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We've done several shows in the last few weeks on the healthcare system, and one issue that keeps poking up is the question of profit. Our commenter Albrecht explored this most fully when he asked:
Is it moral to profit hugely from the illnesses and medical care needs of our fellow citizens?... Is the free market, or the profit motive, in fact always the best option? Or are there undertakings in the life of our communities and our nations that serve us better when done in common, that is, socially? We undertake fire protection, policing, and education in common, or socially. Why not health care?
With various health care proposals in Congress, some watchers — and not just the insurance industry — are nervous about a "public option," and what it might mean for the economy at large. On the other hand, advocates for reform point to profit as one of the main reasons the current health care system is broken, citing rising costs and tens of millions of Americans who are un- or under-insured.
Where do profit and healthcare intersect for you? Do you have insurance through a for-profit company — or a non-profit insurer? Do you go to a doctor-owned clinic, or a public hospital?
Are you a doctor, or a medical or pharmaceutical researcher? What might be lost — and what might be gained — if profit were taken out of the system?
GUESTS:
- Matthew Carlson: Assistant Professor of Sociology, Portland State University
- Thomas Miller: Resident Fellow, American Enterprise Institute
- Wendell Potter: Senior Fellow on Healthcare at the Center for Media and Democracy and a former chief spokesman for CIGNA Corporation
Tagged as: insurance · medicine · public health · rx
Photo credit: Tracy O / Creative Commons
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"It's not immoral for insurance companies to make a profit. It's immoral for them to make too much profit that enriches shareholders instead of customers."
But where do you draw the line?
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Dave,
In our current system we know that personnel, equipment, medicine, facilities and administration incur costs.
There are health care systems in the country and world where people have excellent health care for reasonable cost. If we apply the best practices of effective and efficient health care we will discover how much it actually costs to provide excellent service.
The U.S. stock market has returned 11% on average over the last century. Inflation has averaged 3% (I'm not sure about this) over the same time. Let's cap profit for all business at 20-25%. I have a huge problem when a handful of people are compensated with billions a year in benefits and bonuses. This process must be revised to be more egalitarian.
The salary inflation of executives and mangers that has ballooned over the last four decades must be revised. Many executives are compensated 1000-10,000 times more than least-paid employees and that is unreasonable.
Let's cap executive pay at 10 times of what their least-paid employee earns. So if a line worker earns $10/hour the top-paid executive earns $100/hour. Bonuses would be capped at 25% of their hourly wage and should only be paid when an executive does something to actually improve their business. Bonuses should be earned, not rubber-stamped by peers.
If we reduce executive and middleman excess compensation we will money to create a more egalitarian, efficient and productive society. Trickle down economics does not work -- this has been shown definitively over the last two decades.
Finally, we should revise the tax system so that the complexities that allow executives to stay rich and workers to stay poor are eliminated. I'm sure we can simplify the tax form to one page where everybody pays their fair share of taxes.
it's a matter of will, Dave. If somebody hands us six and seven figure salaries most of us are not going to push it away and say, "Thanks, but no thanks. That's too much money given there are people standing at busy intersections begging passing drivers for money."
We control the economic system. There is no "free market". The word "free" implies that excessively rich people are "free" to make the system as unlevel a playing field as they can get away with without being thrown in jail.
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If you look at the huge numbers of people desperate for medical, vision and dental treatment who are attending medical "expeditions" in this country perhaps the truth of what the health insurance companies have done to this country might be a little more "real" to people indoctrinated from toddlerhood with the concept of laissez-faire capitalism. Capitalism run amok is the culprit. Socialism is not the answer but more regulation of capitalism might be the only thing that will save millions of lives and get the American population back on a healthy track. My personal belief is it IS immoral for insurance companies to make a profit on people's sickness. I recommend Bill Moyers' recent journal presentation on this issue as well as some basic research on the "medical expeditions" in this country which is looking more and more like the Third World every day.
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When we talk about profiting from medicine, I have a question/thought about what we mean by "medicine" and where the boundaries are drawn. Are we referring to the actual service side of medicine: the patient care, the hospital or the doctor's office? Does this extend to the manufacturing side of medicine and related industries such as pharmaceutical companies and other makers of medical devices and equipment?
It seems like there is perhaps a big difference between the service side, insurance side and the manufacturing side of medicine---and also how we view those industries. Hopefully I am not just naive on this distinction. But I wonder if there is some consensus of thought on this differentiation among ethicists and what the thought process is. Perhaps the question I am asking lies in something like this: Does the further you get away from providing the actual service of medicine lessen the impact of profits or change the "moral" implications? Or is it the same throughout the entire chain or industry?
