Monday, July 27, 2009

Ok, So Do You Really Want To Fix Healthcare?

The OECD, is a cooperative organization of 30 countries (including the United States), that are focused on economic growth. Their mission statement reads as follows:

  • Our mission
    OECD brings together the governments of countries committed to democracy and the market economy from around the world to:
    - Support sustainable economic growth
    - Boost employment
    - Raise living standards
    - Maintain financial stability
    - Assist other countries' economic development
    - Contribute to growth in world trade

    The Organisation provides a setting where governments compare policy experiences, seek answers to common problems, identify good practice and coordinate domestic and international policies.

Okay, so why a reference to OECD on a blog post regarding Health Care? Well, the reason I point you toward the OECD (check out their site by clicking the link above), is that it is an organization focused on economic development and growth. They have excellent statistics on a wide array of subjects, including Health Care Spending.

Let us look at some reference points.

1. The United States has the most expensive Health Care "system" in the world.

2. The United States has almost 50 million of its citizens without health insurance. These people have to exercise "last resort" options when they are ill. Examples include people taking their children to Hospital Emergency Rooms for basic infections. Another 17 - 20 million people are estimated to be "under-insured" (as of 2003), which means their coverage is not adequate for their needs and typically they will have to make up the cost for the gap in their coverage.

3. The United States does have a public health care option, it is just not "universal" in that not just anyone can join. Medicare and Medicaid, have been providing service to the elderly and the impoverished since the late 1960's, and it has been working very well. Our country is one of the few industrialized countries that lacks an overall public option.

4. Our Health Care system has not improved infant mortality rates, the average life-span of its citizens, nor provided better preventative care regarding chronic illness such as diabetes, asthma, etc. than countries who have a Public Option.

Why do we have the most expensive system in the world and one that is not as effective as other countries like Canada and the UK? Well, there are many opinions and possible answers to that question and this post is not going to attempt to answer the "Why" question. However, there is likely only one way to gain control over the costs and improve the overall quality of service of our Health Care system. We must provide a public option system that sets the stage for a "single-payer" system on the model of the Canadian and British system. I do not believe we need to eliminate private, for-fee insurance and health care. If you have the money and elect to exercise that option, it should be your choice. However, no one should have to make a decision on whether or not to pay rent or get their medications. We have a crisis in the country with more people uninsured than make up the entire population of Canada.

Those of us with jobs who have decent health care (me included), often unintentionally ignore the plight of others who don't have good coverage. While sympathetic, we are also apathetic and complacent. It is a complex problem that most of us get overwhelmed with and look to the government to solve the problem. Then, opponents of government intervention will castigate the efforts to resolve the problem as attempting to bring evil "socialism" to our shores, which will "destroy our American Way of Life". If you think there aren't crazies out there (in congress as well (See Michelle Bachmann)) who think if we provide health insurance to everyone, we will all fall from God's good grace, you are fooling yourself.

More insidious are the Industry lobby. They are spending over $1.5M per day in efforts to lobby against health care reform. That's half a billion dollars in a year! Think of how many people that could treat who don't have coverage! Why are they fighting this so strenuously? Well, why do they keep building hotels in Las Vegas? 'Cause there is money in this business; Big, Big money. Insurance companies are fighting this with everything they have, and don't want reform. Too much money is at stake.

So, it falls to us, the well insured, to step up and say enough. I've had it with the system. We must see massive change in order to treat everyone equally. I'm not a religious man, but I do recognize the wisdom in the following statement: From Matthew 25:40 - "The King will reply, 'I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me." Simply put, let's treat the least among us the way we'd like to be treated. It is an obligation those of us fortunate enough to be able to afford good health insurance must take on.

The way change comes is when those who are well served by the system recognize it has faults and elect to make a change for the greater good.

I'm a "dyed in the wool" capitalist who checks his stock portfolio every morning. I do not subscribe to the notion that making money is necessarily bad. However, when profit takes precedent over treatment, I must re-think our approach to a system that is focused on making money over treating illness.

Here is some more data for you. If you have to consider the reason why the compensation for CEOs of the Top Health Insurance companies is so robust, you might think that it is because of the excellent care and products they offer. You would however be wrong. The reason their compensation is so high, is that the companies' boards of directors and compensation committees set the salaries by and large based on the financial performance of the company versus any positive result of care given. See the list below for compensation levels from 2007 and 2008:

Ins. Co. & CEO With 2007 Total CEO Compensation
Aetna Ronald A. Williams: $23,045,834
Cigna H. Edward Hanway: $25,839,777
Coventry Dale B. Wolf : $14,869,823
Health Net Jay M. Gellert: $3,686,230
Humana Michael McCallister: $10,312,557
U.Health Grp Stephen J. Hemsley: $13,164,529
WellPoint Angela Braly (2007): $9,094,271L. Glasscock (2006): $23,886,169

Ins. Co. & CEO With 2008 Total CEO Compensation
Aetna, Ronald A. Williams: $24,300,112
Cigna, H. Edward Hanway: $12,236,740
Coventry, Dale Wolf: $9,047,469
Health Net, Jay Gellert: $4,425,355
Humana, Michael McCallister: $4,764,309
U. Health Group, Stephen J. Hemsley: $3,241,042
Wellpoint, Angela Braly: $9,844,212

Now, I don't have a quarrel with people making a lot of money. I really don't. If the money earned is based on a reasonable metric focused on the improved health care of it's customers versus one that is unfortunately engineered to do harm to the community it serves that it intends.

The current method of making money by the insurance companies requires decisions that run into direct conflict with care giving. Denying coverage is not done because the companies are mean and want the patient to stay sick or die. It's because providing the coverage is expensive and will reduce their profits. That's it. That's the entire reason the Health Care system is as fucked up as it is. Profits before treatment.

Check out Michael Moore's brilliant "Sicko" for an example of what happens with the big Insurance companies like Humana, Aetna, etc. etc. His documentary discusses people with insurance coverage who wind up bankrupt simply because they had the temerity to get sick.

If you really want to fix health care, you have to remove Profit as the overriding reason a health insurance company is in business. Find another way to reward your shareholders or executives. Earnings Per Share = Denial Of Coverage, and it's about time this equation changed. Wouldn't it be cool if a company made half a billion dollars because it was able to reduce the rate of cancer or obesity or diabetes in the country and it was rewarded not by profits of drugs or denial of service, but because of the results of a service provided that improved the lives of its customers?

Tell me what you think,



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