Journal Mekkis's Journal: Why the Private Medicine System Doesn't Work
These thoughts have been rattling around in my head for several weeks now, after having attended a National Hemophilia Council conference and then most recently, having seen "Sicko". The debates I've gotten into over the past several days have made it necessary to move my thoughts from out of my head and onto the page so I can think about something else for a while.
Health care is expensive. We all know this. The increasing cost of health care is fast becoming the #1 issue facing the American public, if it's isn't already. Along with Iraq war, the situation surrounding health care and health insurance is the chief topic of discussion in the national discourse.
Argument #1. Medicine is expensive because medical school is expensive, and doctors have to pay for their training somehow.
Yes, med school is expensive. But it is only expensive for the prospective med school student because the U.S. government allows it to be. The U.S. stands alone among Western nations in its opinion that medical care is not considered a public service.
Medical training is only minimally subsidized by tax dollars. Med school (and health care in general) would be affordable if the U.S. government placed as much value on medicine as they do on the military industrial complex. Consider the no-bid contracts to Halliburton or the other greedy piglets suckling at the teat of government funds. Review the reports from the Office of the Inspector General in regard to Halliburton property in Iraq and you'll see just how much of our tax money Cheney's cronies have run off with. Halliburton can't account for 75% of the items it supposedly purchased with tax dollars -- and this isn't just office supplies. This is stuff like bulldozers, tractor trailers, computer equipment, etc. But somehow nobody squeaks about "fraud" or "waste". These thieves hide under the blanket of "support the troops" while they bleed the nation dry of funds that could be used for other, more constructive uses. All this while the real soldiers fighting the war have to deal with reductions in combat pay, removal of death benefits and reduced funding to the VA. Go fight and die, but don't get wounded because we don't have the money to take care of you.
But I digress. Another cost most folks don't consider is the vicious circle that medical costs increase to meet the increasing cost of keeping costs high. Wait, wha-aa...? Let me say it in a different way: the higher costs to consumers get, the more lobbyists have to be hired to explain to Congress why costs should be allowed to be so high, and the more "campaign contributions" have to be made, all of which in turn increases costs to consumers.
Argument #2. Health care is expensive because drug companies have to spend a great deal of money in research and development, and drugs are expensive.
This argument holds as much water as your average Kleenex(tm), because drug and medical research is the one aspect of the medical industry that is heavily subsidized by the government. The drug companies don't tell you about the real costs to them -- lobbyists and advertisements, both of which are entirely superfluous. Drugs are wildly profitable, especially if you need the drug to survive. Like HIV/AIDS or cancer patients. Or hemophiliacs.
Take, for example, the situation hemophiliacs have to deal with in this country. The average hemophiliac runs a tab of $250,000 to $500,000 a year in clotting factor alone. Not preventative care, not doctor visits, not emergency room costs, just the drug they have to take to keep from bleeding to death. Severe hemophilia cases run well over $1,000,000 a year in factor. This isn't something they caught from indiscreet sexual encounters, this is a genetic disorder. But U.S. drug manufacturers make a killing of folks with this disability. Drug manufacturers in the U.S. keep the cost to create a unit of factor a closely-guarded secret. Why? Because they might get hauled into court for price gouging if it ever got out. In every western nation but the U.S., factor is fully subsidized by the government. Everywhere but here Hemophiliacs don't have to pay a red cent for having been born with a handicap. Yet here they can't get insurance coverage -- or if they do they burn through a lifetime's worth of coverage in 18 months.
When drugs are as profitable as they are in the private business model, consumer safety becomes secondary to the product's marketability. Drugs which address universal insecurities like impotence and baldness pretty much sell themselves. Addictive drugs are even better, because they create their own need. Addictive drugs like Vicodin, the most abused prescription painkiller in the U.S. Is it only coincidence then that Vicodin is also one of the most highly-prescribed prescription painkillers in the U.S.?
Argument #3. We live in a highly litigious society and lawsuits drive up costs. It is expensive to make a mistake in the medical system.