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I would draw a line between service and manufacturing. The military is a perfect example. There is an obscene amount of money to be made in defense contracting and plenty of people willing to volunteer for the military.
A for-profit military would be a scary scary thing, but I don't mind people making a profit on the manufacturing side. Though, I'm not sure how someone can design something like a cluster bomb and then go home and sleep at night.
An interesting question would be: would manufacturing innovation remain, but with different priorities? Would we go back to the days when we used to discover cures for diseases instead of developing "treatments" that conveniently provide a continuous revenue stream?
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Where do insurance companies fall? We seem to talk about this mostly from the insurance side, which I can understand, because they hold many of the cards and power, but I am assuming everyone is making excessive amounts of money.
One thing I want to know: who is profiting the most? Are all parties manipulating the system to the maximum of their abilities? Clearly things are costing more, I assume not just on the insurance side, but from every side.
You said the service sector profiting is what bothers you, but what about pharmaceuticals?
Why should a doctor inserting a hip replacement and perhaps his hospital not profit but the manufacturer of the hip replacement should profit. Aren't these products an extension of the care or of medicine itself? Because they are not like computers or carpeting within a hospital that clearly can be used by other businesses; medical equipment and pharmaceuticals are only used directly in health-care. There is some weird thing about this line we seem willing to draw that I can't exactly figure out or define. I feel like there might be some merit in this separation, but I can't figure out what it is---yet.
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It just seems odd that we focus on the people who are closest to providing the care or are at the bottom of the chain in some ways. I guess perhaps they also seem like easy targets in a way. It would be awkward for hospitals and doctors not to profit, but have everyone else profiting only because they aren't at the front-lines of care. It would seem really inequitable for pharmaceutical and medical equipment manufacturers to make excessive profits and then the people providing the actual patient care not to profit.
I am not sure where insurance companies lie on the chain either. Do we have a problem with them more then pharmaceuticals because they are sort of ethereal and intangible, a sort of middleman. Insurance companies of course don't add anything to the service of medicine, they are a layer that profits solely off the top and gets their dividends from the work of actual life-savers.
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Yeah, I messed up in what I said.
Speaking mostly from a managerial position in a medical software company, I do not think manufacturers are pulling the same profit ratios as insurance companies.
Even if they were, though, I do not think it matters. Medical manufacturers add value to the system. They research and develop newer, cheaper, better devices and software.
Using that metric, hospitals, clinics, and such should profit because they do add value. I had blinders on and just assumed you meant insurance companies. I would imagine that they would have to win contracts like defense contractors to make those profits, but that seems to work fine for the defense industry.
Talking about profit is kind of missing the point anyway. It just seems like a way to rally the masses in a class struggle like way.
The real point is that insurance companies provide essentially negative value.
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I would like to agree but I can't! There is an inherent and terribly important philosophical question about whether it is okay to profit from sickness or medicine. I think the show didn't entirely address it, or not in a conceptual way---perhaps it is too esoteric to discuss on a show like this. Or you would at least need an ethicist or philosopher to talk about it.
Are you saying that everyone should be able to profit from medicine but insurance companies?
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I think I muddied things up by not thinking my first post out well enough.
I think insurance companies should simply go away because they derive profit from providing no (or negative) value to the system. At best, they are administrative overhead. At worst, they deny care, or even access to any care, based solely on profit incentive.
So, step 1, make them go away.
Then the question is: should anyone else profit from health care?
I only see profit as a problem when it becomes the deciding factor in someone's health.
For manufacturing, that is not really a problem. There are already consequences for manufacturers that cut corners.
For hospitals, private practices, clinics, and labs, it takes more...
If you settle on a single-payer system with clearly defined, or at least uniform and level, reimbursement policies, you would probably eliminate a lot of the profit-centric decisions made on the service end while still allowing profit.
If you have the government reimbursing for everyone instead of just requiring that hospitals treat everyone regardless of ability to pay, then service providers will have much more predictable revenue and be able to make more legitimate, patient-oriented moves to increase revenue and profits.
Patient care and profit are not mutually exclusive. They are just not inherently proportional.
This is somewhat contrary to another post of mine earlier, but that post was made with the same blinders focusing only on insurance companies.
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A similar question: if is not moral to make a profit on health care, is it moral to make a profit on the sale of food and water?
