, and are healthier than we are. Where's that Yankee Can-Do spirit?
My only objection to O'Hehir's piece was him sniping at Cuba at the beginning; for all its Castroist warts, Cuba does have an excellent healthcare system. Given our insane embargo of that little country, it's amazing that they have it at all, but they put a priority on the health of their people, and it shows -- compare Cuba'a health system to the rest of the Third World's, and you'll find it shames them.
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Taxes DO NOT "have to go up"
One of the biggest stumbling blocks to having an effective health care system in the US is the common belief, that seems to hold from the far left to the far right, that (paraphrased):
"We could have a great healthcare system, sure, but we'd have to pay more taxes."
Let me spell it out for you. W.R.O.N.G.
Commonly related to that belief is "Sure, the US system is expensive, but it's the best in the world!" Again, totally, completely, wrong.
There are countries in the world (Singapore, Czech Republic, for two examples) where health outcomes are better than those in the US, and in those two examples, the government pays many times less per person on healthcare than the US government pays per person.
And in case you think I'm cherry picking, there are many more countries where health outcomes are equivalent, and whose governments also pay substantially less: Australia, Canada, France, Germany, Italy, Japan, the UK.
That's the greatest irony. By reforming health care, the US could actually have a system that was better and also cheaper! Taxes, in other words, could actually go down. What's not to like!?
What's stopping reform is, in large part, not lack of exposure to sad stories (ala Moore's film; every family in the US has one) but simply erroneous assumptions like the two I mention above.
Tim Harford, in his excellent book The Undercover Economist, brings together much of the best research on the subject, and I heartily recommend his book (which also discusses economic "everyone wins" solutions for peak hour traffic!).
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Something new needs to happen.
You really can't deny health insurance companies are in business to treat as little as possible. People often complain about insurance through the looking glass of a patient coming through door. I work in a doctor's office and the other side of the curtain is littered with its own problems.
People who pay a lot of money for what they think is good insurance because they might not pay anything at the door or the fees are greatly reduced really might have a worthless policy. Some insurances like some DMOs or HMOs give a doctor a capitation check once a month for carrying so many patients on a roster. The fees paid by the insurance company for procedures done on people who are on your roster are substantially low with the thinking that the capitation check will pay itself off in the long run because there's more people on the list than people who actually physically enter your office for treatment. The people who do come in often get underpar treatment because the doctors get paid next to nothing for treating them and while the patients think they got away with nothing, treatment could be ignored, faulty, or sent out to a different office.
That's on top of the fact that doctor's offices will sometimes go by "best insurance" appointment. Meaning you might have the 11am appointment but you're just an HMO and the 11:15am appointment is a PPO, which pays better. You treat the PPO first and make the HMO wait. The idea is what patient will bring money into the office the fastest? Because it is not uncommon for many insurances to be late on checks and refuse to pay for treatment that's already been done.
Many doctors are not greedy but merely trapped in a vice. The ones who are in private practice have staffs they have to support, office upkeep, and their own home bills. The ones who practice in the corporate entities have to listen to some pencil pusher with maybe a biology degree on treatment plans so their office can make a profit because they have a board of directors to please.
What's so wrong about insurance companies is that they pull the strings on both the supply and demand sides of an issue that shouldn't even be calculated in supply and demand terms. People tout how much better care is in the USA but that's only because of our brillant doctors and universities not because of Aetna! This is the welfare of human beings and that's why everyone agrees there is something wrong with the system (except for the devil's advocates out there). I hope this film exposes people to the fallacy of a for-profit healthcare system.