True enough. But have you ever stopped to consider the reasons behind why there are so many medical suits? The profitability of the practice of law is only part of the reason. Consider that when illness become profitable, those who practice medicine will be financially motivated to keep people ill. When people realize their doctors aren't out to heal them, but rather are out to keep them ill; when people realize they're being given expensive operations that aren't really necessary and have driven them into bankruptcy; when people realize their loved ones were allowed to die because they didn't have the funds to pay the usurious rates charged by the industry; when people realize their insurance carrier has dropped them for a bullshit reason because they had the audacity to get sick, then they seek the legal aid within a system that is, sadly, only likely to exploit them further.
Take for example, a well-known hospital chain: Tenet Health. The newspapers from over the past ten years have been full of news on Tenet. They've been repeatedly investigated for performing unnecessary and expensive procedures on patients -- like open heart surgery. Yet every time they manage to be dragged into court, they fire a few doctors, settle out of court and have to admit no wrongdoing. Then it's back to business-as-usual. Telling you about me, you'd better believe I'd be pissed if I found out a doctor prescribed open heart surgery when I didn't need it, especially if I'd been forced into bankruptcy because of it -- and you'd better believe I'd want to sue
Then of course there's all the suits that come up because an insurance carrier decides to start gaming their clients. If you get sick enough, and you're not independently wealthy or famous, you'd better believe your insurance company will drop you like a hot potato. They'll find some bullshit excuse for why they won't cover your costs and why they've decided to drop your coverage. This leaves you and many others only one available recourse: legal action. You have to force the insurance company to do what they originally promised. All these legal actions are costly to everyone involved, government included. But somehow, in the end, the victims bear the blame -- and the current sentiment is to remove the few tools consumers have to seek redress for the wrongs done them.
Argument #4. Health care costs are high because we place a high value on life, and it is expensive to provide the best care possible. The for-profit model is the only one that allows the freedom to provide the best care.
Let's face it -- it is unprofitable to cure an illness. On the other hand, it is wildly profitable to treat an illness, especially in a fully privatized system. The trick is getting someone into the system for as long as you can to milk as much money from them as possible. Survival is an instinct, and if necessary people will pay for their continued survival. The Mafia figured this one out a while back.
When profit is the motive, all other considerations become secondary. This is why the for-profit model is flawed, especially when it comes to medicine: it puts the motivations in all the wrong places. That's why a private system will never discover a cure for HIV/AIDS -- cure the disease and you cut off a major source of income. It is not profitable to provide permanent solutions, so only those with a vast enough income can pay for permanent solutions. Like LASIK. Wonderful solution to bad vision. But only those with a large enough discretionary income can pay for the surgery because insurance companies consider it "cosmetic" and refuse to cover the procedure. If you have your bad vision fixed permanently, you no longer have to pay for glasses every year and contacts every month. It's the same reason why the most efficient car engines aren't allowed into the U.S. -- car manufacturers make too much money on replacement parts and kickbacks from oil companies. A fine business model your goal is to sell cars, but a poor one if your ostensible motivation is to heal those who are ill.
Then of course there's preventative care. If your goal is to make money, as it is in a private for-profit system, it's not profitable to prevent illness. People get sick, you get rich. Why prevent illness in that case? Why educate the public in preventing illness themselves? If you encourage people to eat bad food and discourage people from exercise and regular check-ups, then they get sick more easily and again, when people get sick, you get rich.
When the above is considered-- along with all the empirical evidence that has been gathered ever since the system began to be privatized in 1971, it becomes clear that the for-profit model does not work for medicine. There are other business models that can be applied: Co-operatives, Non-Profit and Not-For-Profits are all viable models of private businesses .
Then there are the dirty words which I favor: "socialized medicine".
The majority of the American public has a near-Pavlovian negative response when anyone says "socialized medicine". The first response is "It's too expensive!" Many things are expensive, but we consider them necessities. What else is expensive that has highly trained professionals? The fire department. The police department. The armed services. All these services are considered invaluable to the public and their provision is considered part of being a citizen. Fully privatized police & fire departments existed in the 19th century. If you didn't pay, you didn't get service. 19th century firemen would stand around and let your house burn if you didn't have that little brass shield nailed up on your front door. Likewise fully privatized armed forces have existed for centuries. They're called "mercenaries" and they have a black reputation for a reason -- you can't trust them to defend you if their loyalty is to the highest bidder.