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I (probably) think there is nothing wrong with profiting from health-care in a morally normative or universal sense. But, I am sort of a moral skeptic anyway. I don't think a specific instance of one company profiting on health-care is an issue, but rather can an entire medical system provide care in an ethically responsible way, when it is driven by profit. I think the answer is no, at least for our system, because it hasn't been able to work so far. We as much as acknowledge this with programs like medicare and medicaid. In order to provide care to everyone (even currently) part of the system is essentially not for profit. But we sort of ignore this in the discussion.
If anything, you would assume that we should object more to the prices we pay to care for people under medicaid and medicare, because these non-profit programs have to pay for-profit prices to care for people who aren't cover-able, because the profit system we currently have has no room for them. So we have already acknowledged by proxy that profit doesn't manage our entire system effectively.
While food is similar (I think) there is a conceptual difference between eating and medical care. Medical care is a human-made service to which there are no other options available, or not at least any price level options. I can buy cheap food or I can buy expensive food, I can't do the same with medicine, there are no other cheaper medical options that I can get by on. Even with food if people are starving we try and step in and give refuge (hopefully). Medical care is generally a negative or a repair. Should you help build my house for me? No. But if you can stop it from burning down, shouldn't you try?
I think if medicine is public on some funding level but the system providing the care is private, it would be odd (perhaps immoral) to make excessive profits off the collective resources and good will of a society that wants to take care of all it's people.
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Why is it so hard to see the insurance companies as the only problem in this discussion. We need a single payer system. Let those that make their living from the illness of others go out and find a real job.
I am very wary of Obama's health care plan. If it gets passed then that means all the lobbyist's from the insurance companies have gotten their way. What then?
Private health insurance is dangerous to the health of the nation and all its inhabitants-except for all those employed by the private health insurers.
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"Let those that make their living from the illness of others go out and find a real job."
Doesn't that include doctors, nurses, x-ray techs, and on and on?
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Yes that does include doctors and others that seek to profit excessively from the pain and sickness that occurs.
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To me, then, the interesting question is: what's excessive profit? And who should decide?
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I'll decide. Or let George Bush decide. He was the original "decider".
Let's cap doctor's pay at $100,000 a year. If that's not enough for them they can leave and get a job on Wall St.
And, please, don't get hung up on doctor's pay. Their income is not the problem. The excessive profits of the insurance companies and their investors--- that's the problem.
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1 insurance co. CEO = 10 doctors+20 nurses+30 techs
1% dividend to shareholders = 100 health care providers
I'm just making up the numbers, but my point is: maybe this is part of the decision on "excessive"?
Here's a number I didn't make up: $300 billion/year just to process insurance claims paperwork (have you seen the ads that say "start a career is medical insurance claims processing" ?).
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As I understand insurance, it's original purpose was to share risk so that any single large calamity would not destroy a company or person's finances not as an engine of profit. Shippers would band together and pool their money so if a ship was lost, the ship's owner(s) could continue in business.
Today, publicly traded insurance company's primary fiduciary responsibility is to it's shareholders so wouldn't it be not only immoral, but unethical and illegal, for an insurance company executive not to take actions denying as many claims as possible? Examples of such actions include paying bonuses for claims denials or policy rescission for any reason whenever and wherever profits may be adversely affected. Insurance companies take these actions regardless of the consequences to the insured and even when illegal.
Further, just as an automobile insurance company will go after the driver that caused an accident for damages, why are insurance companies not attempting to get companies that create added health costs to pay for those added costs?
The problem we face today with medical insurance companies, as well as with pharmaceutical and other medical companies, is that they exist to provide profit to their shareholders, not to provide health services to their customers. Just as a pharmaceutical company will bury a safer and more efficacious drug in favor of a more profitable one, health insurance companies continue to accept premiums while having full time staffs of doctors, lawyers, and bureaucrats to ensure their ability to fight and decline payments regardless of the adverse affects on the claimant and her/his family.
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"...they exist to provide profit to their shareholders, not to provide health services "
That's very true: I expect you'd find that in their Articles of Incorporation (something like "maximize return to shareholders"). So it IS their legal responsibility to do so.
What bugs me is that they advertise that 'service is Our primary concern' ("We're here to serve you", "Safety is job one"). I'd like to see some ad agency sued for FALSE advertising!
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I don't see why medical care couldn't and/or shouldn't be an effective for-profit professional comodity. The better you are AT YOUR JOB, the more you make.
The problem is that the majority of the profit is going to someone other than the health care provider -- a gatekeeper, if you will, whose primary motivation is solely profit, NOT health. Further what "profit" there is for our health care providers themselves is going for "services" and not for actually providing HEALTH.
