SCHIP and the Rigged Health Insurance Game
The House on Thursday passed a modified version of the SCHIP bill, with a vote that was seven votes shy of a veto-proof majority. There were 142 members of Congress who voted against extending health care to more poor children. Behind their rhetoric, their intentions are clear: they want to protect the health insurance market and the huge profits that go with it.
But the huge profits are killing health care. We all know that now. Profit-maximizing insurance companies are bad economics. They make money by denying care, which is a terrible way to try to keep us healthy. (The Rockridge Institute's white paper on health care security has details.)
And, profit-maximizing health insurance does more harm than that. It is also killing our sense of community. It pits us one against another to get affordable and available insurance policies, strangling the trust and cooperation we need to thrive. If we can't come together when we need each other most—when we're sick, injured or dying—without our vulnerability being used as an opportunity to maximize profits, then the U.S. is a hollow shell. The community that makes our nation a family is dead.
Huge health insurance profits are killing community because they are killing Americans. This is obvious. We know that over 100 million Americans are under- or un-insured. They can't get the insurance necessary to receive adequate medical care. So, millions of Americans remain sick unnecessarily and die prematurely.
But there is a second, more subtle impact of the profit imperative of health insurance that is destroying our communities.
In our current health insurance system, companies can't maximize their profits unless they turn people away. According to Princeton economist Paul Krugman, in any given year about 80% of us need very little medical care. Some aspirin and cough syrup, more or less. But 20% of us have an accident or illness that requires major medical treatment. That's expensive.
If everyone in the U.S. were covered by the same insurance company or were part of a nationally organized universal health care plan, then this would all balance out. In any given year, the large number of healthy people would pay for the small number of really sick people. And, the years when you are part of the 20% with large medical expenses, the others will pay for you. Spread out the risk, share the costs, and we all get good health care. We thrive. This is what every other industrialized country in the world does. Except the United States.
Currently, we don't spread the risk and costs evenly. Instead, we have lots of insurance companies all competing against each other to maximize their profits. Which they have—to the tune of billions of dollars a year. But they make their billions by not getting "stuck" with the people needing expensive medical treatment—sort of like avoiding the Old Maid in the children's card game. The more sick people an insurance company ends up with, the lower their profits. "Stuck" with too many people needing medical care at any one time and an insurance company loses some of their profits. So, insurance companies avoid people needing medical care—the Old Maids—at all costs. And we know the result: over 100 million Americans who are un- or under-insured, pushed into the health care cracks between insurance companies by the companies themselves.
And those of us with insurance have been dragged into this sick game. Those of us who have health insurance get it in a system that works by excluding some of our neighbors. With the present profit imperative of our competitive health insurance system, we have created a national Sophie's Choice: millions of people must be denied care so that the rest of us—healthier, wealthier, or fortunate enough to have employer-based insurance—can get it.
Health insurance companies are playing us in a lose-lose game, where we are the exploited and the exploiter together. They exploit our family responsibilities. I know that I couldn't live with myself, if I didn't provide my wife and daughter the insurance they need to get health care. But, having aided them (and me), I participate in the national Sophie's Choice. How do I face my uninsured neighbors now? Damned if I do, damned if I don't.
Insurance companies have dragged us into this rigged game and millions are losing. We can look the other way and pretend our neighbors and neighborhoods aren't needlessly suffering and dying. We can hope that our luck holds and that we will continue to have insurance. It might be self-denial, but if we're lucky we just might beat the house and survive. But we know some of our neighbors will lose. Whatever happens to us individually, our community is lost.
Health care doesn't have to be this way. It could actually empower community. But first we must stopping playing the insurance company game. As long as health insurance companies control health care, these problems will continue.
We already know that we can have better health care for everyone for less money, if we remove the competition and distrust that insurance company profits have injected into the process. SCHIP is a prime example of just this approach. It demonstrates what we can accomplish when we put lives before profit. Those who voted against expanding SCHIP, know that. That's their fear. And, that SCHIP might become a powerful rallying point toward rebuilding a thriving American community through health care for all.
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Spiritual cost of health care inequality
I really like this entry - it addresses the issue of how a sense of community is destroyed when so many people cannot get the health care they need, both the uninsured and underinsured. I haven't seen anyone try to do that before.
There are few experiences as disillusioning and embittering as when someone is disabled or dies as a result of the lack of enough money to afford treatment. It lays bare any illusion of community when people value material goods over someone's very life- the real trade-off. As a volunteer EMT (for 36 years) I have seen so many people suffer horribly and die for lack of the money to save them that it has destroyed any measure of connection and companionship I once felt with my community. I have often despaired about humanity, observing how many people tolerate this injustice and how many feel fine about it- they don't believe health care is a "right".
It really does seem soul-destroying to me. What a tremendous cost to society to allow corporate profiteering to so dominate our politics that life itself is so cheapened.
On framing the insurance companies- I want to add in that when we talk about insurance companies solely in terms of our relationship to them as patients it distorts the true nature of that relationship, and dignifies an exploitative ensnarement of our resources. It feeds into the conservatives' "free market competition" idea that we are the customers being served, and their fantasy that prices will go down when insurers try to capture more market share by pleasing us, like what happens in many other markets. Nonsense. They are financial services entities, like banks and stockbrokers, that use our resources for as long as possible to create a return for their shareholders, who are their true customers. They hope we each will die before they ever have to pay out a claim on us. That describes their best insurance client, the healthy victim of sudden death. They do not want to insure anyone who will cost them money, and will go to huge lengths to avoid it, and try to get rid of anyone who looks like their health is taking a turn toward expensive. They delay paying doctors and hospitals as long as possible by whatever means necessary in order to hang onto each cent as long as possible, every minute it makes more money for them. Patients die while their doctors fight insurance companies to approve procedures, and pay for them. Children die. Loved ones die. Or irreversible disabilities occur, leading to lives of constant pain for survivors, and often lifelong poverty and shame. So insurance companies can make another nickle of interest off someone's dollar.
My brother was a claims adjuster, and later an executive, for a major national insurer, and he explained clearly how they operate. During the underwriting process they would investigate the financial status of every applicant for their policies, and categorize that person according to whether they could afford to hire a lawyer to contest their claims denials or not. People who could afford a lawyer would have their medical claims paid without delay, the insurer knows it will just be an additional expense to fight with their lawyer over legitimate claims. People they thought could not afford a lawyer had all their claims denied, over and over,in the hopes that they would give up without a fight and never get their rightfully owed claims paid. That was their only criteria for whether to pay a claim. He explained how it was unfair, but the sickest, poorest people who needed the coverage the most never got it, and the ones who needed the least got the most back, without a hassle. Nice guys, huh? What is appropriate language to describe that type of relationship? I haven't found any I can use in polite company.
New! Insurance is the *opposite* of health care!
Hi all!
I really like the framing of this article: health care run by insurance companies means turning away the sick. If this indecency is not the literal opposite of health care, well, I don't know what is! This is exciting and feels really right.
Thanks!
Luis.