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22 July 2009

America's Healthcare Dilemma - Profit Versus Patients

Consider the following scenarios and then decide what you would do:

First Scenario
Two people are trapped in vehicles that have collided. They are in imminent danger of being burned alive as the vehicles catch fire. In one vehicle, a wealthy business person calls to you for help. In the other vehicle, a small child whose mother is receiving welfare payments. The wealthy business person calls to you for help and offers you $1 million to pull him from the car. The child’s mother has nothing to offer you, but begs for your help. You have the resources to save only one of them. Who would you save?

Second Scenario
Two people are hanging from a cliff and are about to fall to their deaths. You have one small inflatable that you can move under one of them to break their fall. You have to choose one or the other as both are about to loose their grip and fall simultaneously. One person is wealthy and offers you money to save her. The other is poor and has nothing to offer, but begs you to save his life. Who would you save?

“These scenarios would never happen in real life,” you say. Really? It happens every day – in America. While the above examples may seem extreme, the serve to illustrate the current state of health care in the United States. Every day, those with money and/or insurance receive medical treatment, while those without coverage or the money to pay up front are often denied. Even those people with health insurance coverage are frequently denied coverage.

The Federal Emergency Medical Treatment and Active Labor Act – EMTALA was enacted to prohibit hospitals from transferring (i.e. “dumping”) patients without health care coverage who seek emergency services on charity hospitals. Hospitals administrators have tried to develop ways to get around the EMTALA requirements, such as ambulance diversion. Once an emergency department patient is “stabilized” he or she can be transferred to another hospital or discharged. EMTALA does does not require any particular level of care, just that one receives care to the point of being stabilized. Studies have shown that people who are uninsured often receive substandard care.

The uninsured represent only half the problem with medical care in the United States. The other half are the insured and under insured.

Insurance companies, being profit driven capitalists, routinely mandate cheaper treatment or deny coverage for treatment altogether. According to Dr. Jay Zdunek, in an op-ed for the Pittsburgh Post Gazette ”. . .the broader story of how patient care is being compromised in the name of profit needs to be told. Patients’ long-term health often is compromised for short-term gains.”
How much is your life worth to the for profit medical industry in America? According to LabCorps one man’s life is worth $7. LabCorps denied medically necessary blood tests following a patient’s heart attack because he owed a bill of $7. The man was insured, yet LabCorps refused to perform medically necessary tests.

Physicians for a National Health Program have proposed a Single Payer National Health Insurance that could work well for everyone in America. Every man, woman and child in America would be covered with no co-payments and no deductibles. Hospitals would receive one check each month as a global payment for all services rendered during that month. Long term and home care would also be covered. The National Health Program proposal will work for everyone. We have reached a point in time when we can no longer afford to push this to the back burner. We must stand up to the insurance industry and demand single payer national health insurance.
“Over 39 million Americans have no health insurance whatsoever, including 33% of Hispanics, 21% of African-Americans and Asians, and 11% of non-Hispanic Whites. Many more – perhaps most of us – are underinsured. The world’s richest health care system is unable to assure such basics as prenatal care and immunizations, and we trail most of the developed world on such indicators as infant mortality and life expectancy. Even the well-insured may find care compromised when HMOs deny them expensive medications and therapies. For patients, fear of financial ruin often amplifies the misfortune of illness.” Proposal of the Physicians’ Working Group
Returning for a moment to our two scenarios – imagine now that you are employed by a health insurance company. Your job is to save the company money by selecting who receives coverage and what treatment will be covered. Most importantly, your company makes lots of money by collecting premiums from subscribers while NOT paying for medical procedures.

In the first scenario the wealthy person trapped in the car has numerous chronic health conditions caused by a lifetime of drinking, smoking, and over eating. The child is healthy with no significant medical history. Who should you save based on your obligation to your company to increase profits by paying less in covered benefits? Reverse the situation, where the wealthy person is otherwise healthy, but the child has a congenital birth defect that may require a liver transplant in the near future. Who do you save now?