The motivation on all sides is just wrong. And until the system actually rewards all players for the outcome we want, it isn' t going to work
I would PREFER that basic preventative and wellness care be publicly subsidized and provided for free to all, because it is a public benefit for the whole population to be as healthy as possible. But how does it benefit us as a nation for the government to be in, say, the transplant business? That is where we need insurance and maybe even for profit competition.
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The better you are AT YOUR JOB, the more you make.
Not true in general. A similar myth is that profit motive ensures companies will act in the best interest of their customers.
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The profit motive only operates to make companies act in the best interest of their customers if customers MAKE them do so by voting with their dollars. If custmers buy better, safer, higher quality products and not worse ones, then the system works.
The flow of information and incentives in the health care system is very poorly set up to enable the end customers to do this. Indeed, health care in general is a very poor candidate for the operation of the "invisible hand," since the nature of health and sickness means that individuals (1) have a very hard time assessing what products and services will make them healthier than others, (2) are often in extremis and not in a position to shop around or make great decisions, and (3) will often pay whatever is necessary for a very small potential improvent in health.
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"The better you are AT YOUR JOB, the more you make"
I think maybe that's still true at the low levels: a line manager rewards a worker for a good job. But it doesn't seem to be true at the high levels: executives get large bonuses even if they make decisions that result in losses (like we're seeing at financial, investment and banking companies).
But I like your thinking: single payer basic preventative care and private insurance for the fancy stuff. Have you thought about running for Congress?
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The health care debate should center on a simple question; is equal health care a right or a privilege? If it is a right, then the government should supply the means by which all citizens can receive equal care. If it is a privilege, then we can continue to operate the system for profit.
If we decide that health care is a privilege and not a right, then we can dispense with the notion that all peoples' lives are equal and recognize that people with money have more of a right to life than do the poor. Let's face it; under the current "for profit" system, those with money who develop cancer can get the best care in the best hospitals that money will buy and will likely live. Those who do not have money will receive lesser care and will die.
What we're really discussing is whether the life of a poor person is less important than that of a rich person.
Gary B in Beaverton, OR -
It seems to me that, if you are concerned with rationing, then there is no room for any profit in health care service.
The notion that you do not want government between you and your doctor is ridiculous. Today, you have a for-profit entity between you and your doctor that makes decisions for you and your doctor based on guidelines established to maintain profits.
So, while there may be rationing in a single-payer system, at least it will be for the benefit of the tax payers and it will be uniform.
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At least with the system we have now, one can go around the insurance company and directly pay the health care provider, or go to an alternative provider of your choice (if you have the money). I seem to remember from the Clinton plan that doing something like that would have been illegal!
And if one works for a large employer, there is usually choice between rationers (insurance plans); once a year you can switch to another insurance if you didn't like your present one.
As much as I do not like insurance companies rejecting claims, they do provide a service in that it does help to keep costs down. If they do that too often, they should eventually lose all their premium paying customers, although employers don't always care ; [unfortunately there may be a delay, and the CEO can resign with a golden parachute before the long term consequences.] The insurance companies also keep cost down when they negotiate with “preferred providers” and pay less than the regular rate. How would negotiation work if there was only a single payer? (Although sometimes I think the rates are artificially high because they become the starting point for negotiation. When I was uninsured and saw a doctor for about the third time, I asked if I could get a discount since I was paying in advance and out of pocket, the doctor without hesitating marked 50% off my bill. I wish I had asked the first time.)
I would feel much better if there were more insurance companies, with more true choice, transparency, and regulation rather than a single-payer system. I would also like to see a system that rewards those that eat healthy, exercise, don't smoke, choose least cost solutions etc. And unreward those that do the opposite, while not punishing those that cost more due to no fault of their own (accidents, birth defects).
Bob
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Health care should always be non profit. People should not get into health care if they think this is a good way to make a lot of money. Unless, we have campaign finance reform, we are not going to get a non profit health care system in this country.
I hope Oregon and Washington will adopt single payer as allowed by an ammendment in Congress.
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There is a third option for insurance companies that used to be pretty common in the US, a mutual insurance company. In this type of company, the policyholders held partial owner rights and input into management. Many insurance companies de-mutualized in the 80s so they could grab more profits and pay higher salaries/bonuses.
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I have worked in the healthcare industry for the past decade. As someone who is intimately familiar with the structure and organization of today's pharmaceutical and biotechnology companies, I cannot see how we could expect future innovation if we capped profits. On average, it takes 10 years and upwards of a billion dollars to bring a new therapy to market and less than 10% of compounds entering the clinical development process make it through to approval. If it wasn't for the motivation to profit, would these companies even bother to do this work? I doubt it.
