Dr. Bill Roy
The Wichita Eagle
March 30, 2008
More good people are spending more good effort and more good money trying to make our inequitable and tattered health care system sustainable than can be measured or imagined. And the “system” per se is getting into deeper and deeper trouble, because Americans refuse to see the elephant in the room — the health insurance companies.
No country can long afford a health care system run by private health insurance companies. They take 15 to 30 percent for their fees (and add 15 percent to the administrative costs of physicians and hospitals); refuse to insure the sick, disabled, chronically ill and elderly; and generally distort the health care delivery system for their own profit.
Paradoxically, only a few health insurance companies are really bad guys. Rather, they behave the way insurance companies behave, just as the aforementioned elephant behaves as elephants behave.
They spend money to get the youngest, healthiest enrollees they can get. So they don’t insure just anybody. And if they do err, they increase next year’s premiums, for example, for the 15-person employee group that has a new diabetic or too many babies.
They underwrite, the ultimate art of evaluating risks. They refuse to accept bad risks, or they boost premiums up front to protect themselves from marginally higher risks.
Insurance companies are necessary for a functioning capitalistic economy. They work very well for expensive, infrequent losses, which they have done for centuries. But not for paying for the billions of treatments and pills of health care — which they accidentally have been designated to do for just a few decades.
Our states, God bless them, are trying to reform health care within their jurisdictions. But they usually end up using tax dollars to pay insurance companies for “managing” the care of the medically needy.
They also try to coerce or induce better health habits for their citizens. But even these public health efforts are modest and difficult, as evidenced by the Kansas Legislature’s struggle to pass a public smoking ban. At best, they just postpone the costly medical care associated with the end of life.
And states are hemmed in. Almost anything states want to do costs money that must be raised by taxes. And any great disparities in taxes among states are noted by business and industry, which head for the state or national border.
So one can easily believe that the American people are deaf, blind and dumb — or just fatalistic — when they fail to respond constructively to reports like the one issued last month by the Centers for Medicare and Medicaid Services.
The centers project our nation’s already bloated health care spending will nearly double by 2017 to $4.3 trillion, or nearly 20 percent of annual total value of all goods and services. Without substantial changes, about half would be paid by Medicare and Medicaid; the rest falls more directly on the private sector.
If elected president, John McCain offers essentially no change, just the old GOP sleight of hand with the tax code. Both Barack Obama and Hillary Clinton intend to nurse the health care system as it sinks into death by making more money available to be wasted.
Neither intends to go to something like Medicare for all (minus Medicare Advantage), which would cover everyone and control costs to the extent possible in the face of more effective and costly medical services.
Meanwhile, we’ll bump along spending about 1 ½ times the amount spent by similar nations without getting more medical care, and with a less healthy populace that does not live as long as people in nations with government-administered (but usually privately provided) universal care.
(Bill Roy is a retired physician and former member of Congress who represented northeast Kansas.)
http://www.kansas.com/205/story/356501.html
Comment:
By Don McCanne, MD
Wake up America! There’s an insurance industry elephant in the room!