Having a national armed service to repel enemies is an important public service and is an integral part of being a nation-state. But have you ever heard anyone cry foul over the armed services being socialized? Or the fire department? Have you ever heard anyone suggest that police departments should be replaced by private security companies? Rarely, if at all. Why? Because we believe that these public necessities are a fundamental part of our democracy. We realize, at some level, that to privatize these necessities would be to remove public accountability and acknowledge as a society that one's citizenship is only as good as one's income. We would, in short, return to the feudal system from which we revolted at the nation's founding.
How, then, would we pay for socialized medicine? Easy. Considering how profligately we pour money into companies like Halliburton with virtually no oversight, we can start by holding military-industrial contractors accountable for their waste, fraud and abuse. That would free up a great deal of money. Once that's been taken care of, we can begin figuring out where other money is being wasted. To quote Neal Stephenson: "...the first thing an organism does is control its sphincters". We are not in control of the sphincters of national finance. Enforce the law. One of the Constitutional definitions of treason is war profiteering. Prosecute companies like Halliburton for treason on those grounds, seize their funds, and then watch how many tax dollars are freed up for other, more constructive purposes.
Finally, I believe should be considered as an investment in our society. We protect our citizens because it is to the benefit of society. If everyone has to worry about having their possessions stolen and their houses burned down, they can't contribute to the betterment of our nation. We educate our population because a well-educated workforce is a more productive workforce and is a good investment in advancing our society in every conceivable way. The better educated a workforce is, the more innovative it is and the more technological advances it makes. The same goes for medical care: if it is viewed as a long-term societal investment like police, fire, education, etc., the benefits outweigh the costs. A healthy workforce is a more productive workforce, from a purely economic standpoint.
If nothing else, take my argument as saying this: "The more we privatize, the more we remove things from public accountability, and the more the system is moved from the ballot to the wallet." That is all.
Mekkis, The Eyeconoclast
Health care is expensive. We all know this. The increasing cost of health care is fast becoming the #1 issue facing the American public, if it's isn't already. Along with Iraq war, the situation surrounding health care and health insurance is the chief topic of discussion in the national discourse.
Argument #1. Medicine is expensive because medical school is expensive, and doctors have to pay for their training somehow.
Yes, med school is expensive. But it is only expensive for the prospective med school student because the U.S. government allows it to be. The U.S. stands alone among Western nations in its opinion that medical care is not considered a public service.
Medical training is only minimally subsidized by tax dollars. Med school (and health care in general) would be affordable if the U.S. government placed as much value on medicine as they do on the military industrial complex. Consider the no-bid contracts to Halliburton or the other greedy piglets suckling at the teat of government funds. Review the reports from the Office of the Inspector General in regard to Halliburton property in Iraq and you'll see just how much of our tax money Cheney's cronies have run off with. Halliburton can't account for 75% of the items it supposedly purchased with tax dollars -- and this isn't just office supplies. This is stuff like bulldozers, tractor trailers, computer equipment, etc. But somehow nobody squeaks about "fraud" or "waste". These thieves hide under the blanket of "support the troops" while they bleed the nation dry of funds that could be used for other, more constructive uses. All this while the real soldiers fighting the war have to deal with reductions in combat pay, removal of death benefits and reduced funding to the VA. Go fight and die, but don't get wounded because we don't have the money to take care of you.
But I digress. Another cost most folks don't consider is the vicious circle that medical costs increase to meet the increasing cost of keeping costs high. Wait, wha-aa...? Let me say it in a different way: the higher costs to consumers get, the more lobbyists have to be hired to explain to Congress why costs should be allowed to be so high, and the more "campaign contributions" have to be made, all of which in turn increases costs to consumers.
Argument #2. Health care is expensive because drug companies have to spend a great deal of money in research and development, and drugs are expensive.