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You're right: most companies don't bother to do this work. Most breakthroughs come from basic research by salaried researchers (often in public Universities, often with government grants). I suspect that those researchers are motivated by 1) wanting to get a paycheck AND 2) wanting to discover new knowledge.
Then private companies, usually motivated by profit, put those discoveries into mass production.
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I do not support needless greed! But keep in mind, profit drives desire, desire drives innovation and innovation in health care cures sickness. How many innovations have been made in a Canadian type health system? Reform is necessary but be careful what you ask for. Long lines to see a doctor may be acceptable for someone that doesn’t work. But I work 10-16 hour days and don’t want to wait in line behind a homeless person. I work harder and deserve better treatment. Sorry but capitalism is natural, survival of the fittest. In the wilderness if you don’t work you die.
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Why can't a company be innovate and motivated without profit being the goal?
When we talk about profits we are talking about money above and beyond what people are actually getting paid as salaries---which is somewhat obvious, but also important---it leads to a question: If you take the profit away from the company itself don't you still have the same researchers and scientists doing their job and getting paid? If all the researchers and scientists are well paid, but just the shareholders/executives are not profiting, won't you still have the same output? You would---because you still have the same people doing the same work.
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innovative
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I do not support needless greed! But keep in mind, profit drives desire, desire drives innovation and innovation in health care cures sickness. How many innovations have been made in a Canadian type health system? Reform is necessary but be careful what you ask for. Long lines to see a doctor may be acceptable for someone that doesn’t work. But I work 10-16 hour days and don’t want to wait in line behind a homeless person. I work harder and deserve better treatment. Sorry but capitalism is natural, survival of the fittest. In the wilderness if you don’t work you die.
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Profit isn't the only driver of innovation. There are people who just like to solve puzzles.
I, too, have had to wait in "lines" for doctors (last visit I waited 2 months, next visit is 5 months away!). I think that's due to doctors having to see too many patients because there's not enough doctors (or nurses).
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The for-profit model favors inequality. The best services go to those with the deepest pockets. What hasn't been mentioned is that many of our problems are interelated. This issue also ties into higher education costs as institutions seek to profit off education. Doctors and nurses cannot be blamed for wanting to make money as they can easily be enslaved by debt. This in turn can force doctors to go into specialties and away from general practice.
I really think we should socialize education and healthcare as doctors and nurses really do perform a public service. -
I have just finished reading a fascinating article in the June 1, 2009 issue of "The New Yorker".
"The Cost Conundrum, What a Texas town can teach us about health care" by Atul Gawande, explores the differences in individual doctor practices in hospitals and clinics which operate for profit and non-profit.
The article raises many interesting questions and thoughts which aren't usually a part of our national discussion. I recommend it to anyone who wants to better understand the debate from a different angle.
barbarabott
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I have recently heard that the insurance companies are the largest lobbying group in the country, rivalling the NRA and the tobacco industries for legislature attention. Some representatives and senators have been threatened with adverse advertising in their districts if they don't favor insurance companies.
I believe insurers should be highly regulated at the national level if they continue as for-profit, lobbying companies.
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Your American Enterprise Institute guest is an outrageous prevaricating propagandist!
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Cost Transparency--
A couple of years ago I had a non-cancerous lump removed for comfort reasons. I had high deductible insurance at the time, so I knew I would be paying the whole thing myself. The procedure took 20 minutes, and a return visit to remove stitches.
First, nobody could tell me up front what the total cost would be, except that it would be more than I expected. After the procedure, I got a TOTAL of seven bills for it over a period of 13 MONTHS through the insurance company, that totalled close to $1,000. I started calling the doctor by the third one to find out what was going on. What I was told variously were things like: "We bill each item separately for clarity." "That test is required, even though we knew it would be negative." "That is a different lab cost. We have know control or knowledge about that."
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Katied expresses the misconception most patients with insurance have. What gets paid out to health care providers and what gets billed to patients is totally dictated by the insurance company rules. Providers and patients are opt out from making these rules. She needed to query her insurance company about these concerns.
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As a nurse I see daily problems in the health care industry. People are able to demand care, doctors are able to practice without oversight to their efficacy, the insurance companies make huge profit, and the charges for services are purposefully confusing.
The system should not be for profit- we could move our system to a science based system using best practice evidence. The profits now are only used to promote drugs, equipment and procedures that might not be the most effective.