Imagine that in the second scenario, the inflatable is a device that your employer, the insurance company, considers experimental. There is data to suggest that this inflatable, as well as a new two-person inflatable (wide enough to catch both cliff hangers) will significantly increase the chances of survival, but because neither device has been in use for very long and are not yet generally accepted by the medical community your employer has instructed you to deny coverage for their use. Both cliff hangers are insured with your company, so their relative personal wealth is of no consequence to you. So you deny them both, right?

Under the proposed National Healthcare Act HR 676 health care benefits cover all medically necessary services, including:

(1) Primary care and prevention.
(2) Inpatient care.
(3) Outpatient care.
(4) Emergency care.
(5) Prescription drugs.
(6) Durable medical equipment.
(7) Long-term care.
(8) Palliative care.
(9) Mental health services.
(10) The full scope of dental services (other than cosmetic dentistry).
(11) Substance abuse treatment services.
(12) Chiropractic services.
(13) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(14) Hearing services, including coverage of hearing aids.
(15) Podiatric care.

In addition to covering all medically-necessary services, you will still have your choice of physicians, providers, hospitals, clinics, and practices. You will never be denied services based on your inability to pay. You will not be denied services based on an insurance company’s insatiable need to maximize profits while minimizing expenditures.

The American Medical Association supports HR 3200 which is the plan that is being battled out on the Hill now.

“We are committed to passing health reform this year consistent with principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”

They are committed to passing health care reform, but not committed enough to support single payer legislation. Perhaps the AMA is hedging their bet. Some type of healthcare reform will pass before the end of 2009. Most likely it will not be a single payer program, so the AMA is putting its money on the public health option. The Democrat sponsored HR 3200 puts the government in competition with the insurance industry to help drive down costs. While this seems like a good idea, the legislation does not go far enough. This legislation leaves the current insurance industry in tact, while expanding government coverage to anyone who is uninsured or under insured.

In theory competition should drive down costs, I have my doubts about the potential for the a measurable decrease in the cost of insurance premiums. I also doubt that we will experience an expansion of coverage by private insurance companies. Private insurance companies do not currently compete with the government for those covered by Medicare or Medicaid. They don’t want the elderly or disabled with all their potential health issues. Those who qualify for Medicaid based on poverty can’t afford private insurance premiums anyway. All that this legislation seems to do is expand the current government health plans to encompass those who can not afford insurance but do not qualify for Medicaid, and to give employers and individuals the option for government health care.

As the healthcare debate rages on, people continue to suffer and die. President Obama’s public health option is not the solution. According to Drs. Steffie Woolhandler and David Himmelstein single payer national health care could save an estimated $400 billion annually. Insurance companies will not support any reform that threatens their profit.
“A public plan option might cut into private insurers’ profits. That’s why they hate it. But their profits — roughly $10 billion annually — are dwarfed by the money they waste in search of profit. They spend vast sums for marketing (to attract the healthy); demarketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. And doctors and hospitals spend billions more meeting insurers’ demands for documentation.” Drs. Steffie Woolhandler and David Himmelstein
It is time to pass comprehensive legislation that transforms our current for profit system of medical care to an inclusive not for profit system. We need a system where everyone, regardless of ability, disability, income, or disease receives medical care. That will never happen as long as there are insurance companies whose sole purpose is to make and keep as much money as possible.

Keep single payer in the debate. Sign the PETITION.

Notes & Resources

The Healthcare Fight Begins
Democracy NOW Interview With President Obama's Former Physician on Single Payer
Broken Bonds
Healthcare Horror
Why Obama’s Public Option Is Defective
Healthcare for All
Medical Treatment Insurers Won’t Touch
National Cancer Institute Approval Process
Postal Worker Denied Treatment
Single Payer Reform Would Stimulate Economy
HR 676 Explained
Full Text of HR 676 PDF Document
Track Status of HR 676

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