We often hear slogans and catch-phrases that speak to corruption within the political process, such as, “Get money out of politics!” These ideas are commonly-believed to highlight a serious problem in our society, the problem that legislation and money do not mix well, and I’d like to make a similar claim about the healthcare finance industry.
With renewed Republican assaults reigning down on the ACA, the Affordable Care Act passed by then-president Barack Obama (discussed here) a lot of people are starting to become concerned over what will come of their healthcare in the future. What if premiums go up? What if I get less care for the same amount of money? What if they strip the protections for people with pre-existing conditions? What will I do then?
There’s no doubt that in the short term, these are very valid questions, ones that people should be asking themselves, but it seems that, in the long term, we've lost sight of what healthcare should be. A social commodity, not a financial product…because America used to believe that you don’t prey upon the sick and the needy, for your day shall too come when you’re no longer at the top of the food chain.
While health insurance may come to the rescue when people are diagnosed for some nightmarish illnesses and conditions, at the same time, good health insurance should never be the end goal of the American push for quality healthcare...it simply cannot be, because health insurance was never a good product, to begin with; nor can it be without severe regulation to the point where it becomes unprofitable. And that's the point…
Health insurance has always been about money flowing upward and never about providing care.
The Separation of Healthcare and Finance
Many people in the western world, in all of its secularist splendor, pride themselves on a separation of church and state; simply put, churches shouldn't be assigned any power, and power shouldn't be assigned a religion. The two are a terrible mix.
Like that, healthcare and the financial industry, also called "financial products," are likewise a hideous mix, for the same reasons; there are some instances in a person's life where they should not be predated, where power should curb itself, and people should be left alone to what's most important to them.
This is what the Bill of Rights sought to protect, to give us places where we could talk about what matters, where we could live out the human experience without fear of predation, like when we're praying or when we're dying.
Despite deflections by political figures with quite obvious agendas to push, the debate has never been about healthcare, it's been about how we finance healthcare in this country.
Questions about what your doctor should or should not do have no bearing on how we fund what they should or should not do — the two are entirely separate discussions in a world where we’ve separated health and finance.
Republicans especially, have deflected the conversation constantly to, “Do you want the government in charge of your healthcare,” and, if that really was the question the answer would be, “Yes, more than a private insurance company that’s hidden behind a mask of corporate anonymity, where I don’t get a vote in any of its board meetings…”
But that’s not the question. The only time the government affects our healthcare is when it legislates the healthcare field — not when it legislates how we finance our healthcare.
You could hypothesize that healthcare which was funded by the government might come with a laundry list of stipulations for doctors, patients, and more, but I’m here to tell you, that’s not a hypothesis in the field of healthcare finance — that’s the reality.
The question of how I want a service to be and how I want to pay for it are two completely different questions, complete with two different sets of ethical implications, and they should never be conflated as being the same thing.
Insurance as a Restaurant
Healthcare finance inflates the cost of actual healthcare by adding additional parties, third parties whose sole job it is to discuss what is permissible:
“We’re sorry, we may cover the surgery which stemmed from your accident, but not the ambulance ride.”
Let’s stop for a minute and imagine that you worked in a bar and grill, a restaurant which conducted business the way our system of healthcare and healthcare finance interplay. The owner of the bar and grill had hired a third-party cost-control company in exchange for investor funds. When they were low on cash, said investor might give it to the owner, but only if it was pre-approved. The investor also needed to know and approve every single expense in order to keep track.
So you’re working in the bar and the kitchen, and every time you pour a drink for a paying customer, you have to call the owner and notify them. Every single drink.
Every bit of prep for the food of the establishment that’s done? Guess what, you have to call and ask for approval to make sure you’re the owner was going to get reimbursed for what he was using.
One could see how quickly this would get very old, very tiring, and most of all, it would eat so greatly into the overhead of the restaurant, that the only option for the owner would be to hire a full-time staff to call the investor and notify them of every move you made to get approval. Simply put, doctors, like your owner, would be much better off if they could operate without the third-party approval for everything.
The Predatory Profits
But who will pay for our healthcare procedures if not insurance?