I entered the field to help my fellow citizens; the reality has left me disheartened and searching for another way to make a living.
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How can we find out how much money each Senator or Congressman receives from the Health Insurance and Pharmaceutical Companies ?
Katie A., Bend, OR
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I think health care should be like police and fire protection: well paid professionals dedicated to "protect and serve" -- part of society's infrastructure, available to everyone, supported by everyone.
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I do not support needless greed! But keep in mind, profit drives desire, desire drives innovation and innovation in health care cures sickness. How many innovations have been made in a Canadian type health system? Reform is necessary but be careful what you ask for. Long lines to see a doctor may be acceptable for someone that doesn’t work. But I work 10-16 hour days and don’t want to wait in line behind a homeless person. I work harder and deserve better treatment. Sorry but capitalism is natural, survival of the fittest. In the wilderness if you don’t work you die.
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The cost of care keeps going up in part because hospitals run like businesses. They must advertise, keep updating their equipment to attract doctors to fill their beds. Prices for procedures are set by the market. In every other country even those with "private" systems, the government sets the price for procedures like MRI scans. The invisible hand has been slapping us silly.
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Of course, revenue has gone down for the insurance companies - people have lost jobs, companies have gone out of business - and those who lost their group coverage either can't afford insurance or are denied due to pre-existing conditions. Their market has shunk - that is, the market which can give them the big profits.
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Moralizing about the profits made by insurance companies is beside the point and counterproductive.
Insurance company profits account for less than 1% of health care costs in the US. Still a very large amount of money, but hardly the driver of the problem.
The polemic that insurers (or drug companies, or hospitals, or doctors) "profit from the sickness of others" is sensationalist and not helpful. The entities and people in the health care system provide services and products needed by people who are sick, or who don't want to get sick. We might as well say that farmers "profit from the hunger of others." It's an equally true statement, and equally unhelpful.
The inability of our health care system to provide coverage to so many people, despite the enormous amounts we spend has to do with many structural flaws in the delivery system and incentives in the system. The problem is not profit. The problem is that we have created a system that creates profit for participants from the wrong things. We need to make it more profitable for doctors and health plans to provide preventative care for everyone, rather than specialty, curative care for a select few.
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There is nothing sensationalist about asking whether it is moral or ethical to profit from medicine. It is an incredibly important question, that has been asked before. Our medical system has clearly and indisputably been shaped by profits. Profits are the driving force that created the "structural flaws in the delivery system." We need to know how we got here, as much as we need to know how to fix the current flaws within the system.
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One guest is talking health care & profit; the other is talking health insurance & profit. These are two very seperate issues. Our legislators talk 'health care reform' when they really mean 'health insurance reform'. Lower health care costs would affect insurance costs; but lower insurance costs won't lower health care costs.
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(OPB and TOL need more computing power to handle peak web traffic. I am getting repeated proxy errors, bad gateway, etc... I am typing this into a document and will copy and paste it after I successfully login.)
A few different some what unrelated points.
The main problem is that most people get their health care paid by insurance, and the individual does not have a lot of incentive to get the best treatment per dollar spent. With insurance mainly provided by employers, the whole system is skewed and free market principles don't apply.
I have a chronic disabling condition, lets call it “back pain.” I would be more than happy to pay say $200,000 (and out of pocket!) to anyone that could guarantee that they could cure me enough to allow me to have a normal life and regular work. If that would result in obscene profits, so be it. I would be so thankful.
Doctors should be able to advertise and publish their rates, providing transparency to the consumer.
Do any major insurance companies provide incentives to the consumers to wisely spend, such as profit sharing with the individuals or employers (premium rebates) when claims were less than forecast? How about a law to require this?
A couple of weeks ago I saw an old medical bill, where I was billed $29 for a doctor office visit in the 1990's. These days, I get billed $150 to $250 for similar visits.
Bob
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Considering the fact that there are only a few large insurance companies, aren't we simply setting ourselves up for an insurance crisis in the same way that we set ourselves up for the current economic crisis - where we will end up needing to bail out one of more of these large providers simply because they are 'too big to fail'?
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There is no more conflict between government administered single payer insurance and individual choice of care givers than there is in the current insurance system. I have health insurance through my employer and I find that not all doctors are approved by my insurance company. Does this constitute "dictating my choice of doctors"? It would be no different under single payer, government administered insurance.
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This is so true - not to mention the fact that when I do see my 'doctor' more often than not I actually see their 'physician's assistant'.