This argument holds as much water as your average Kleenex(tm), because drug and medical research is the one aspect of the medical industry that is heavily subsidized by the government. The drug companies don't tell you about the real costs to them -- lobbyists and advertisements, both of which are entirely superfluous. Drugs are wildly profitable, especially if you need the drug to survive. Like HIV/AIDS or cancer patients. Or hemophiliacs.
Take, for example, the situation hemophiliacs have to deal with in this country. The average hemophiliac runs a tab of $250,000 to $500,000 a year in clotting factor alone. Not preventative care, not doctor visits, not emergency room costs, just the drug they have to take to keep from bleeding to death. Severe hemophilia cases run well over $1,000,000 a year in factor. This isn't something they caught from indiscreet sexual encounters, this is a genetic disorder. But U.S. drug manufacturers make a killing of folks with this disability. Drug manufacturers in the U.S. keep the cost to create a unit of factor a closely-guarded secret. Why? Because they might get hauled into court for price gouging if it ever got out. In every western nation but the U.S., factor is fully subsidized by the government. Everywhere but here Hemophiliacs don't have to pay a red cent for having been born with a handicap. Yet here they can't get insurance coverage -- or if they do they burn through a lifetime's worth of coverage in 18 months.
When drugs are as profitable as they are in the private business model, consumer safety becomes secondary to the product's marketability. Drugs which address universal insecurities like impotence and baldness pretty much sell themselves. Addictive drugs are even better, because they create their own need. Addictive drugs like Vicodin, the most abused prescription painkiller in the U.S. Is it only coincidence then that Vicodin is also one of the most highly-prescribed prescription painkillers in the U.S.?
Argument #3. We live in a highly litigious society and lawsuits drive up costs. It is expensive to make a mistake in the medical system.
True enough. But have you ever stopped to consider the reasons behind why there are so many medical suits? The profitability of the practice of law is only part of the reason. Consider that when illness become profitable, those who practice medicine will be financially motivated to keep people ill. When people realize their doctors aren't out to heal them, but rather are out to keep them ill; when people realize they're being given expensive operations that aren't really necessary and have driven them into bankruptcy; when people realize their loved ones were allowed to die because they didn't have the funds to pay the usurious rates charged by the industry; when people realize their insurance carrier has dropped them for a bullshit reason because they had the audacity to get sick, then they seek the legal aid within a system that is, sadly, only likely to exploit them further.
Take for example, a well-known hospital chain: Tenet Health. The newspapers from over the past ten years have been full of news on Tenet. They've been repeatedly investigated for performing unnecessary and expensive procedures on patients -- like open heart surgery. Yet every time they manage to be dragged into court, they fire a few doctors, settle out of court and have to admit no wrongdoing. Then it's back to business-as-usual. Telling you about me, you'd better believe I'd be pissed if I found out a doctor prescribed open heart surgery when I didn't need it, especially if I'd been forced into bankruptcy because of it -- and you'd better believe I'd want to sue
Then of course there's all the suits that come up because an insurance carrier decides to start gaming their clients. If you get sick enough, and you're not independently wealthy or famous, you'd better believe your insurance company will drop you like a hot potato. They'll find some bullshit excuse for why they won't cover your costs and why they've decided to drop your coverage. This leaves you and many others only one available recourse: legal action. You have to force the insurance company to do what they originally promised. All these legal actions are costly to everyone involved, government included. But somehow, in the end, the victims bear the blame -- and the current sentiment is to remove the few tools consumers have to seek redress for the wrongs done them.
Argument #4. Health care costs are high because we place a high value on life, and it is expensive to provide the best care possible. The for-profit model is the only one that allows the freedom to provide the best care.
Let's face it -- it is unprofitable to cure an illness. On the other hand, it is wildly profitable to treat an illness, especially in a fully privatized system. The trick is getting someone into the system for as long as you can to milk as much money from them as possible. Survival is an instinct, and if necessary people will pay for their continued survival. The Mafia figured this one out a while back.