- Healthcare is insanely too expensive in the first place — costs need to come down, and the costs are largely inflated by insurance companies who leech money out of the healthcare system, money that could and should go to the actual men and women who do the healthcare work. Any talk of lowering the cost of healthcare while supporting health insurance companies is total nonsense, these corporations have goals to maximize profitability, and that means raising costs to the maximum degree they possibly can get away with — and they contribute nothing to the industry of healthcare.
- If health insurance companies actually invested in the healthcare (not healthcare finance) industry, they would be losing money rather than gaining it. There is simply no way that they put out more than they take in while providing no tangible service in exchange. One might say, “Well, they pay big money when we need it,” but they also inflate costs which make healthcare so expensive in the first place, so it’s quite literally a racket.
- The Social Security Administration operates with a 1% operating cost. That’s way better than anything you’d ever find in the market because Social Security isn’t designed for profit. Outside of rare philanthropic moments, the market, for all of it’s a wonder, could never come up with a retirement plan that only seeks to give back all of the money that it takes in except for operating expenses, and secure funding. Investors want a return on their money, they don’t want to give it away to make society better.
Any discussion of what good healthcare might look like that avoids this basic, fundamental flaw in our current system is misguided at worst, incomplete at best.
By allowing insurance companies to continually post record profits, we’re actually just giving them money to essentially be a bank, a bank that may or may not return our deposited funds when we ask for them. This is dangerous.
In fact, health insurance companies have been outdoing themselves steadily in their earnings for quite some time, with one health insurance company, UnitedHealth, posting a record 46.5 billion dollars USD, a $10 billion increase from the previous year’s July of 2015. Those dollars don’t go into the care of patients, nor the doctors and men and women who help make the actual healthcare industry operate, by laboring, by studying, by inventing. No, those profits go into the pockets of investors and investors alone, investors who’ve bought stocks or invested in each respective company and want a return.
This means that, no matter how you slice it, your dollars paid on your premiums will never, in total, meet the amount the insurance companies are paying out in repayments for care services — we give them money, they cover their overhead, they post record profits with the rest, and divvy it up among the investors. It’s as if we allowed private entities to take a certain percentage off of the top of our Social Security funds.
Call me radical, but I think that we need to popularize the phrase, “get money out of healthcare!” just as we have, “get money out of politics,” and, “separation of church and state!” It would behoove us to begin talking about eliminating the health insurance industry as our go-to means of paying for healthcare services entirely.
“But That’s Socialism!”
- No, it’s not. Socialism is when the means of production are entirely owned by the government, so, a) no one is proposing that only the government agencies control and hire their own doctors, leaving you one government choice, we’re suggesting that you choose your doctor, you and your doctor decide what medicine is best for you, and the state picks up the tab at the end, because (and this is important) neither state nor financial corporation know enough about healthcare to be making our health-related decisions for us.
- I’ve got news for you if this is your objection for literally anything political, everything that transpires under the market is socialism. The market is a social entity, just like the state is. There is no free-market individualism. Even if I sell my neighbor a bicycle for $150 less than I paid for it new, let’s say half of the $300 I originally bought the bike for, the retailer socialized their price by referencing the competition of the market for that particular type of bike, for bikes in general, and a slew of other things. I didn’t just make the price up on my own, I referenced what it was sold to me for originally, calculated how much I valued my neighbor and made a conclusion based on how much I feel I should give them a break. Even if I wanted to be nice and sell the bike to my neighbor for $1 to really hook them up with a sweet deal, this can’t take place in a vacuum; $1 wouldn’t be a good deal if I’d bought the bike for $0.50.
I find it funny how we complain bitterly about bribery and corruption in the medical industry, far and wide, from terms like “big pharama,” to raising questions about the cost of an IV bag vs how much we’re charged for it at the hospital, but not many are addressing the biggest question there is: Why have we decided to allow people to profit off of our sickness?
Because the fact is, no matter how good our health insurance becomes, it could be better by not being health insurance. Health insurance in itself is a financial product, not the social good that it can never be.
© 2019; Joe Duncan. All Rights Reserved