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I also don't understand why people think single payer would be some kind of panecia. You'll likely still have strange rules - and even the oregon health plan 'prioritizes' services to it's members. That is why I feel any arguments about specifics of coverage are not useful in these conversations of policy. *Every* coverage system makes tradeoffs and prioritizations. You'll always find someone unhappy with what is covered.
However, when really bad things happen like folks being cherry-picked, or your long-standing coverage getting suddely canceled because you came down with cancer - that's another matter.
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Good health for humans should be an inviolable right. Human greed has gotten in the way of creating and efficient and effective society.
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The health care coverage for all can not be solved until root cause of the problem is addressed. The insurance industry must be required to operate under the same rules as the greater economy. COMPETITION. Currently the insurance industry is exempt form anti-trust laws and exercises anti-competitive behavior. For more details see H.R. 1583.
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Near the end of the 08/06/09 “Think Out Loud” conversation about outrageous behavior by medical care insurance companies, I was taken aback to hear the assertion made – unchallenged – that no proposal for excluding insurance companies from the medical arena was being considered. That is patently false. 07/31/09, House Speaker Nancy Pelosi promised that the full House of Representatives will debate and vote on the national single-payer plan of payment for medical care: HR 676. (See YouTube “Waxman to Weiner: Pelosi Will Allow Single-Payer Full House Vote!” and YouTube “Weiner Pushes for Single Payer Plan”.) http://www.youtube.com/watch?v=H0fA2DfwFn4&feature=related and http://www.youtube.com/watch?v=NOqE4dzsDgk
Single-payer is clearly on the table.
Indeed, at his 07/22/09 news conference, President Barack Obama said this: “I want to cover everybody. Now, the truth is that unless you have a what's called a single-payer system, in which everybody's automatically covered, then you're probably not going to reach every single individual.” http://www.whitehouse.gov/the_press_office/News-Conference-by-the-President-July-22-2009/
He’s quite right. He knows it, our Senators and Representatives know it, and we know it. A majority of Americans, and of American physicians in clinical practice, favors a national single-payer system of payment for medical care. The AFL-CIO of Oregon favors single-payer, as do more than 20 other union organizations in Oregon; such other occupational groups as the Oregon Nurses Association, the Oregon Academy of Family Practice, the Oregon Federation of Nurses and Health Professionals, the Oregon Education Association, and the Oregon affiliate of the American Federation of Teachers; and the County Commissions of Lane County and Multnomah County.
(Detailed documentation is available on request.)
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We should leave the "rich" and "poor" dichotomy out of this debate. There is no inherent moral component to being rich or poor. Rich people are not inherently bad and poor people are not inherently good, which is essentially the conclusion you draw from the way many use these terms. Poor people don't stay poor because it is the moral way to be, and given the chance many poor people would act horribly if they had access to money. We should stop using these terms so willy-nilly---and to explain every argument or define who is bad or good. Overuse probably annoys many people, it is an unfair assumption and it also usually isn't relevant to the argument.
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It is hard to see how "rich" and "poor" can be left out. I agree that there is no moral component to being rich or poor - but there is a moral component to behavior. Things are stacked heavily in favor of the wealthy. The possibilty of getting good health care and education beyond high school level decreases drastically as family income decreases.
In the past, we have prided ourselves as a nation as being a moral example to the rest of the world. How do we square that with the fact that despite our national wealth, we have one of the poorest health care delivery systems of the industrialized nations? How do we square that with the fact that people who do not have the good fortune to be born into wealthy familes find it next to impossible to get a college education?
We should be working to ensure that we are truely born with equal rights. Those rights include basic health care and education to the highest level that a person is intellectually capable of attaining. I also believe that ensuring these rights is the best way to ensure that our country remains a moral leader in the world, a leader in development of technology and one of the most prosperous nations in the world.
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People try to say too much about the wealthy and imply more then is actually there. Besides it being totally inaccurate it gets tiresome hearing so many people, over and over again talk about rich or poor, like they are talking about good and evil.
Yes, I pretty much entirely agree with your comment. But. There is a not a moral component to the actions of rich people or poor people across the board. There is an inherent problem perhaps with certain people from these groups; or on a conceptual level being ridiculously wealthy when other people are starving. These concepts are also relative, because by some standards all Americans are wealthy.
I think a statement like "things are stacked heavily in favor of the wealthy" implies too much, that isn't really there. It makes it seem like there is some conspiracy occurring. It is like saying "Neiman Marcus is stacked heavily in favor of the wealthy." Well of course it is! Isn't anything that costs money, especially a lot of money stacked heavily in favor of the wealthy? The health-care problem in the US is an inherent problem to a free-market without socialized health-care---irrespective of what rich people are up to.
