Wednesday, October 14, 2009
For-profit health care will fail
From the RoundTable blog
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W.D. Clarkson
Clarkson, of Check, is a psychiatrist who has been in private practice in Roanoke since 1969.
It is no surprise that after months of wrangling and debate, health care reform is foundering, with the likelihood that only a watered-down version is emerging based on for-profit insurance, which almost certainly will fail.
True health care reform has been defeated by the opposition giving financial donations to key politicians of both parties and mounting a successful propaganda blitz that would have made Joseph Goebbels proud.
We are the only developed nation in the world with a for-profit health care system. Among the 23 wealthiest nations, we are the most expensive but are next to the bottom in quality of care delivered to our citizens. The irony is we have the best care, if you can afford it, but have the worst health care system.
The main complaints are escalating costs and lack of access. But the primary driver of costs is not being mentioned in the debate: Wall Street investors.
On Wall Street there is relentless pressure to show ever-increasing profits each quarter, otherwise the company stock will be summarily dumped. Since all the available profit has long since been exhausted, insurance companies resort to raising premiums and co-pays, denying care and insuring only healthy people.
It is of interest that hedge funds are major investors in health insurance, the same folks whose greed contributed to our present worldwide financial meltdown.
The opposition has denigrated government-run health care, the best example being Medicare, which treats the most high-risk, insurance-using segment of our population. Medicare has only about 3 percent overhead compared to anywhere from 15 percent to 30 percent for private insurance. Most of the latter goes to underwriting (denying care to those who need it most), paperwork and profit to investors. If you don't like government-run health care, burn your Medicare card and try getting private insurance.
However, unless payments to primary care doctors are increased beyond current Medicare levels, most reform benefits will be useless, since doctors could not afford to treat patients. With adequate compensation, the projected shortage of physicians would correct itself.
There are other efficiencies being proposed that could reduce health care costs, but don't count on these being passed on in decreased premiums. Instead, these savings will go to investors. "Doing health care reform right" are code words for doing just that.
Another issue raised in the debate is the threat of malpractice and its handmaiden, defensive medicine, which certainly contribute to our costly health care. But lawyers aren't all to blame. Our present health care insurance rewards testing and procedures, but gives short shrift to providing adequate time talking to patients. Asking the right questions and getting an accurate history can provide the diagnosis 70 percent of the time.
It's the same process you hear on "Click and Clack," the automobile mechanics on National Public Radio. In fact, medical schools have recommended that students listen to the program to better hone this skill.
Many needless malpractice claims could be forestalled if insurance and the legal system permitted doctors to adequately explain the situation to patients up front.
Lastly, when a malpractice suit is unavoidable, a major part of the award goes for future health care of the injured patient. The lawyers then take a large portion of the award. With private insurance, most of the patients would be deemed uninsurable. If everyone is covered by private-option insurance, awards for future health care would essentially be off the table. With the malpractice prize shrinking, it would be less enticing to lawyers and the cost of malpractice insurance and defensive medicine would be reduced.
The bottom line is that, for the reasons stated, for-profit insurance is destined to have continually rising premiums and decreased access ending in catastrophic failure, but in the process undermining our individual and national economy. Only a nonprofit system like Medicare can reduce costs and improve access and quality. The rest of the world recognizes this fact, but some countries must learn it the hard way.
