This post is follow up commentary on an essay about this subject in the Washington Post February 17, 2012 written by Bob Reiss (http://www.washingtonpost.com/opinions/how-health-care-costs-are-taxing-the-middle-class/2012/02/14/gIQAJHFiKR_story.html). This essay, in my view, is a complaint, which does not offer guidance towards a path of real solutions for our healthcare system. Perhaps, it was only intended to be a complaint. But the rhetoric in it is confusing and not all that helpful, except for the major point of the essay which I think is that people in the economic middle class, who both pay taxes and purchase health insurance, are going bankrupt to pay for the greed of the private sector and the phony ideology of the politicians who regulate the public sector.
Let me look at some of this rhetoric a little more closely:
1. Ford, Chevy, and Cadillac health plans: What does this actually mean? How is it that this type of thinking is part of our healthcare system? No one can accurately predict what their illnesses and thus the cost of caring for those illnesses are going to be. Until Johnny Carson arises from the grave and resurrects his role as Carnac The Magnificent, why do we tolerate this dollar-based game of predicting the future from our health insurance carriers, whose sole function is to administer payment of the bill to hospitals and doctors?
2. …he was indigent and could not afford care. Why are the words, indigent & unable to afford, part of our healthcare vocabulary at all? They shouldn’t be. The proper primary goal of our healthcare system must be seen as clear and equal access to sound, ongoing, non-conflicted health care for everyone living in America at an affordable cost, which does not bankrupt individuals by any mechanism. The dollar bill is NOT a primary goal and, although important for our way of life, must be relegated to a secondary supportive role in our healthcare system. The word, indigent, is, in my view, discriminatory in a healthcare context and places an adjectival curtailment upon health care, which must be sound, ongoing, and non-conflicted by the dollar bill or anything else.
3. Premiums paid by the middle class go up when the federal government tells insurance companies which services they must provide. This sounds correct but it misses a major mechanism by which health insurance companies justify their increasing premiums, deductibles, and other dollar-garnering ploys: The Cost Shift, which is a dollar game played by hospitals and health insurance companies. To the extent that public programs are not adequately funded through general tax revenues and trust funds, and the uninsured get care for which they do not fully pay, hospitals must attempt to “tax” the privately insured to make up the shortfall (http://content.healthaffairs.org/cgi/content/full/25/1/22). Some of this shortfall is absorbed by increased hospital efficiency or decreased emphasis on hospitals’ social missions, but much of the difference eventually resurfaces in the form of increased health insurance premiums (ibid). Of course, remember that hospitals are dollar-driven business empires functioning locally in their individual communities. So how much of what hospital billing departments charge for a service or product represents minimum cost to them for that service or product is debatable, as the words, not-for-profit, become more and more bogus.
Conclusions: Our healthcare system is a Big Dollar Pie with every type of healthcare business conceivable, including doctors’ practices; hospitals; health insurance companies; drug & technology companies; and many others, grabbing as big a fistful of dollars as possible. Until a system is developed in which the outflow of dollars paid by every person living in America is controlled in such a manner that necessary healthcare businesses are properly compensated including the absolute need for solid profit above cost, while actual health care for everyone living in America is structured such that access is clear and equal and that the care itself is sound, ongoing, and non-conflicted, essays like that in the Washington Post and on this blog will simply be blowing in the wind. Such a system has been described and ignored (Equal Health Care For All & Socialized Health Care Reform— see the books page of this blog). I wonder why! And, why do we tolerate multimillion and billion dollar health insurance carriers, when all that we really need is a clerk to administer payment of a bill for healthcare services and product to necessary healthcare businesses?
R. Garth Kirkwood, MD