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I haven't heard a compelling argument as to why the for profit model of health insurance is so much better than a non-profit option would be. What can it offer me as a consumer that I would not be getting if I opted to go with a non-profit? My small understanding of free market pricipals is that the consumer will drive prices down because they will go with the best and least expensive model, thus creating price wars. The problem with putting health insurance in the free market is that the insurers hold the cards. The consumer frankly does not have choice once they have seen a doctor for any condition that merits a flag - even minor conditions - they are denied coverage or given options with very high deductibles. How does this drive competion? I have my own opinions as to the morality of putting profit in health care, but it seems to me the agrument can be broken down into much more concrete, dollars and cents (sense) issues.
Nancy
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Consider this also: I worked for several years in (the software end of) the health care industry. The last such company I worked for made their money by providing insurance providers with data regarding the deniability and/or lowest cost option possible for the services submitted; for this service, they were paid on average $8 per claim. At the time I left, they were in the process of going into the business of completely processing the claims, for which they would be paid an average of $30 per claim.
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Comment about changing morality, censored.
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Tom,
I'm not sure what happened with your comment, but we didn't do anything on our end!
Dave
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One thing that wouldn't have to change in a profitless system, is the quality of care. We all know the studies that say how America ranks in comparison to the other developed countries with largely socialized care.
There are many people who then argue: well even if the quality is the same, you perhaps have to wait around for services and may not have as much "choice" in the type of care you receive and who is giving you the care. It seems as though those concerns lie largely in the area of customer service and convenience. But even under a more socialized system those who can afford it can always pay for whatever level of medical luxury they desire.
So what now? Why object? This essentially leads to: I don't want to pay for someone else's care. And why should some jobless layabout have the same medical care as I do when I work so hard? We don't want anyone getting a free-ride.
In matters of life and death the uninsured will generally get care anyway at the local hospital and someone will pay for it. Not to mention that even the staunchest capitalist is effected by the high costs of medical care in the US in comparison to the global market. To provide health-care to employees, companies in the US pay more for the same care that in other countries is provided by a public system. If the quality of care (the most important element) is the same in a public system it would seem absurd not to adopt it, not only would care go up for everyone, but it would also cover and help a greater number of people.
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TOL, if you are going to have a guest from the extreme right, like The American Enterprise Institute, why don't you have a guest from the extreme left to balance him, like Communist Party USA or the like?
Then a moderate person like your other guest can reasonably represent the centrist middle, and you have all your bases covered.
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Since I e-mailed NPR requesting them to add a program about the history of the morality of profiting from healthcare to their heathcare series, and since I knew a little about that history and how it has changed and whose morality changed, I tried to post about that today and was censored from doing so.
It used to be considered immoral to profit from healthcare.
I got an error message that I was over 2500 characters.
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Which was obviously untrue, so someone did some kind of censoring, somehow.
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Maybe the "loglady" is a saboteur!?
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We have got to find a way to seperate our discussion into different components, with different solutions.
1. Preventitive and Primary care - society has a strong interest in funding it. This is a very small part of the 'Medical costs' pie.
2. Work related accidents/illnesses - society also has an interest and a responsibility.
3. No fault accident/illness - Societie's interest here is more contingent on future potential productivity of the patient. [ This is potentially the most sticky area to sort out. Institutional charity becomes an obvious candidate to play a role.]
4. Lifestyle related accident/illness - The charity of family/friends, or private insurance makes the most sense in these cases. [ Again, a hard area to draw boundaries around. ]
5. End of life/heroic measures and cosmetic surgery - Leave these exclusively to the private insurance companies. They know how to assess risk and will adjust rates accordingly. Society has little interest in this very large part of the 'Medical costs' pie.
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Even he works in a bookstore doesn’t mean he don’t care bout fashion. He have interest in fashion. You can see that in his appereance everyday. He is always smells good too. Its nice to stand near him.
free business listing -
Comments are now closed.
It's not immoral for insurance companies to make a profit. It's immoral for them to make too much profit that enriches shareholders instead of customers. When will we decide that our capitalist, winner-take-all system only benefits the few instead of the majority? We have allowed greed to triumph over well being every time throughout history. I don't consider 80-90% of the people being impoverished anything to gloat about. Our vaunted technology and cleverness means nothing as people starve needlessly because a few privileged people want to live in sand castles on the beach at low tide.