When profit is the motive, all other considerations become secondary. This is why the for-profit model is flawed, especially when it comes to medicine: it puts the motivations in all the wrong places. That's why a private system will never discover a cure for HIV/AIDS -- cure the disease and you cut off a major source of income. It is not profitable to provide permanent solutions, so only those with a vast enough income can pay for permanent solutions. Like LASIK. Wonderful solution to bad vision. But only those with a large enough discretionary income can pay for the surgery because insurance companies consider it "cosmetic" and refuse to cover the procedure. If you have your bad vision fixed permanently, you no longer have to pay for glasses every year and contacts every month. It's the same reason why the most efficient car engines aren't allowed into the U.S. -- car manufacturers make too much money on replacement parts and kickbacks from oil companies. A fine business model your goal is to sell cars, but a poor one if your ostensible motivation is to heal those who are ill.
Then of course there's preventative care. If your goal is to make money, as it is in a private for-profit system, it's not profitable to prevent illness. People get sick, you get rich. Why prevent illness in that case? Why educate the public in preventing illness themselves? If you encourage people to eat bad food and discourage people from exercise and regular check-ups, then they get sick more easily and again, when people get sick, you get rich.
When the above is considered-- along with all the empirical evidence that has been gathered ever since the system began to be privatized in 1971, it becomes clear that the for-profit model does not work for medicine. There are other business models that can be applied: Co-operatives, Non-Profit and Not-For-Profits are all viable models of private businesses .
Then there are the dirty words which I favor: "socialized medicine".
The majority of the American public has a near-Pavlovian negative response when anyone says "socialized medicine". The first response is "It's too expensive!" Many things are expensive, but we consider them necessities. What else is expensive that has highly trained professionals? The fire department. The police department. The armed services. All these services are considered invaluable to the public and their provision is considered part of being a citizen. Fully privatized police & fire departments existed in the 19th century. If you didn't pay, you didn't get service. 19th century firemen would stand around and let your house burn if you didn't have that little brass shield nailed up on your front door. Likewise fully privatized armed forces have existed for centuries. They're called "mercenaries" and they have a black reputation for a reason -- you can't trust them to defend you if their loyalty is to the highest bidder.
Having a national armed service to repel enemies is an important public service and is an integral part of being a nation-state. But have you ever heard anyone cry foul over the armed services being socialized? Or the fire department? Have you ever heard anyone suggest that police departments should be replaced by private security companies? Rarely, if at all. Why? Because we believe that these public necessities are a fundamental part of our democracy. We realize, at some level, that to privatize these necessities would be to remove public accountability and acknowledge as a society that one's citizenship is only as good as one's income. We would, in short, return to the feudal system from which we revolted at the nation's founding.
How, then, would we pay for socialized medicine? Easy. Considering how profligately we pour money into companies like Halliburton with virtually no oversight, we can start by holding military-industrial contractors accountable for their waste, fraud and abuse. That would free up a great deal of money. Once that's been taken care of, we can begin figuring out where other money is being wasted. To quote Neal Stephenson: "...the first thing an organism does is control its sphincters". We are not in control of the sphincters of national finance. Enforce the law. One of the Constitutional definitions of treason is war profiteering. Prosecute companies like Halliburton for treason on those grounds, seize their funds, and then watch how many tax dollars are freed up for other, more constructive purposes.
Finally, I believe should be considered as an investment in our society. We protect our citizens because it is to the benefit of society. If everyone has to worry about having their possessions stolen and their houses burned down, they can't contribute to the betterment of our nation. We educate our population because a well-educated workforce is a more productive workforce and is a good investment in advancing our society in every conceivable way. The better educated a workforce is, the more innovative it is and the more technological advances it makes. The same goes for medical care: if it is viewed as a long-term societal investment like police, fire, education, etc., the benefits outweigh the costs. A healthy workforce is a more productive workforce, from a purely economic standpoint.
If nothing else, take my argument as saying this: "The more we privatize, the more we remove things from public accountability, and the more the system is moved from the ballot to the wallet." That is all.
Mekkis, The Eyeconoclast
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